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2.
Khirurgiia (Mosk) ; (12): 91-99, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825348

RESUMO

Recently, more and more attention has been paid to the utility of artificial intelligence in medicine. Radiology differs from other medical specialties with its high digitalization, so most software developers operationalize this area of medicine. The primary condition for machine learning is met because medical diagnostic images have high reproducibility. Today, the most common anatomic area for computed tomography is the thorax, particularly with the widespread lung cancer screening programs using low-dose computed tomography. In this regard, the amount of information that needs to be processed by a radiologist is snowballing. Thus, automatic image analysis will allow more studies to be interpreted. This review is aimed at highlighting the possibilities of machine learning in the chest computed tomography.


Assuntos
Diagnóstico por Computador/tendências , Detecção Precoce de Câncer , Neoplasias Pulmonares/diagnóstico por imagem , Aprendizado de Máquina/tendências , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/tendências , Detecção Precoce de Câncer/instrumentação , Detecção Precoce de Câncer/métodos , Previsões , Humanos , Reprodutibilidade dos Testes
3.
Cancer Imaging ; 19(1): 78, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783926

RESUMO

PURPOSE: A newly developed image processing technique fuses conventional windows into a single 'All-In-One' (AIO) window. This study aims to evaluate variability of CT measurement of lesions in thoracic oncology patients on this novel AIO-window. METHODS: Six radiologists with different levels of expertise measured 368 lesions of various size, origin and sharpness. All lesions were measured twice on the AIO-window and twice on the conventional window settings. Intraclass correlation coefficients and Bland-Altman plots were used to assess intra- and interobserver variability. RESULTS: Overall intra-observer agreement for lesion diameters on the AIO-window and conventional window settings was 0.986 (95% Confidence interval (CI): 0.983-0.989) and 0.991 (95% CI 0.989-0.993) respectively. For interobserver agreement this was 0.982 (95% CI 0.979-0.985) (AIO) and 0.979 (95% CI 0.957-0.982) (conventional). For both the AIO and conventional windows, intra- and interobserver agreement were dependent on size, sharpness and reader experience. Measurement variability decreased with increasing lesion size. Regarding sharpness, inter- and intra-observer agreement ranged from 0.986-0.989 (AIO) and 0.985-0.992 (conventional) for well-defined lesions and from 0.978-0.983 (AIO) and 0.974-0.991 (conventional) for ill-defined lesions. CONCLUSIONS: Lesion diameters were consistently smaller on the AIO-window compared to conventional window settings. Overall intra- and interobserver variability rates were similar for the AIO-window and conventional window settings. We conclude that the AIO-window offers a reliable and reproducible alternative for measurement of thoracic lesions.


Assuntos
Abdome/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada Multidetectores/métodos , Neoplasias/diagnóstico por imagem , Tórax/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Processamento de Imagem Assistida por Computador/normas , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/normas , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos
7.
BMC Infect Dis ; 19(1): 964, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718571

RESUMO

BACKGROUND: The aim of this study was to evaluate the correlation between clinical and imaging findings with a worse clinical outcome in patients with a confirmed diagnosis of H1N1 influenza A virus. METHODS: Patients with a positive viral test for influenza A H1N1 in 2016 and chest radiography (CR) and/or computed tomography (CT) results had clinical and imaging data reviewed. Hospitalization, admission to the intensive care unit or death were defined as worse clinical outcomes. The association between clinical and imaging features and the worse outcome was calculated in a logistical regression model. RESULTS: Eighty of 160 (50%) patients were men, with a mean age of 43 ± 19 years. The most common symptoms were as follows: flu-like symptoms 141/160 (88%), dyspnea (25/160, 17%), and thoracic pain (7/160, 5%). Abnormalities on CR were detected in 8/110 (7%) patients, and 43/59 (73%) patients had an abnormal CT. The following variables were associated with worse clinical outcomes: the presence of diabetes mellitus (DM), hypertension, dyspnea, thoracic pain, abnormal CR or CT regardless of the type of finding, CT with consolidation or ground glass opacity. CONCLUSIONS: The presence of DM, hypertension, dyspnea, thoracic pain, or an abnormal CR or CT on admission were associated with worse clinical outcomes in patients with H1N1 influenza A virus infection. Thus, the use of readily accessible clinical and imaging features on admission may have a role in the evaluation of patients with H1N1 infection.


Assuntos
Influenza Humana/diagnóstico , Adulto , Feminino , Hospitalização , Humanos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/patologia , Influenza Humana/virologia , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Estudos Retrospectivos , Índice de Gravidade de Doença , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Rev Med Suisse ; 15(672): 2137-2144, 2019 Nov 20.
Artigo em Francês | MEDLINE | ID: mdl-31746570

RESUMO

The interpretation of chest x-rays, which is part of a comprehensive medical management, requires a specific mastery, this despite the promising performance of artificial intelligence software. Alternatives to this imaging modality exist, particularly ultra-low dose CT (CT-ULD) and thoracic ultrasound (US) in some indications, but they are not a substitute for chest x-rays in clinical routine. Among the rules to be followed, a systematic reading technique is required, in order to reduce the risk of error. In addition, the observational and interpretive capabilities necessary for this task must be exercised, referring to the normal radiographic aspect. The objective of this article is to demonstrate the interpretation of pathological chest x-rays using clinical cases.


Assuntos
Radiografia Torácica , Tórax/diagnóstico por imagem , Humanos , Doses de Radiação
9.
BMC Infect Dis ; 19(1): 976, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31747890

RESUMO

BACKGROUND: Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care. METHODS: From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model. RESULTS: Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics. CONCLUSIONS: Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.


Assuntos
Biomarcadores/análise , Pneumonia/diagnóstico , Infecções Respiratórias/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Calcitonina/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Atenção Primária à Saúde , Prognóstico , Estudos Prospectivos , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Tórax/diagnóstico por imagem
11.
Respir Res ; 20(1): 218, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31606045

RESUMO

BACKGROUND: Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis. METHODS: All individuals enrolled in the Registry of Critical Illness at Brigham and Women's Hospital between June 2008 and August 2018 who had a CXR within 24 h of admission were included. Each patient's CXR was assigned an opacification score of 0-4 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score's association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively. RESULTS: A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10% (OR 1.10, CI 1.05-1.16, p < 0.001) and 60-day mortality increased by 12% (OR 1.12, CI 1.07-1.17, p < 0.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04-1.07, p < 0.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02-1.07, p < 0.001). CONCLUSIONS: Higher values on a simple visual score of a patient's CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.


Assuntos
Estado Terminal , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tórax/diagnóstico por imagem , APACHE , Adulto , Idoso , Biomarcadores/sangue , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/terapia , Estudos Retrospectivos , Resultado do Tratamento
12.
BMC Infect Dis ; 19(1): 862, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623573

RESUMO

BACKGROUND: Idiopathic CD4 lymphocytopenia (ICL) is a rare clinical disease with relative CD4 deficiency in the absence of HIV infection. The pathogenicity of ICL is poorly understood with an unclear incidence rate in the general population. Sequelae of ICL includes AIDS-defining infections, which most commonly includes Cryptococcus neoformans. Typically, C. neoformans infections present with CNS involvement but rarely with extra-CNS manifestations. Here, we present a rare case of ICL with exclusively primary pulmonary cryptococcus and a review of the literature. CASE PRESENTATION: A 56-year-old female presented to our tertiary care hospital requiring a right hip open reduction intervention. The patient became febrile during admission, prompting a work-up that included a chest X-ray showing a peripheral pulmonary solitary nodule. Transthoracic biopsy revealed encapsulated yeast forms in keeping with C. neoformans. CD4 counts, repeated at least one month apart, were < 200 cells/mm3, with negative HIV testing. Flow cytometry and genetic testing were completed to elucidate the etiology of the immune deficiency, both of which were unremarkable. She was subsequently treated with 12 months of posaconazole with clinical resolution. CONCLUSIONS: Our patient highlights a rare clinical disease, which a review of literature revealed only five cases in the literature with exclusive pulmonary Cryptococcus in ICL/ This case demonstrates the strong clinical acumen required to properly diagnose and ultimately manage the patient.


Assuntos
Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Linfopenia/diagnóstico , Infecções Respiratórias/diagnóstico , Antifúngicos/uso terapêutico , Contagem de Linfócito CD4 , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Feminino , Humanos , Pulmão/microbiologia , Pulmão/patologia , Linfopenia/etiologia , Pessoa de Meia-Idade , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico
13.
Medicine (Baltimore) ; 98(42): e17413, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626096

RESUMO

INTRODUCTION: VACTERL association is an acronym that includes vertebral anomalies (V), anal atresia (A), cardiac defects (C), tracheoesophageal fistula (TEF) or esophageal atresia (EA), renal anomalies (R), and limb defects (L). Airway anomalies have rarely been reported with VACTERL association. PATIENT CONCERNS: A 10-month-old boy who had been diagnosed with anal atresia and received surgical corrections soon after birth consulted our institution by complaining repeated cough and fever. DIAGNOSIS: Diagnosis of VACTERL association was finally made. Bronchoscopy and chest CT with computed tomography angiography confirmed multiple airway abnormalities including bridging bronchus, airway malacia, and complete tracheal rings. INTERVENTIONS: Supplemental oxygen was provided and antibiotics was initiated. OUTCOMES: The patient resolved gradually and was discharged 10 days later. The follow-up showed the patient has remained well just with mild psychomotor retardation. CONCLUSION: Multiple airway anomalies may be seen in VACTERL association. It is worthwhile to make special note for evaluating the tracheobronchial pulmonary system by chest CT and bronchoscopy, especially patients presenting with breathing anomalies.


Assuntos
Canal Anal/anormalidades , Esôfago/anormalidades , Cardiopatias Congênitas/diagnóstico , Rim/anormalidades , Deformidades Congênitas dos Membros/diagnóstico , Coluna Vertebral/anormalidades , Traqueia/anormalidades , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/etiologia , Manuseio das Vias Aéreas/métodos , Broncoscopia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/terapia , Humanos , Lactente , Deformidades Congênitas dos Membros/complicações , Deformidades Congênitas dos Membros/terapia , Masculino , Oxigenoterapia , Tórax/anormalidades , Tórax/diagnóstico por imagem , Tibet , Tomografia Computadorizada por Raios X
15.
Int J Mycobacteriol ; 8(3): 302-304, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31512610

RESUMO

Extrapulmonary tuberculosis (TB) can rarely be transmitted to others. The disease mostly affects adults and immunocompromised individuals. A 26-year-old male presented with weight loss and occasional chest pain with a deep breath, but he was otherwise normal. The patient had a history of severe dry coughs, night sweats, fever, confusion, and dizziness for >3 weeks. The patient was initially misdiagnosed with an allergic cough and was treated with anti-allergic medications. Due to small and sticky effusion, the thoracentesis procedure failed, and the patient was referred to a thoracic surgeon for an open decortication. Pleural biopsy (PB) was negative for acid-fast bacilli, but the report showed necrotizing granulomatous inflammation. The patient was started on anti-TB treatment according to the WHO guidelines. The patient gained about 6% of the body weight at the end of the intensive phase and about 15% of the body weight at the end of the continuation phase. His chest pain subsided. Chest radiography showed improvement. The patient recovered, and no relapse occurred. This study recommends that a patient with dry coughs, night sweat, and fever for >3 weeks should be followed up with a chest X-ray for at least the next 3 months.


Assuntos
Empiema Tuberculoso/diagnóstico por imagem , Empiema Tuberculoso/tratamento farmacológico , Adulto , China , Tosse/microbiologia , Humanos , Masculino , Mycobacterium tuberculosis , Radiografia , Sudorese , Tórax/diagnóstico por imagem , Tórax/microbiologia , Resultado do Tratamento
16.
Ned Tijdschr Geneeskd ; 1632019 09 05.
Artigo em Holandês | MEDLINE | ID: mdl-31556494

RESUMO

An 82-year-old woman attended our outpatient clinic because of a swollen right arm and hoarseness. Upon raising both arms, the patient developed a red and swollen face (Pemberton's sign). An MRI of the thorax showed a large intrathoracic goitre, which compressed venous structures and limited blood flow even when she lowered her arms.


Assuntos
Bócio Subesternal/diagnóstico por imagem , Rouquidão/diagnóstico por imagem , Doenças Vasculares Periféricas/diagnóstico por imagem , Idoso de 80 Anos ou mais , Braço/irrigação sanguínea , Braço/diagnóstico por imagem , Constrição Patológica , Feminino , Bócio Subesternal/fisiopatologia , Rouquidão/etiologia , Rouquidão/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/fisiopatologia , Pressão , Tórax/diagnóstico por imagem , Veias/patologia
17.
Phys Med ; 65: 181-190, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31494372

RESUMO

PURPOSE: The purpose of this study is to create an organ dose database for pediatric individuals undergoing chest, abdomen/pelvis, and head computed tomography (CT) examinations, and to report the differences in absorbed organ doses, when anatomical differences exist for pediatric patients. METHODS: The GATE Monte Carlo (MC) toolkit was used to model the GE BrightSpeed Elite CT model. The simulated scanner model was validated with the standard Computed Tomography Dose Index (CTDI) head phantom. Twelve computational models (2.1-14 years old) were used. First, contributions to effective dose and absorbed doses per CTDIvol and per 100 mAs were estimated for all organs. Then, doses per CTDIvol were correlated with patient model weight for the organs inside the scan range for chest and abdomen/pelvis protocols. Finally, effective doses per dose-length product (DLP) were estimated and compared with the conventional conversion k-factors. RESULTS: The system was validated against experimental CTDIw measurements. The doses per CTDIvol and per 100 mAs for selected organs were estimated. The magnitude of the dependency between the dose and the anatomical characteristics was calculated with the coefficient of determination at 0.5-0.7 for the internal scan organs for chest and abdomen/pelvis protocols. Finally, effective doses per DLP were compared with already published data, showing discrepancies between 13 and 29% and were correlated strongly with the total weight (R2 > 0.8) for the chest and abdomen protocols. CONCLUSIONS: Big differences in absorbed doses are reported even for patients of similar age or same gender, when anatomical differences exist on internal organs of the body.


Assuntos
Tamanho Corporal , Método de Monte Carlo , Doses de Radiação , Tomografia Computadorizada por Raios X , Abdome/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Cabeça/diagnóstico por imagem , Humanos , Masculino , Pelve/diagnóstico por imagem , Imagens de Fantasmas , Tórax/diagnóstico por imagem
19.
Vet J ; 251: 105344, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31492390

RESUMO

Aerodigestive diseases, hybrid disorders representing a pathologic link between respiratory and alimentary tracts, may manifest with respiratory signs without gastrointestinal signs. These are underdiagnosed in dogs due to poor clinical recognition and diagnostic limitations. We hypothesize that a subset of dogs presenting for cough without gastrointestinal signs would have occult aerodigestive disorders identified using videofluoroscopic swallow study (VFSS). Data were retrospectively obtained from 31 client-owned dogs presenting for cough, with thoracic radiographs, and a VFSS between April 2015 and December 2017. Exclusion criteria were cough of cardiac origin or gastrointestinal signs within 6 months. Swallow study parameters included pharyngeal/esophageal motility, laryngeal obstruction/defects, penetration-aspiration, reflux, excessive aerophagia, megaesophagus (ME), lower-esophageal sphincter achalasia-like syndrome (LES-AS), and sliding hiatal hernia (HH). The median (interquartile range) duration of cough was 4 (2-8) months. Thoracic radiographs were unremarkable in 11 dogs, with aspiration pneumonia suspected in seven. In 25/31 dogs (81%), VFSS abnormalities were detected and some dogs had more than one defect: pharyngeal (n=10) or esophageal hypomotility (n=10), reflux (n=9), penetration-aspiration (n=8), excessive aerophagia (n=6), laryngeal obstruction (n=3), ME (n=3), HH (n=2), and LES-AS (n=1). A respiratory disorder causing cough was identified in 17 dogs with VFSS abnormalities (laryngeal obstruction/defect and airway disease including chronic or eosinophilic bronchitis, tracheal/mainstem bronchial collapse, bronchiectasis, and bronchomalacia). An alimentary disorder identified on VFSS in absence of a discrete respiratory disorder causing cough was diagnosed in eight dogs. In conclusion, canine aerodigestive disorders can manifest as cough without alimentary signs. VFSS is a useful diagnostic to determine the contribution of esophageal/gastrointestinal pathology in dogs with cough.


Assuntos
Tosse/veterinária , Doenças do Cão/diagnóstico por imagem , Fluoroscopia/veterinária , Gastroenteropatias/veterinária , Doenças Respiratórias/veterinária , Animais , Tosse/diagnóstico por imagem , Deglutição , Cães , Fluoroscopia/métodos , Gastroenteropatias/diagnóstico por imagem , Radiografia/métodos , Radiografia/veterinária , Doenças Respiratórias/diagnóstico por imagem , Estudos Retrospectivos , Tórax/diagnóstico por imagem , Gravação em Vídeo
20.
Chemotherapy ; 64(2): 57-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484176

RESUMO

Invasive fungal infections are one of the main infectious complications in allogeneic stem cell transplantation (SCT). Triazoles (voriconazole, posaconazole) are the main prophylactic and therapeutic options for the treatment of invasive aspergillosis. However, pharmacological interactions and hepatotoxicity limit its use. Isavuconazole (ISV) is a recently approved azole with a promising interaction and safety profile. We present a case with invasive aspergillosis in the post-allogeneic SCT setting in a critically ill patient with severe multiorgan failure due to veno-occlusive disease. The patient was treated with ISV and B amphotericin during severe kidney and liver failure and multiple immunosuppressants, without significant drug-related toxicity and with favorable outcome. The interaction and safety profile of ISV is discussed along the reported experience. ISV can be an effective salvage therapy even in complex clinical situations with multiple potential interactions.


Assuntos
Antifúngicos/uso terapêutico , Aspergilose/terapia , Transplante de Células-Tronco Hematopoéticas , Nitrilos/uso terapêutico , Piridinas/uso terapêutico , Triazóis/uso terapêutico , Adulto , Aspergilose/tratamento farmacológico , Aspergillus fumigatus/genética , Aspergillus fumigatus/isolamento & purificação , DNA Fúngico/metabolismo , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Masculino , Tórax/diagnóstico por imagem , Transplante Homólogo/efeitos adversos
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