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1.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370929

RESUMO

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.


Assuntos
Infecções por HIV , Obstrução Intestinal , Penicilinas/administração & dosagem , Proctite/diagnóstico , Neoplasias Retais/diagnóstico , Reto , Treponema pallidum , Idoso , Antibacterianos/administração & dosagem , Diagnóstico Diferencial , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Masculino , Proctite/etiologia , Proctite/fisiopatologia , Proctite/terapia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia , Sigmoidoscopia/métodos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/terapia , Tomografia Computadorizada por Raios X/métodos , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação
2.
BMC Surg ; 20(1): 250, 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33092548

RESUMO

BACKGROUND: Establishing anastomotic integrity is crucial for avoiding anastomotic complications in colorectal surgery. This study aimed to evaluate the safety and feasibility of assessing anastomotic integrity using novel oxygen saturation imaging endoscopy in a porcine ischemia model. METHODS: In three pigs, a new endoscope system was used to check the mechanical completeness of the anastomosis and capture the tissue oxygen saturation (StO2) images. This technology can derive the StO2 images from the differences in the absorption coefficient in the visible light region between oxy- and deoxy-hemoglobin. Bowel perfusion at the proximal rectum was assessed before and after the anastomosis, and 1 min and 30 min after the ligation of the cranial rectal artery (CRA). RESULTS: The completeness of the anastomoses was confirmed by the absence of air leakage. Intraluminal oxygen saturation imaging was successfully performed in all animals. There was no significant difference in the StO2 level before and after the anastomosis (52.6 ± 2.0 vs. 52.0 ± 2.6; p = 0.76, respectively). The StO2 level of the intestine on the oral side of the anastomosis one minute after the CRA ligation was significantly lower than immediately after the anastomosis (15.9 ± 6.0 vs. 52.0 ± 2.6; p = 0.006, respectively). There was no significant difference in the StO2 level between 1 min after and 30 min after the CRA ligation (15.9 ± 6.0 vs. 12.1 ± 5.3; p = 0.41, respectively). CONCLUSION: Novel oxygen saturation imaging endoscopy was safe and feasible to assess the anastomotic integrity in the experimental model.


Assuntos
Anastomose Cirúrgica , Endoscopia , Hemoglobinas/análise , Isquemia , Oxigênio/análise , Reto/irrigação sanguínea , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/diagnóstico por imagem , Fístula Anastomótica/etiologia , Animais , Modelos Animais de Doenças , Endoscopia/métodos , Estudos de Viabilidade , Feminino , Isquemia/sangue , Isquemia/diagnóstico por imagem , Oxiemoglobinas/análise , Reto/diagnóstico por imagem , Reto/metabolismo , Reto/cirurgia , Suínos , Resultado do Tratamento
3.
Nat Commun ; 11(1): 4308, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32855399

RESUMO

Distant metastasis (DM) is the main cause of treatment failure in locally advanced rectal cancer. Adjuvant chemotherapy is usually used for distant control. However, not all patients can benefit from adjuvant chemotherapy, and particularly, some patients may even get worse outcomes after the treatment. We develop and validate an MRI-based radiomic signature (RS) for prediction of DM within a multicenter dataset. The RS is proved to be an independent prognostic factor as it not only demonstrates good accuracy for discriminating patients into high and low risk of DM in all the four cohorts, but also outperforms clinical models. Within the stratified analysis, good chemotherapy efficacy is observed for patients with pN2 disease and low RS, whereas poor chemotherapy efficacy is detected in patients with pT1-2 or pN0 disease and high RS. The RS may help individualized treatment planning to select patients who may benefit from adjuvant chemotherapy for distant control.


Assuntos
Antineoplásicos/uso terapêutico , Nomogramas , Protectomia , Neoplasias Retais/terapia , Reto/diagnóstico por imagem , Adulto , Idoso , Quimioterapia Adjuvante/estatística & dados numéricos , Conjuntos de Dados como Assunto , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/prevenção & controle , Estadiamento de Neoplasias , Planejamento de Assistência ao Paciente , Seleção de Pacientes , Radioterapia Adjuvante/estatística & dados numéricos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos
4.
J Comput Assist Tomogr ; 44(5): 759-765, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842061

RESUMO

OBJECTIVE: To compare the intravoxel incoherent motion (IVIM) parameters of rectal tumors before and after lumen distension obtained with sonography transmission gel. METHODS: Twenty-five patients were enrolled. The multiple b values of IVIM including 0, 20, 50, 100, 150, 200, 400, 600, 800, 1000, 1500, and 2000 s/mm. Two blinded readers have drawn the region of interests and calculated the D, D*, and f values. Interobserver variability between the 2 readers was measured by intraclass correlation coefficients and Altman-Bland plots. The intergroup differences of the average values were compared with the paired sample t test. RESULTS: After distention, the interrater agreement of the D* value increased obviously (from 0.547 to 0.692) and that of the D and f values increased slightly (from 0.731 and 0.618 to 0.807 and 0.666). The difference in the D value had statistical significance (P = 0.0043). CONCLUSIONS: Intraluminal distension can increase the repeatability of IVIM parameters and the value of IVIM.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Géis/uso terapêutico , Neoplasias Retais/diagnóstico por imagem , Reto/diagnóstico por imagem , Adulto , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Variações Dependentes do Observador , Neoplasias Retais/fisiopatologia , Reto/fisiopatologia , Ultrassonografia
5.
Turk Neurosurg ; 30(4): 632-635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32672344

RESUMO

Spinal meningiomas are rare in the lumbosacral region. The best solution is complete tumor resection. However, how to preserve the patient?s rectum/bladder function after en bloc resection is still a considerable challenge, even without spinopelvic reconstruction. The use of the three-dimensional (3D) printing technique may simplify it. The final step after restoration is the establishment of rigid fixation. The purpose of this article was to present a case of lumbosacral meningiomas treated by en bloc resection, 3D-printed prosthesis reconstruction, and fixation with pedicle screws and cortical bone trajectory screws. A 35-year-old woman has suffered from lumbosacral and two legs pain for two months. During the previous month, she limped, and her strength was 4/5 in both legs. Magnetic resonance imaging (MRI) revealed space-occupying lesions from the lumbar 5 (L5) to sacral 3 (S3) vertebral bodies. The previous biopsy confirmed the lesions were spinal meningiomas. The patient underwent an en bloc resection followed by 3D-printed prosthesis reconstruction and internal fixation with a novel technique. The surgery was successful, and the patient recovered well postoperatively according to follow-up examination. En bloc resection of L5-S3 meningiomas without rectum/bladder function sacrifice is a feasible procedure, and 3D-printed prosthesis provides an alternative method for the reconstruction of the spinopelvic ring. The rigid fixation construct using the novel four-rod technique could develop strong bony fusion.


Assuntos
Fixadores Internos , Região Lombossacral/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Impressão Tridimensional , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Prótese Ancorada no Osso , Feminino , Humanos , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Reto/diagnóstico por imagem , Reto/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
6.
Int J Surg ; 80: 168-174, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32650119

RESUMO

BACKGROUND: The diversity in definitions for the rectosigmoid junction is becoming a major obstacle in standardizing optimal treatment of rectal cancers. The study aimed to determine the average distance of the sigmoid take-off from the anal verge and its association with individual factors. MATERIALS AND METHODS: Patients diagnosed with rectal and sigmoid colon cancer in our centre from January 2010 to December 2018 were retrospectively enrolled in the cancer group. The results of 200 controls without colorectal disease were also reviewed (normal group). The distance of different landmarks and margins of cancer from the anal verge were retrieved from computed tomography (CT), magnetic resonance imaging (MRI), and endoscopy findings. RESULTS: The cancer group comprised 635 patients (381 men, median age: 64 years). The average distances of the sigmoid take-off from the anal verge measured in CT and MRI were comparable (P = 0.483). On MRI, the average distance of the sigmoid take-off from the anal verge in the cancer group was comparable with that of the normal group (P = 0.070). Multivariate regression revealed that the distance of the sigmoid take-off from the anal verge was associated with the distances of the sacral promontory (P < 0.001) and peritoneal reflection (P < 0.001) from the anal verge. CONCLUSION: The cancer distributions of patients varied widely with the application of different definitions. The point of sigmoid take-off is an intuitive landmark influenced by individual factors. The measurement of the sigmoid take-off by different researchers in both CT and MRI revealed good consistency. Further studies regarding the clinical significance of this definition are still needed.


Assuntos
Canal Anal/patologia , Pontos de Referência Anatômicos/patologia , Colo Sigmoide/patologia , Neoplasias Retais/patologia , Reto/patologia , Neoplasias do Colo Sigmoide/patologia , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Pontos de Referência Anatômicos/diagnóstico por imagem , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Reto/diagnóstico por imagem , Reto/cirurgia , Análise de Regressão , Estudos Retrospectivos , Neoplasias do Colo Sigmoide/diagnóstico por imagem , Neoplasias do Colo Sigmoide/cirurgia , Tomografia Computadorizada por Raios X
7.
JAMA Netw Open ; 3(7): e208522, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32639566

RESUMO

Importance: The percentage of tumor-positive surgical resection margin rates in patients treated for locally advanced primary or recurrent rectal cancer is high. Image-guided navigation may improve complete resection rates. Objective: To ascertain whether image-guided navigation during rectal cancer resection improves complete resection rates compared with surgical procedures without navigation. Design, Setting, and Participants: This prospective single-center nonrandomized controlled trial was conducted at the Netherlands Cancer Institute-Antoni van Leeuwenhoek in Amsterdam, the Netherlands. The prospective or navigation cohort included adult patients with locally advanced primary or recurrent rectal cancer who underwent resection with image-guided navigation between February 1, 2016, and September 30, 2019, at the tertiary referral hospital. Clinical results of this cohort were compared with results of the historical cohort, which was composed of adult patients who received rectal cancer resection without image-guided navigation between January 1, 2009, and December 31, 2015. Intervention: Rectal cancer resection with image-guided navigation. Main Outcomes and Measures: The primary end point was the complete resection rate, measured by the amount of tumor-negative resection margin rates. Secondary outcomes were safety and usability of the system. Safety was evaluated by the number of navigation system-associated surgical adverse events. Usability was assessed from responses to a questionnaire completed by the participating surgeons after each procedure. Results: In total, 33 patients with locally advanced or recurrent rectal cancer were included (23 men [69.7%]; median [interquartile range] age at start of treatment, 61 [55.0-69.0] years). With image-guided navigation, a radical resection (R0) was achieved in 13 of 14 patients (92.9%; 95% CI, 66.1%-99.8%) after primary resection of locally advanced tumors and in 15 of 19 patients (78.9%; 95% CI, 54.4%-94.0%) after resection of recurrent rectal cancer. No navigation system-associated complications occurred before or during surgical procedures. In the historical cohort, 142 patients who underwent resection without image-guided navigation were included (95 men [66.9%]; median [interquartile range] age at start of treatment, 64 [55.0-70.0] years). In these patients, an R0 resection was accomplished in 85 of 101 patients (84.2%) with locally advanced rectal cancer and in 20 of 41 patients (48.8%) with recurrent rectal cancer. A significant difference was found between the navigation and historical cohorts after recurrent rectal cancer resection (21.1% vs 51.2%; P = .047). For locally advanced primary tumor resection, the difference was not significant (7.1% vs 15.8%; P = .69). Surgeons stated in completed questionnaires that the navigation system improved decisiveness and helped with tumor localization. Conclusions and Relevance: Findings of this study suggest that image-guided navigation used during rectal cancer resection is safe and intuitive and may improve tumor-free resection margin rates in recurrent rectal cancer. Trial Registration: Netherlands Trial Register Identifier: NTR7184.


Assuntos
Dissecação , Recidiva Local de Neoplasia , Neoplasias Retais , Reto , Cirurgia Assistida por Computador , Dissecação/efeitos adversos , Dissecação/métodos , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Países Baixos/epidemiologia , Estudos Prospectivos , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos
8.
Cancer Radiother ; 24(8): 805-811, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32565071

RESUMO

PURPOSE: The optimal management of locally recurrent prostate cancer after curative radiotherapy is still unknown. In this study, we evaluated the preliminary results of reirradiation using stereotactic body radiotherapy for locally recurrent prostate cancer after initial definitive local radiotherapy. MATERIALS AND METHODS: Between April 2016 and February 2019, 11 patients with recurrent disease at the previously irradiated prostate were treated. Local recurrence was detected by radiological with or without functional imaging modalities including prostate multiparametric/pelvic MRI or positron-emission tomography-computerised tomography with (68Ga)-labelled prostate-specific membrane antigen performed after rising prostate specific antigen serum level during follow-up. All patients received stereotactic body radiotherapy to the recurrent nodule to a total dose of 30Gy in five fractions. Hyaluronic acid spacer was injected between prostate and rectum in seven patients to decrease the rectal dose. Acute toxicity was evaluated by using Common Terminology Criteria for Adverse Events version 4.0, and late toxicity was evaluated by using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. RESULTS: At the diagnosis, the median age was 64 years, and the mean prostate specific antigen serum concentration was 17.7ng/mL. The median interval time between local recurrence and initial definitive radiotherapy was 63 months. Mean prostate specific antigen concentration nadir value during follow-up was 0.43ng/mL. With a median follow up of 19 months, three patients developed either local or distant relapse. One patient had grade 3 acute rectal toxicity, and one patient had grade 2 late urinary toxicity. We did not observe any acute or late toxicity due to hyaluronic acid spacer injection. CONCLUSION: Reirradiation after local recurrence following initial definitive radiotherapy together with hyaluronic acid spacer use seems to be effective and safe.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Ácido Hialurônico/análogos & derivados , Recidiva Local de Neoplasia/radioterapia , Neoplasias da Próstata/radioterapia , Reirradiação/métodos , Viscossuplementos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Humanos , Ácido Hialurônico/administração & dosagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/diagnóstico por imagem , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Próstata/diagnóstico por imagem , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Lesões por Radiação/prevenção & controle , Radiocirurgia/métodos , Radioterapia Guiada por Imagem/métodos , Reto/diagnóstico por imagem , Reto/efeitos da radiação , Terapia de Salvação/métodos , Fatores de Tempo , Carga Tumoral
9.
J Comput Assist Tomogr ; 44(4): 501-510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32558775

RESUMO

OBJECTIVES: Rectosigmoid involvement by endometriosis causes intestinal symptoms such as constipation, diarrhea, and dyschezia. A precise diagnosis about the presence, location, and extent of bowel implants is required to plan the most appropriate treatment. The aim of the study was to compare the accuracy of magnetic resonance with distension of the rectosigmoid (MR-e) with computed colonography (CTC) for diagnosing rectosigmoid endometriosis. METHODS: This study was based on the retrospective analysis of a prospectively collected database of patients with suspicion of rectosigmoid endometriosis who underwent both MR-e and CTC, and subsequently were treated by laparoscopy. The findings of imaging techniques were compared with surgical and histological results. RESULTS: Of 90 women included in the study, 44 (48.9%) had rectosigmoid nodules and underwent bowel surgery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of rectosigmoid endometriosis were 88.6%, 93.5%, 92.9%, 89.6%, and 91.1% for CTC, and 93.2%, 97.9%, 97.6%, 93.8%, and 95.6% for MR-e. There was no significant difference in the accuracy of both radiologic examinations for diagnosing rectosigmoid endometriosis (P = 0.344). However, MR-e was more accurate than CTC in estimating the largest diameter of the main rectosigmoid nodule (P < 0.001). The pain perceived by the patients was significantly lower during MR-e than during CTC (P < 0.001). CONCLUSIONS: MR-e and CTC have similar diagnostic performance for the diagnosis of rectosigmoid involvement of endometriosis. However, MR-e is more accurate in the estimation of the largest diameter of main rectosigmoid nodule and more tolerated than CTC.


Assuntos
Colo Sigmoide/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Endometriose/diagnóstico por imagem , Enema/métodos , Reto/diagnóstico por imagem , Adulto , Colo Sigmoide/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Estudos Prospectivos , Reto/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
Aliment Pharmacol Ther ; 51(12): 1373-1383, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32383166

RESUMO

BACKGROUND: Transabdominal ultrasound is useful to assess inflammation in patients with ulcerative colitis (UC); however, the assessment of the rectum is challenging and a barrier for its widespread use. AIM: To evaluate if transperineal ultrasound is useful for predicting endoscopic and histological findings of the rectum in UC. METHODS: Fifty-three consecutive adults with UC who required colonoscopy were included and transperineal ultrasound was performed in combination with transabdominal ultrasound within a week before or after colonoscopy with rectal biopsy. Mayo endoscopic subscore (MES) ≤1 was defined as endoscopic healing and Geboes score <2.1, Robarts histopathology index ≤6, and Nancy index ≤1 were defined as histological healing. Limberg score and bowel wall thickness were recorded with transperineal ultrasound. Faecal calprotectin was also measured. RESULTS: Excellent correlation was confirmed between colonoscopy and transabdominal ultrasound in all segments except for the rectum. Rectal bowel wall thickness and Limberg score in transperineal ultrasound well correlated with rectal MES and histological indices. Bowel wall thickness ≤4 mm predicted endoscopic (Area under the curve [AUC] = 0.90) and histological (AUC = 0.87-0.89) healing. In multivariable logistic regression analysis, only bowel wall thickness in transperineal ultrasound was a significant independent predictor for rectal endoscopic and histologic healing (P < 0.05) and the predictability was better than faecal calprotectin. CONCLUSIONS: Transperineal ultrasound predicts endoscopic and histological healing of the rectum. The combination of transperineal ultrasound with transabdominal ultrasound visualises the entire colorectum and is an ideal modality for the treat-to-target strategy. Clinical Trials Registry number UMIN000033611 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038323).


Assuntos
Colite Ulcerativa/diagnóstico , Endoscopia Gastrointestinal/métodos , Períneo/diagnóstico por imagem , Ultrassonografia/métodos , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/patologia , Colite Ulcerativa/fisiopatologia , Colonoscopia/métodos , Feminino , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Mucosa Intestinal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Períneo/patologia , Períneo/fisiopatologia , Prognóstico , Reto/diagnóstico por imagem , Reto/patologia , Reto/fisiopatologia , Índice de Gravidade de Doença , Adulto Jovem
11.
Jpn J Nurs Sci ; 17(4): e12340, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32394621

RESUMO

AIM: The present study aimed to analyze the use of machine learning in ultrasound (US)-based fecal retention assessment. METHODS: The accuracy of deep learning techniques and conventional US methods for the evaluation of fecal properties was compared. The presence or absence of rectal feces was analyzed in 42 patients. Eleven patients without rectal fecal retention on US images were excluded from the analysis; thus, fecal properties were analyzed in 31 patients. Deep learning was used to classify the transverse US images into three types: absence of feces, hyperechoic area, and strong hyperechoic area in the rectum. RESULTS: Of the 42 patients, 31 tested positive for the presence of rectal feces, zero were false positive, zero were false negative, and 11 were negative, indicating a sensitivity of 100% and a specificity of 100% for the detection of rectal feces in the rectum. Of the 31 positive patients, 14 had hard stools and 17 had other types. Hard stool was detected by US findings in 100% of the patients (14/14), whereas deep learning-based classification detected hard stool in 85.7% of the patients (12/14). Other stool types were detected by US findings in 88.2% of the patients (15/17), while deep learning-based classification also detected other stool types in 88.2% of the patients (15/17). CONCLUSIONS: The results showed that US findings and deep learning-based classification can detect rectal fecal retention in older adult patients and distinguish between the types of fecal retention.


Assuntos
Constipação Intestinal/diagnóstico por imagem , Aprendizado Profundo , Idoso , Fezes , Humanos , Reto/diagnóstico por imagem
12.
Eur J Radiol ; 127: 109028, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32361587

RESUMO

PURPOSE: To compare four region-of-interest (ROI) protocols for apparent diffusion coefficient (ADC) quantifications derived from reduced field-of-view diffusion-weighted imaging (rDWI) in histological characterization of rectal cancer. MATERIALS AND METHODS: Forty-nine patients with rectal cancer underwent rDWI at 3.0 T. Two readers independently performed mean and minimum ADC measurements using four different ROI positioning protocols (whole tumor volume [WTV], single-slice [SS], three-slices observer-based sampling [TSOB] and three-slices predefined sampling [TSPD]). Inter-observer variation was evaluated. Mean and minimum ADC values obtained from each method were compared in terms of different histological factors of rectal cancer, and their diagnostic abilities were assessed by receiver operating characteristic curve (ROC) analysis. The corresponding times for ADC measurements were recorded and compared between ROI methods. RESULTS: The inter-observer agreement was excellent for ADC values obtained by two readers using the four ROI methods (ICC range, 0.906-0.994). Mean and minimum ADC values by WTV method were significantly higher and lower than other methods respectively for both readers (P < 0.05). The AUCs of mean ADC measurements for assessment of well-differentiated tumors, T2 stage tumors and N0 status (no lymph node metastasis) (0.936, 0.840 and 0.714) were greater by WTV method than those by SS method (0.782, 0.761 and 0.677). The WTV method required longer measurement time than other ROI methods (P < 0.001). CONCLUSION: ADC measurements based on rDWI were influenced by ROI positioning protocols. rDWI technique had diagnostic value for histological characterization of rectal cancer, using WTV method with overall best inter-observer reproducibility, but with the longest measurement time.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Curva ROC , Reto/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
13.
Anticancer Res ; 40(4): 2079-2087, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234900

RESUMO

BACKGROUND/AIM: The European MRI and Rectal Cancer Surgery (EuMaRCS) score was proposed to identify preoperatively difficult laparoscopic total mesorectal excision (L-TME) for locally advanced rectal cancer (LARC). This study aimed to test EuMaRCS's validity. PATIENTS AND METHODS: Data were retrieved from a European multicenter database, including patients with mid/low LARC, treated with neoadjuvant chemoradiation therapy and L-TME with primary anastomosis. The EuMaRCS score was calculated on: BMI>30 (3 points), interspinous distance<96.4 mm (2 points), ymrT stage≥T3b (4 points), and male sex (1 point). RESULTS: The sample was composed of 141 patients, of whom 23 (16.3%) had a difficult L-TME. The EuMaRCS score demonstrated high accuracy in predicting difficult surgery (AROC: 0.806, 95%CI=0.72-0.88), with a cut-off >3 being associated with the best balance in sensitivity (82.6%) and specificity (66.1%). CONCLUSION: The EuMaRCS score represents a validated tool to predict preoperatively difficult L-TME in LARC patients.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , Reto/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Quimiorradioterapia , Feminino , Humanos , Laparoscopia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Análise de Sobrevida
14.
Radiology ; 296(1): 56-64, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32315264

RESUMO

Background Preoperative response evaluation with neoadjuvant chemoradiotherapy remains a challenge in the setting of locally advanced rectal cancer. Recently, deep learning (DL) has been widely used in tumor diagnosis and treatment and has produced exciting results. Purpose To develop and validate a DL method to predict response of rectal cancer to neoadjuvant therapy based on diffusion kurtosis and T2-weighted MRI. Materials and Methods In this prospective study, participants with locally advanced rectal adenocarcinoma (≥cT3 or N+) proved at histopathology and baseline MRI who were scheduled to undergo preoperative chemoradiotherapy were enrolled from October 2015 to December 2017 and were chronologically divided into 308 training samples and 104 test samples. DL models were constructed primarily to predict pathologic complete response (pCR) and secondarily to assess tumor regression grade (TRG) (TRG0 and TRG1 vs TRG2 and TRG3) and T downstaging. Other analysis included comparisons of diffusion kurtosis MRI parameters and subjective evaluation by radiologists. Results A total of 383 participants (mean age, 57 years ± 10 [standard deviation]; 229 men) were evaluated (290 in the training cohort, 93 in the test cohort). The area under the receiver operating characteristic curve (AUC) was 0.99 for the pCR model in the test cohort, which was higher than the AUC for raters 1 and 2 (0.66 and 0.72, respectively; P < .001 for both). AUC for the DL model was 0.70 for TRG and 0.79 for T downstaging. AUC for pCR with the DL model was better than AUC for the best-performing diffusion kurtosis MRI parameters alone (diffusion coefficient in normal diffusion after correcting the non-Gaussian effect [Dapp value] before neoadjuvant therapy, AUC = 0.76). Subjective evaluation by radiologists yielded a higher error rate (1 - accuracy) (25 of 93 [26.9%] and 23 of 93 [24.8%] for raters 1 and 2, respectively) in predicting pCR than did evaluation with the DL model (two of 93 [2.2%]); the radiologists achieved a lower error rate (12 of 93 [12.9%] and 13 of 93 [14.0%] for raters 1 and 2, respectively) when assisted by the DL model. Conclusion A deep learning model based on diffusion kurtosis MRI showed good performance for predicting pathologic complete response and aided the radiologist in assessing response of locally advanced rectal cancer after neoadjuvant chemoradiotherapy. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Koh in this issue.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Quimiorradioterapia , Aprendizado Profundo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Valor Preditivo dos Testes , Estudos Prospectivos , Reto/diagnóstico por imagem , Resultado do Tratamento
15.
Diagn Interv Radiol ; 26(2): 82-86, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32116218

RESUMO

PURPOSE: We aimed to evaluate the diagnostic performance of computed tomography colonography (CTC) in the detection of internal hemorrhoids. METHODS: Three gastroenterologists systematically reported on the presence of internal hemorrhoids in patients with incomplete colonoscopy, for whom they considered a subsequent CTC. For 44 patients with internal hemorrhoids revealed by optical colonoscopy, an age- and gender-matched cohort of 66 patients with normal findings in the rectum was selected. Endoluminal and transaxial CTC views of the rectum were evaluated for the presence of internal hemorrhoids, the anal verge prominence, asymmetry, and cushion-like appearance on a Likert scale by two experienced radiologists and two gastroenterologists. RESULTS: The sensitivity, specificity, and AUC for identification of internal hemorrhoids were 0.61 (95% CI, 0.53-0.68), 0.69 (95% CI, 0.63-0.75) and 0.66 (95% CI, 0.62-0.70), respectively. The radiologists showed a better specificity, the gastroenterologists a slightly better sensitivity. When only the rating "very likely" was considered as positive, the specificity rose to 0.89 (95% CI, 0.81-0.94) with a sensitivity of 0.50 (95% CI, 0.38-0.62). The interobserver agreement was fair. The best predictor of the presence of hemorrhoids was a prominent anal verge in the supine position (OR=1.789, 95% CI, 1.267-2.525). The difference between supine and prone positions in the evaluated features in patients with internal hemorrhoids was not significant. CONCLUSION: CTC has low sensitivity but high specificity in the detection of internal hemorrhoids, if the rater is confident in detecting them. Internal hemorrhoids do not substantially change their shape between prone and supine positions.


Assuntos
Colonografia Tomográfica Computadorizada/métodos , Hemorroidas/diagnóstico por imagem , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Estudos Prospectivos , Reto/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores Sexuais
16.
Br J Surg ; 107(5): 567-579, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32154585

RESUMO

BACKGROUND: Bowel dysfunction after anterior resection is well documented, but its pathophysiology remains poorly understood. No study has assessed whether postoperative variation in colonic transit contributes to symptoms. This study measured colonic transit using planar scintigraphy and single-photon emission CT (SPECT)/CT in patients after anterior resection, stratified according to postoperative bowel function. METHODS: Symptoms were assessed using the low anterior resection syndrome (LARS) score. Following gallium-67 ingestion, scintigraphy was performed at predefined time points. Nine regions of interest were defined, and geometric centre (GC), percentage isotope retained, GC velocity index and colonic half-clearance time (T½ ) determined. Transit parameters were compared between subgroups based on LARS score using receiver operating characteristic (ROC) curve analyses. RESULTS: Fifty patients (37 men; median age 72·6 (range 44·4-87·7) years) underwent planar and SPECT scintigraphy. Overall, 17 patients had major and nine had minor LARS; 24 did not have LARS. There were significant differences in transit profiles between patients with major LARs and those without LARS: GCs were greater (median 5·94 (range 2·35-7·72) versus 4·30 (2·12-6·47) at 32 h; P = 0·015); the percentage retained isotope was lower (median 53·8 (range 6·5-100) versus 89·9 (38·4-100) per cent at 32 h; P = 0·002); GC velocity indices were greater (median 1·70 (range 1·18-1·92) versus 1·45 (0·98-1·80); P = 0·013); and T½ was shorter (median 38·3 (17·0-65·0) versus 57·0 (32·1-160·0) h; P = 0·003). Percentage tracer retained at 32 h best discriminated major LARS from no LARS (area under curve (AUC) 0·828). CONCLUSION: Patients with major LARS had accelerated colonic transit compared with those without LARS, which may help explain postoperative bowel dysfunction in this group. The percentage tracer retained at 32 h had the greatest AUC value in discriminating such patients.


Assuntos
Colo/diagnóstico por imagem , Colo/fisiopatologia , Trânsito Gastrointestinal , Neoplasias Retais/cirurgia , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Curva ROC , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/fisiopatologia , Reto/diagnóstico por imagem , Reto/fisiopatologia , Reto/cirurgia
17.
BMC Urol ; 20(1): 28, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183763

RESUMO

BACKGROUND: Prostate cancer is a common cancer among men in developed countries. Prostate magnetic resonance imaging (MRI) has been widely employed for early diagnosis of prostate cancer and recommending a treatment plan. The incidence of rectal perforation during endorectal prostate MRI is rare and has never been reported before. Herein, we present a case of rectal perforation after a prostate MRI examination that was subjected to emergency surgical intervention because of the acute presentation of generalized peritonitis. Patients with systemic comorbidities are reportedly at greater risks of encountering colonoscopic perforation. Endorectal prostate MRI is a safe diagnostic modality, but inadequate lubrication of the endorectal coil or over-insufflation of the balloon during the procedure may also lead to serious complications such as hollow organ perforation. Early surgery will be necessary should peritoneal symptoms persist. CASE PRESENTATION: In 2015, a 56-year-old man came to our ER due to acute abdominal pain after he finished his MRI exam. The exam indicated diffuse tenderness over his abdomen and at the ER, his abdominal CT (computerized tomography) was checked. The images revealed extraluminal air in the perirectal fat and the pneumoperitoneum. In response, exploratory laparotomy, simple closure of rectal perforation, and loop-S colostomy were performed and the patient was discharged 1 month after operation. CONCLUSIONS: Prostate MRI is a secure procedure with few complications. Clinicians must keep in mind the possibility of perforation when using ultrasound probe. Hollow organ perforation can result in serious morbidity or death. As a result, patients need to be informed of the complications of prostate MRI. When performing the procedure, clinicians must be cautioned about the potential problems for patients with high-anesthetic risk.


Assuntos
Perfuração Intestinal/etiologia , Imagem por Ressonância Magnética/instrumentação , Neoplasias da Próstata/diagnóstico por imagem , Reto/lesões , Colostomia , Humanos , Doença Iatrogênica , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Reto/diagnóstico por imagem , Reto/cirurgia , Tomografia Computadorizada por Raios X
18.
Sci Rep ; 10(1): 5599, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32221359

RESUMO

We aimed to investigate the prevalence of true rectocele and obstructed defecation (OD) in patients with pelvic organ prolapse (POP), to investigate the correlation between true rectocele and OD, and to understand the diagnostic value of translabial ultrasound (TLUS) in the diagnosis of true rectocele. The patients who scheduled for POP surgery were enrolled in this study. Patients who had previous reconstructive pelvic surgery or repair of rectocele were excluded. Birmingham Bowel and Urinary symptoms questionnaires and Longo's obstructed defecation syndrome scoring system were used to assess the bowel symptoms of patients. TLUS was used to evaluate anatomical defects. P value <0.05 was considered statistically significant, and confidence intervals were set at 95%. 279 patients were included into this study. The prevalence rate of OD was 43%, and the average value of ODS score was 6.67. 17% patients presented straining at stool, 33% presented incomplete emptying, 13% presented digitations, and 12% required laxatives or enema. The prevalence rate of true rectocele was 23%. Defecation symptoms were significantly correlated with age, levator-ani hiatus, levator-ani muscle injury and true rectocele. Logistic regression showed that true rectocele and increased levator-ani hiatus were independent risk factors of OD. True rectocele was significantly correlated with straining at stool, digitation, incomplete emptying and requirement of laxatives or enema.In POP patients, the prevalence rate of true rectocele and OD was 23% and 43%, respectively. True rectocele was related to OD. TLUS was a valuable approach in anatomical evaluation of POP.


Assuntos
Constipação Intestinal/etiologia , Prolapso de Órgão Pélvico/complicações , Retocele/etiologia , Constipação Intestinal/diagnóstico por imagem , Estudos Transversais , Defecação , Feminino , Humanos , Prolapso de Órgão Pélvico/diagnóstico por imagem , Retocele/diagnóstico por imagem , Reto/diagnóstico por imagem , Reto/patologia , Inquéritos e Questionários , Ultrassonografia
19.
Can Assoc Radiol J ; 71(2): 140-148, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063002

RESUMO

The accuracy of computed tomography (CT) colonography (CTC) requires that the radiologist be well trained in the recognition of pitfalls of interpretation. In order to achieve a high sensitivity and specificity, the interpreting radiologist must be well versed in the causes of both false-positive and false-negative results. In this article, we review the common and uncommon pitfalls of interpretation in CTC.


Assuntos
Colonografia Tomográfica Computadorizada , Ceco/diagnóstico por imagem , Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/métodos , Meios de Contraste , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Imageamento Tridimensional , Interpretação de Imagem Radiográfica Assistida por Computador , Reto/diagnóstico por imagem , Sensibilidade e Especificidade
20.
Gastroenterology ; 158(6): 1546-1547, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32017908

Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Coinfecção/diagnóstico , Granuloma/diagnóstico , Proctite/diagnóstico , Doenças Sexualmente Transmissíveis/diagnóstico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/imunologia , Antibacterianos/administração & dosagem , Antivirais/administração & dosagem , Ceftriaxona/administração & dosagem , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção/tratamento farmacológico , Coinfecção/imunologia , Coinfecção/microbiologia , Colonoscopia , Citomegalovirus/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Doxiciclina/administração & dosagem , Quimioterapia Combinada/métodos , Granuloma/tratamento farmacológico , Granuloma/imunologia , Granuloma/microbiologia , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Proctite/tratamento farmacológico , Proctite/imunologia , Proctite/microbiologia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/imunologia , Doenças Sexualmente Transmissíveis/microbiologia , Resultado do Tratamento , Valganciclovir/administração & dosagem
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