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1.
Radiol Med ; 125(11): 1124-1134, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33025305

RESUMO

Myocarditis is an inflammatory disease of the heart muscle, diagnosed by histological, immunological, and immunohistochemical criteria. Endomyocardial biopsy represents the diagnostic gold standard for its diagnosis but is infrequently used. Due to its noninvasive ability to detect the presence of myocardial edema, hyperemia and necrosis/fibrosis, Cardiac MR imaging is routinely used in the clinical practice for the diagnosis of acute myocarditis. Recently pixel-wise mapping of T1 and T2 relaxation time have been introduced into the clinical Cardiac MR protocol increasing its accuracy. Our paper will review the role of MR imaging in the diagnosis of acute myocarditis.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Endocárdio/patologia , Imagem por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Doença Aguda , Adulto , Doenças Assintomáticas , Betacoronavirus , Bioprospecção , Doença Crônica , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Miocardite/etiologia , Miocardite/patologia , Pandemias , Pericardite/diagnóstico por imagem , Pericardite/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Prognóstico
2.
Niger J Clin Pract ; 23(10): 1483-1486, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047710

RESUMO

Metastatic lesions represent approximately 1% of all the intraoral lesions. They most commonly originate from lung and breast carcinomas, while the third most common source is the renal cell carcinoma. In this paper, we present the rare case of metastases of renal cell carcinoma in the mandibular gingiva of a 53-year-old male patient.


Assuntos
Carcinoma de Células Renais/secundário , Gengiva/patologia , Neoplasias Gengivais/secundário , Neoplasias Renais/patologia , Dor nas Costas , Biópsia , Carcinoma de Células Renais/patologia , Neoplasias Gengivais/patologia , Cabeça/diagnóstico por imagem , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Pescoço/diagnóstico por imagem
3.
J Card Surg ; 35(11): 2979-2986, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33111443

RESUMO

AIM: To evaluate the imaging characteristics and associations in patients with twisted atrioventricular connections on multidetector computed tomography (CT) angiography. MATERIAL AND METHODS: We retrospectively reviewed 2605 CT angiography studies performed for suspected congenital heart diseases in our institution from January 2014 to December 2018. Twisted atrioventricular connections were diagnosed in 12 patients. Segmental sequential approach developed by Anderson et al was employed to characterize the complex congenital heart disease. Ventricular topology was also determined. CTA was also assessed to look for any associated intra- and extracardiac anomalies. RESULTS: Out of 12 patients with twisted atrioventricular connections, usual viscero-atrial arrangement was seen in nine patients, two patients had mirror-imaged viscero-atrial arrangement and one patient had mirror-imaged atrial arrangement. Right-sided heart was seen in four patients. Two patients had discordant atrioventricular connections, seven had concordant atrioventricular connections while three showed double-inlet right ventricle. Ventriculoarterial connections were concordant in two patients, discordant in one patient while nine patients had double-outlet right ventricle. Superior-inferior ventricular morphology with near-horizontal interventricular septum was seen in four patients. Left-sided aortic arch with normal branching pattern was observed in nine patients. No coronary anomaly was seen in any patient. Other associations included ventricular and atrial septal defects, pulmonic stenosis, hypoplasia/atresia of tricuspid valve, straddling of mitral valve, and duplicated superior caval veins. CONCLUSION: CT angiography is useful in diagnosis of twisted atrioventricular connections with accurate identification of viscero-atrial arrangement, atrioventricular and ventriculoarterial connections, and orientation and presence or absence of associated anomalies.


Assuntos
Coração Entrecruzado/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Anormalidades Múltiplas , Adolescente , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Dupla Via de Saída do Ventrículo Direito/diagnóstico por imagem , Feminino , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Humanos , Lactente , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Atresia Tricúspide/diagnóstico por imagem
4.
Medicine (Baltimore) ; 99(43): e22440, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120738

RESUMO

To assess the prevalence and missed reporting rate of potential clinically-significant incidental findings (IFs) in the neck CTA scans.All consecutive patients undergoing neck CTA imaging, from January 1, 2017 to December 31, 2018, were retrospectively evaluated by a radiologist for the presence of incidental findings in the upper chest, lower head and neck regions. These incidental findings were subsequently classified into 3 categories in terms of clinical significance: Type I, highly significant, Type II, moderately significant; and Type III, mildly or not significant. Type I and Type II IFs were determined as potential clinically significant ones and were retrospectively analyzed by another 2 radiologists in consensus. The undiagnosed findings were designated as those that were not reported by the initial radiologists. The differences in the rate of unreported potential clinically significant IFs were compared between the chest group and head or neck group.A total of 376 potential clinically significant IFs were detected in 1,698 (91.19%) patients, of which 175 IFs were classified as highly significant findings (Type I), and 201 (53.46%) as moderately significant findings (Type II). The most common potential clinically significant findings included thyroid nodules (n = 88, 23.40%), pulmonary nodules (n = 56, 14.89%), sinus disease (n = 39, 10.37%), intracranial or cervical artery aneurysms (n = 30, 7.98%), enlarged lymph nodes (n = 24, 6.38%), and pulmonary embolism (n = 19, 5.05%). In addition, 184 (48.94%) of them were not mentioned in the initial report. The highest incidence of missed potential clinical findings were pulmonary embolism and pathologic fractures and erosions (100% for both). The unreported rate of the chest group was significantly higher than that of the head or neck one, regardless of Type I, Type II or all potential clinically significant IFs (χ = 32.151, χ = 31.211, χ = 65.286, respectively; P < .001 for all).Important clinically significant incidental findings are commonly found in a proportion of patients undergoing neck CTA, in which nearly half of these patients have had potential clinically significant IFs not diagnosed in the initial report. Therefore, radiologists should beware of the importance of and the necessity to identify incidental findings in neck CTA scans.


Assuntos
Angiografia por Tomografia Computadorizada , Achados Incidentais , Diagnóstico Ausente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Aneurisma Intracraniano/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem
5.
Int Heart J ; 61(5): 1059-1069, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921666

RESUMO

Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle ≥ 70°) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein, we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% ± 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71° to 83° (mean, 75.1°± 4.5°). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up.Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Based on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.


Assuntos
Aorta Torácica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Aorta Torácica/anatomia & histologia , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Tamponamento Cardíaco/epidemiologia , Infarto Cerebral/epidemiologia , Infarto Cerebral/etiologia , Angiografia por Tomografia Computadorizada , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Marca-Passo Artificial , Pericardiocentese , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento
6.
Am J Case Rep ; 21: e926781, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32952147

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease.


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico , Intensificação de Imagem Radiográfica , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Corticosteroides/administração & dosagem , Idoso , Antibacterianos/administração & dosagem , Técnicas de Laboratório Clínico , Meios de Contraste , Infecções por Coronavirus/complicações , Tosse/diagnóstico , Tosse/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Seguimentos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/terapia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Medição de Risco , Síndrome Respiratória Aguda Grave/virologia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(33): e21685, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872040

RESUMO

Chest injuries are common and inevitable complications of chest compressions during cardiopulmonary resuscitation (CPR). This study aimed to investigate lung parenchymal and thoracic skeletal injuries after CPR by using computed tomography (CT) and to analyze the correlation between the duration of CPR and related complications.We examined 43 non-traumatic cardiac arrest patients who were successfully resuscitated after CPR and had chest CT scans within 24 hours of CPR. Lung parenchymal injuries were assessed by quantifying the lung contusion score (LCS) on the CT images, and each skeletal injury was investigated by classifying the location and the distribution. Other CPR-related chest injuries were also described, such as pleural effusion/hemothorax, pneumothorax, and retrosternal hematoma. Statistical analysis was conducted to determine whether the duration of CPR was correlated with each complication.Lung contusions were found in all of the patients (mean LCS: 22, range: 5-47). The distribution of lung contusions were predominantly in the bilateral dependent portions of the lungs (41 patients). All of the rib fractures occurred in the anterior arc (43 patients), and the sternal fractures occurred predominantly in the mid-sternal body (31 patients). In patients younger than 70 years old, the number of rib fractures significantly increased among those who underwent CPR for more than 25 minutes compared to those who received CPR for less than 25 minutes (median 4.5 vs 9; mean 8.3 vs 5.6 per person, respectively; P = .035). The risk of sternal fracture tended to be higher for patients who received CPR for more than 10 minutes compared to those who received CPR for less than 10 minutes (odds ratio: 3.60; 95% confidence interval: 0.86-15.06; P = .079). However, there was no statistically significant correlation between the duration of CPR and LCS or other CPR-related chest injuries.The duration of CPR was associated with the number of rib fractures and the occurrence of sternal fractures, but it did not affect the extent of CPR-related lung contusions or other CPR-related chest injuries. All of the rib fractures occurred in the anterior arc, while the sternal fractures occurred predominantly in the mid-sternal body. However, since this study was conducted in a single institution, the number of patients included was relatively small, thus limiting the statistical analysis.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Lesão Pulmonar/diagnóstico por imagem , Fraturas das Costelas/diagnóstico por imagem , Esterno/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Criança , Feminino , Humanos , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Fraturas das Costelas/etiologia , Esterno/lesões , Fatores de Tempo , Adulto Jovem
8.
PLoS One ; 15(9): e0239066, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941486

RESUMO

BACKGROUND: Combined pulmonary fibrosis with emphysema (CPFE) is a clinically meaningful syndrome characterized by coexisting upper-lobe emphysema and lower-lobe interstitial fibrosis. However, ambiguous diagnostic criteria and, particularly, the absence of objective methods to quantify emphysematous/fibrotic lesions in patients with CPFE confound the interpretation of the pathophysiology of this syndrome. We analyzed the relationship between objectively quantified computed tomography (CT) measurements and the results of pulmonary function testing (PFT) and clinical events in CPFE patients. MATERIALS AND METHODS: We enrolled 46 CPFE patients who underwent CT and PFT. The extent of emphysematous lesions was obtained by calculating the percent of low attenuation area (%LAA). The extent of fibrotic lesions was calculated as the percent of high attenuation area (%HAA). %LAA and %HAA values were combined to yield the percent of abnormal area (%AA). We assessed the relationships between CT parameters and other clinical indices, including PFT results. Multivariate analysis was performed to examine the association between the CT parameters and clinical events. RESULTS: A greater negative correlation with percent predicted diffusing capacity of the lung for carbon monoxide (DLCO %predicted) existed for %AA (r = -0.73, p < 0.001) than for %LAA or %HAA alone. The %HAA value was inversely correlated with percent predicted forced vital capacity (r = -0.48, p < 0.001), percent predicted total lung capacity (r = -0.48, p < 0.01), and DLCO %predicted (r = -0.47, p < 0.01). Multivariate logistic regression analysis found that %AA showed the strongest association with hospitalization events (odds ratio = 1.20, 95% confidence interval = 1.01-1.54, p = 0.029). CONCLUSION: Quantitative CT measurements reflected deterioration in pulmonary function and were associated with hospitalization in patients with CPFE. This approach could serve as a useful method to determine the extent of lung morphology, pathophysiology, and the clinical course of patients with CPFE.


Assuntos
Pulmão/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/diagnóstico por imagem , Idoso , Feminino , Humanos , Pulmão/fisiopatologia , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Enfisema Pulmonar/complicações , Enfisema Pulmonar/fisiopatologia , Fibrose Pulmonar/complicações , Fibrose Pulmonar/fisiopatologia , Testes de Função Respiratória
9.
PLoS One ; 15(8): e0237939, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813730

RESUMO

INTRODUCTION: Quantitative analysis of multi-detector computed tomography (MDCT) plays an increasingly important role in assessing airway disease. Depending on the algorithms used, airway dimensions may be over- or underestimated, primarily if contrast material was used. Therefore, we tested a modified integral-based method (IBM) to address this problem. METHODS: Temporally resolved cine-MDCT was performed in seven ventilated pigs in breath-hold during iodinated contrast material (CM) infusion over 60s. Identical slices in non-enhanced (NE), pulmonary-arterial (PA), systemic-arterial (SA), and venous phase (VE) were subjected to an in-house software using a standard and a modified IBM. Total diameter (TD), lumen area (LA), wall area (WA), and wall thickness (WT) were measured for ten extra- and six intrapulmonary airways. RESULTS: The modified IBM significantly reduced TD by 7.6%, LA by 12.7%, WA by 9.7%, and WT by 3.9% compared to standard IBM on non-enhanced CT (p<0.05). Using standard IBM, CM led to a decrease of all airway parameters compared to NE. For example, LA decreased from 80.85±49.26mm2 at NE, to 75.14±47.96mm2 (-7.1%) at PA (p<0.001), 74.96±48.55mm2 (-7.3%) at SA (p<0.001), and to 78.95±48.94mm2 (-2.4%) at VE (p = 0.200). Using modified IBM, the differences were reduced to -3.1% at PA, -2.9% at SA and -0.7% at VE (p<0.001; p<0.001; p = 1.000). CONCLUSIONS: The modified IBM can optimize airway wall segmentation and reduce the influence of CM on quantitative CT. This allows a more precise measurement as well as potentially the comparison of enhanced with non-enhanced scans in inflammatory airway disease.


Assuntos
Algoritmos , Meios de Contraste/química , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Animais , Feminino , Pulmão/anatomia & histologia , Reprodutibilidade dos Testes , Suínos
10.
Leg Med (Tokyo) ; 47: 101778, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32829289

RESUMO

Sex estimation is an important part of creating a biological profile, and ultimately assisting in creating a presumptive identification of unidentified skeletal remains. However, manual methods of anthropometric are time-consuming and prone to observer variability. The present study is an attempt to estimation of sex from automatic measurement of patella by multidetector computed tomography (MDCT) in a contemporary Chinese population. Four measurements for every patella, including maximum height (MAXH), maximum breadth (MAXB), maximum thickness (MAXT) and patellar volume (PV), were automatically provided by the software from CT image of 300 Chinese. The sample is composed of 156 males and 144 females with an average age of 41.44 and 45.68 years, respectively. The statistical analyses showed that all variables were sexually dimorphic. Receiver operating characteristic (ROC) analysis was performed to estimate sex from patella. The univariate analysis of each patellar parameter yielded a sex classification accuracy rate of 73.1% to 85.7%. The classification accuracy rates of sex estimation using the combination of the patellar parameters are 81.9% to 91.6%. This paper provides indications that the patella is important bone for sex estimation and it may be used as an alternative in forensic cases when the skull and pelvis are unavailable.


Assuntos
Antropologia Forense/métodos , Tomografia Computadorizada Multidetectores , Patela/anatomia & histologia , Patela/diagnóstico por imagem , Determinação do Sexo pelo Esqueleto/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Adulto Jovem
11.
Adv Clin Exp Med ; 29(8): 983-992, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32853487

RESUMO

BACKGROUND: Aortic valve stenosis is among the most common valvular defects in developed countries. In the assessment of eligibility for transcatheter aortic valve implantation (TAVI), multidetector row computed tomography (MDCT) is performed to determine the precise dimensions of the aortic valve, the topography of the aortic ostium and the ability to use various arterial access routes. OBJECTIVES: To evaluate the relationships between the radiation dose and the repeatability of measurements of dimensions of the aortic valve in MDCT performed before TAVI. MATERIAL AND METHODS: The study involved a group of 60 consecutive patients undergoing MDCT before TAVI. The radiation dose was expressed as computed tomography dose index volume (CTDIvol) and dose length product (DLP). The coefficient of variation (CV) of each measurement was defined as the standard deviation (SD) of the measurements/mean measurement × 100%, based on the measurements performed independently by 2 radiologists. RESULTS: A statistically significant negative linear correlation was observed between the DLP value of the MDCT before TAVI, and the CV of the measurement of the minimum dimension of the aortic annulus (r = -0.25; p < 0.05). Lower DLP doses of the MDCT before TAVI constitute an independent factor associated with a higher CV for the measurement of the minimum dimension of the aortic annulus. CONCLUSIONS: It is proposed that tests using lower radiation doses should be followed by an assessment of the degree of repeatability of the aortic valve sizing.


Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco , Humanos , Tomografia Computadorizada Multidetectores , Doses de Radiação
12.
AJR Am J Roentgenol ; 215(4): 945-953, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32783561

RESUMO

OBJECTIVE. The purpose of this study was to determine in a phantom the dose exposure of different dental 3D sectional imaging methods (CT and cone-beam CT [CBCT]) and different CT protocols. The aim was to establish optimal protocols with the lowest possible dose and diagnostically high image quality with special consideration given to tin prefiltration. MATERIALS AND METHODS. Dose was determined with thermoluminescence detectors at 20 different measuring points on an anthropomorphic phantom. Eight different CT protocols with and without tin filtering were compared with iterative reconstruction methods and a standard CBCT protocol. Objective and subjective image evaluations and a figure-of-merit analysis of the image data were performed by radiologists and maxillofacial surgeons. RESULTS. The determined dose-length products of the nine examinations were 5.0-111.9 mGy · cm with a calculated effective whole body dose of 20.7-505.9 µSv. Cone-beam CT was in the upper midfield with an effective dose of 229.3 µSv. On the basis of dose, objective image quality, and clinical evaluation results, tin filter protocols performed best. Protocols with higher doses were significantly less useful in the figure of merit comparison but because of their detailed bony representation are particularly necessary to answer certain questions about trauma and tumors. CONCLUSION. The use of tin filtering can reduce dose in dental CT examinations, compared with standard low-dose examinations, while maintaining good image quality. The dose performance is significantly inferior even to that of a cone-beam CT examination. High-dose protocols are necessary only for certain questions.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Cabeça/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada Multidetectores , Doses de Radiação , Radiografia Dentária , Protocolos Clínicos , Humanos , Imagens de Fantasmas , Estanho
13.
AJR Am J Roentgenol ; 215(4): 970-977, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32809864

RESUMO

OBJECTIVE. The purpose of this study was to evaluate whether CT features can predict bone marrow edema (BME) on MRI and fracture age in vertebral fragility fractures. MATERIALS AND METHODS. A total of 189 thoracolumbar compression fractures in 103 patients (14 men, 89 women; mean age, 76 years) imaged with both spine CT and MRI were retrospectively included. The presence and extent of BME were assessed on MRI to divide fractures into those with and without BME. The group with BME was then classified for subgroup analysis into fractures with extensive BME (comprising 50% or more of the vertebral body) and those with BME comprising less than 50% of the vertebral body. On CT, five features (presence of cortical or endplate fracture line, presence of trabecular fracture line, presence of condensation band, change in trabecular attenuation, and width of paravertebral soft-tissue change) were analyzed. RESULTS. All five CT findings were predominantly seen in fractures with BME (p < 0.001). Elevated trabecular attenuation, presence of a cortical or endplate fracture line, and paravertebral soft-tissue width showed excellent diagnostic indication for fractures with BME (ROC AUCs: 0.990, 0.976, and 0.950, respectively). In the subgroup with extensive BME, paravertebral soft-tissue width was significantly higher, whereas the change in trabecular attenuation was lower compared with those with BME comprising less than 50% of the vertebral body (p < 0.001). When BME was present, fracture age was not significantly different between the two subgroups, and only greater trabecular attenuation elevation was predictive of older fracture age on linear mixed model analyses (p < 0.001). Interobserver agreement was good for the trabecular fracture line factor and excellent for all other factors. CONCLUSION. CT features accurately correlate with the presence and extent of BME in vertebral fragility fractures. Elevation of trabecular attenuation was the only significant image predictor of fracture age.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Fraturas por Compressão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Fraturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças da Medula Óssea/etiologia , Edema/etiologia , Feminino , Fraturas por Compressão/complicações , Humanos , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões
14.
Stroke ; 51(9): e250-e253, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755345

RESUMO

BACKGROUND AND PURPOSE: The purpose of this study is to examine the ability of ex vivo derived Agatston, Volume, and Density-Volume calcium scores or calcium density measurements to differentiate between carotid plaques based on preoperative cerebrovascular symptomatology. METHODS: Thirty-eight carotid plaques were acquired from standard endarterectomy. Micro-computed tomography was performed on the ex vivo samples. Image series were downsampled to represent the resolution of clinical multidetector computed tomography. Agatston, Volume, and Density-Volume carotid calcium scores were then calculated using coronary methodologies. The fractions of low- and high-density calcification were also determined. RESULTS: The coronary calcium scores could not differentiate between carotid plaques from asymptomatic versus symptomatic patients. However, plaques from asymptomatic patients contained significantly lower fractions of low-density calcification and higher fractions of high-density calcification. CONCLUSIONS: Screening for carotid calcium density in noncontrast computed tomography could reflect plaque stability.


Assuntos
Calcinose/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Calcinose/complicações , Cálcio/sangue , Doenças das Artérias Carótidas/complicações , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Transtornos Cerebrovasculares/etiologia , Endarterectomia das Carótidas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Placa Aterosclerótica , Microtomografia por Raio-X
15.
Medicine (Baltimore) ; 99(28): e21086, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664128

RESUMO

The associations between the presence and severity of coronary artery disease (CAD) and measurements of the psoas major muscle (PMM) as assessed by multidetector row coronary computed tomography angiography (MDCT) are not known.We enrolled 793 patients who were clinically suspected to have CAD or had at least one cardiac risk factor and had undergone MDCT. The number of significantly stenosed coronary vessels (VD) and measurements of the PMM index (PMMI) were determined using MDCT.PMMI in the CAD group was significantly lower than that in the non-CAD group in males, but not females. In addition, the levels of PMMI tended to increase as the number of VD decreased in males. When male patients were divided into 2 groups according to median value of age, that is, relatively younger (53.4 ±â€Š9.2 years) and older (72.6 ±â€Š5.7 years) groups, the presence of CAD was independently associated with PMMI in the younger group by a multiple logistic regression analysis. The cut-off level of PMMI that gave the greatest sensitivity and specificity for the diagnosis of CAD in younger males was 8.3 cm/m (sensitivity 0.441, specificity 0.752).In conclusion, PMMI may be an imaging marker for evaluating the presence and/or severity of CAD in males, and particularly in the non-elderly.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
16.
Methodist Debakey Cardiovasc J ; 16(2): 86-96, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670468

RESUMO

Of the 100,000-plus valve surgeries performed each year in the United States, up to 6% of those develop complications from prosthetic valve dysfunction. Prosthetic valve dysfunction (PVD) can be life threatening and often challenging to diagnose. In this review, we discuss the prevalence and incidence of PVD, explore its different etiologies, and assess the role of multimodality imaging with an emphasis on cardiac multidetector computed tomography (MDCT) for evaluating patients with PVD. We also investigate the utility of MDCT in preprocedural planning for transcatheter devices and redo surgical planning and discuss management strategies for patients with PVD.


Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias/diagnóstico por imagem , Falha de Prótese , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Humanos , Incidência , Imagem Multimodal , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Valor Preditivo dos Testes , Prevalência , Reoperação , Fatores de Risco , Resultado do Tratamento
17.
Am J Physiol Heart Circ Physiol ; 319(2): H360-H369, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32678708

RESUMO

Proper inlet boundary conditions are essential for accurate computational fluid dynamics (CFD) modeling. We developed methodology to derive noninvasive FFRB using CFD and computed tomography coronary angiography (CTCA) images. This study aims to assess the influence of brachial mean blood pressure (MBP) and total coronary inflow on FFRB computation. Twenty-two patients underwent both CTCA and FFR measurements. Total coronary flow was computed from left ventricular mass (LVM) measured from CTCA. A total of 286 CFD simulations were run by varying MBP and LVM at 70, 80, 90, 100, 110, 120, and 130% of the measured values. FFRB increased with incrementally higher input values of MBP: 0.78 ± 0.12, 0.80 ± 0.11, 0.82 ± 0.10, 0.84 ± 0.09, 0.85 ± 0.08, 0.86 ± 0.08, and 0.87 ± 0.07, respectively. Conversely, FFRB decreased with incrementally higher inputs value of LVM: 0.86 ± 0.08, 0.85 ± 0.08, 0.84 ± 0.09, 0.84 ± 0.09, 0.83 ± 0.10, 0.83 ± 0.10, and 0.82 ± 0.10, respectively. Noninvasive FFRB calculated using measured MBP and LVM on a total of 30 vessels was 0.84 ± 0.09 and correlated well with invasive FFR (0.83 ± 0.09) (r = 0.92, P < 0.001). Positive association was observed between FFRB and MBP input values (mmHg) and negative association between FFRB and LVM values (g). Respective slopes were 0.0016 and -0.005, respectively, suggesting potential application of FFRB in a clinical setting. Inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions.NEW & NOTEWORTHY While brachial mean blood pressure (MBP) and left ventricular mass (LVM) measured from CTCA are the two CFD simulation input parameters, their effects on noninvasive fractional flow reserve (FFRB) have not been systematically investigated. We demonstrate that inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. This is important in the clinical application of noninvasive FFR in coronary artery disease diagnosis.


Assuntos
Pressão Arterial , Artéria Braquial/fisiopatologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Ventrículos do Coração/diagnóstico por imagem , Modelos Cardiovasculares , Tomografia Computadorizada Multidetectores , Modelagem Computacional Específica para o Paciente , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Hidrodinâmica , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
Radiologe ; 60(7): 610-623, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32601929

RESUMO

BACKGROUND: The assessment of traumatic lesions to the chest and thoracic spine can pose a challenge for the emergency radiologist. Collaboration with the treating clinicians and knowledge of the patients' history and the trauma mechanism are essential. STANDARD RADIOLOGICAL METHODS: In case of minor trauma, digital radiography may be sufficient for diagnosis. For the diagnostic work-up of polytrauma patients, multidetector computed tomography (MDCT) is the most important modality due to its broad availability and higher sensitivity. The chest has to be completely contained within the scan volume to be able to adequately analyze the bony structures and thoracic spine. Reconstruction in three planes and multiplanar reconstruction are prerequisite for a correct diagnosis and further therapy planning. PERFORMANCE: Magnetic resonance imaging (MRI) serves as a third level diagnostic modality in special cases. MRI can demonstrate bone marrow edema of vertebral bodies or other bones. In addition, the myelon and the epidural space are best assessed with MRI. RESULT: In this article, the most relevant knowledge for the diagnostic work-up of traumatic lesions of the bony chest and the thoracic spine is summarized.


Assuntos
Tomografia Computadorizada Multidetectores , Traumatismo Múltiplo , Traumatismos da Coluna Vertebral , Coluna Vertebral , Traumatismos Torácicos , Humanos , Imagem por Ressonância Magnética , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Tórax
19.
J Comput Assist Tomogr ; 44(4): 511-518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697521

RESUMO

OBJECTIVES: The aim of this study was to develop a radiomics model for a differential diagnosis of focal-type autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma. METHODS: A total of 96 patients, 45 with AIP and 51 with pancreatic ductal adenocarcinoma, were retrospectively evaluated. All patients underwent pretreatment abdominal computed tomography imaging acquired at noncontrast, arterial, and venous phases. Furthermore, 1160 radiomics features were extracted from each phasic image to build radiomics models. The performance of radiomics model was evaluated by sensitivity, specificity, and accuracy. The results of radiomics model were also compared with those of radiologists' visual assessments. RESULTS: The sensitivity, specificity, and accuracy of the optimal radiomics model were 93.3%, 96.1%, and 94.8%, respectively. They were higher than those of the radiologists' assessments with sensitivity of 57.78% and 73.33%, specificity of 88.24% and 90.20%, and accuracy of 75.00% and 81.25%, respectively. CONCLUSION: Radiomics is helpful for a differential diagnosis of AIP in clinical practice as a noninvasive and quantitative method.


Assuntos
Pancreatite Autoimune/diagnóstico por imagem , Carcinoma Ductal Pancreático/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Korean J Radiol ; 21(8): 1018-1023, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677386

RESUMO

The coronavirus disease (COVID-19) outbreak has reached global pandemic status as announced by the World Health Organization, which currently recommends reverse transcription polymerase chain reaction (RT-PCR) as the standard diagnostic tool. However, although the RT-PCR test results may be found negative, there are cases that are found positive for COVID-19 pneumonia on computed tomography (CT) scan. CT is also useful in assessing the severity of COVID-19 pneumonia. When clinicians desire a CT scan of a patient with COVID-19 to monitor treatment response, a safe method for patient transport is necessary. To address the engagement of medical resources necessary to transport a patient with COVID-19, our institution has implemented the use of mobile CT. Therefore, we report two cases of COVID-19 pneumonia evaluated by using mobile cone-beam CT. Although mobile cone-beam CT had some limitations regarding its image quality such as scatter noise, motion and streak artifacts, and limited field of view compared with conventional multi-detector CT, both cases had acceptable image quality to establish the diagnosis of COVID-19 pneumonia. We report the usefulness of mobile cone-beam CT in patients with COVID-19 pneumonia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/instrumentação , Pneumonia Viral/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
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