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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 984-989, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630498

RESUMO

Objective: To study the sensitivity of multi-slice spiral CT in the diagnosis of lymph node metastasis in different lymph node stations of gastric cancer. Methods: A retrospective series of case study was employed in the research. Inclusion criteria: (1) patients undergoing preoperative abdominal CT scan plus enhanced examination, and data in the image archiving and communication system of Sun Yat-sen University Cancer Center; (2) patients undergoing total or subtotal gastrectomy plus D2 or D1+ lymphadenectomy, with more than 15 harvested lymph nodes and more than 1 metastatic lymph node confirmed by postoperative pathology; (3) WHO pathological classification defined as gastric adenocarcinoma; (4) no history of lymph node tuberculosis, giant lymph node hyperplasia, lymphoma or other diseases resulting in enlarged lymph nodes; (5) no history of gastrectomy; (6) no preoperative neoadjuvant therapy. Clinicopathologic data of gastric cancer patients at the Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center from January 2009 to December 2012 were retrospectively analyzed. Using the pathologically positive lymph nodes as a reference, the sensitivity of CT-positive lymph nodes was calculated (total number of positive image lymph nodes/total number of positive pathological lymph nodes) and complete coincidence rate (number of case defined as complete coincidence/number of case with positive pathologic lymph nodes; complete coincidence indicated that the number of positive image lymph nodes was consistent with the number of positive pathologic lymph nodes in each lymph node station). The χ(2) test was used to compare the sensitivity of CT in the diagnosis of lymph node metastasis in each lymph node station. Results: A total of 228 patients with pathology-proven gastric cancer were enrolled in the study, including 147 male and 81 female. The overall sensitivity of CT in diagnosis of metastatic lymph nodes in gastric cancer was 68.7% (1769/2576). The sensitivity of CT in diagnosis of lymph node metastasis of groups 1 to 8 from high to low was group 3 [81.1% (506/624)], group 7 [73.9% (246/333)], group 2 [70.3% (111/158)], group 6 [68.7% (248/361)], group 4 [68.1% (262/385)], group 8 [60.4% (116/192)], group 1 [53.8% (155/288)], group 5 [47.1% (82/174)]. The CT diagnostic sensitivity of group 3 was significantly higher than the overall level (χ(2)=37.689, P<0.001). The CT diagnostic sensitivity of group 5 was significantly lower than the overall level (χ(2)=34.387, P<0.001). The CT diagnostic sensitivity of group 1 was also significantly lower than the overall level (χ(2)=25.918, P<0.001). Significant differences were not found in the CT diagnostic sensitivity of group 2, 4, 6, 7, 8 compared with the overall level (all P>0.05). The complete coincidence rate was 56.9% (536/942) between pathological positive lymph nodes and CT positive lymph nodes. The highest complete coincidence rate was observed in group 3 (68.0%, 123/181) and the lowest was in group 1 (41.4%, 46/111), whose difference was statistically significant (χ(2)=9.673, P=0.002). Conclusion: The sensitivity of CT in diagnosis of lymph nodes in different lymph node stations of gastric cancer is different.


Assuntos
Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Neoplasias Gástricas/diagnóstico por imagem , Feminino , Gastrectomia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada Espiral
2.
Medicine (Baltimore) ; 98(42): e17629, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626147

RESUMO

The potential relationship between coronary artery calcium (CAC) and colorectal adenoma has been widely indicated. This study aimed to investigate the relationship between the risk of colorectal adenoma and CAC progression in asymptomatic Korean adults who underwent serial assessments by colonoscopy and CAC scan.A total of 754 asymptomatic participants, who had undergone serial CAC scans and colonoscopies for screening, were enrolled. Changes in CAC were assessed according to the absolute change between baseline and follow-up results. CAC progression was defined using Multi-Ethnic Study of Atherosclerosis method. Risk for adenoma at follow-up colonoscopy was determined using hazard ratio (HR) by Cox regression. The area under the receiver operating characteristic (ROC) curve was measured.The mean follow-up duration was 3.4 ± 2.5 years. CAC progression was found in 215 participants (28.5%). Participants with adenoma at index colonoscopy showed a higher rate of CAC progression than those without (38.8% vs 23.6%, P < .01). In participants with adenoma at index colonoscopy, CAC progression significantly increased the cumulative risk for adenoma at follow-up colonoscopy (HR = 1.48, 95% confidence interval [CI] 1.06-2.06, log-rank P = .021). In multivariate analysis, male sex (HR = 2.57, 95% CI 1.22-5.42, P = .013), ≥3 adenomas at index colonoscopy (HR = 2.60, 95% CI 1.16-5.85, P = .021), and CAC progression (HR = 2.74, 95% CI 1.48-5.08, P = .001) increased the risk of adenoma at follow-up colonoscopy. In participants without adenoma at index colonoscopy, neither baseline CAC presence nor CAC progression increased the risk of adenoma at follow-up colonoscopy. The interaction between CAC progression and adenoma at index colonoscopy was significant in multivariable model (P = .005). In the ROC analysis, AUC of CAC progression for adenoma at follow-up colonoscopy was 0.625 (95% CI 0.567-0.684, P < .001) in participants with adenoma at index colonoscopy.Participants with CAC progression, who are at high risk of coronary atherosclerosis, may need to be considered for follow-up evaluation of colorectal adenoma, especially those with adenoma at index colonoscopy.


Assuntos
Adenoma/complicações , Cálcio/metabolismo , Neoplasias Colorretais/complicações , Doença da Artéria Coronariana/etiologia , Vasos Coronários/diagnóstico por imagem , Medição de Risco/métodos , Calcificação Vascular/etiologia , Adenoma/diagnóstico , Doenças Assintomáticas , Colonoscopia , Neoplasias Colorretais/diagnóstico , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/metabolismo , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Calcificação Vascular/diagnóstico , Calcificação Vascular/epidemiologia
3.
Br J Radiol ; 92(1102): 20190271, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31453720

RESUMO

OBJECTIVE: Radiomics pipelines have been developed to extract novel information from radiological images, which may help in phenotypic profiling of tumours that would correlate to prognosis. Here, we compared two publicly available pipelines for radiomics analyses on head and neck CT and MRI in nasopharynx cancer (NPC). METHODS AND MATERIALS: 100 biopsy-proven NPC cases stratified by T- and N-categories were enrolled in this study. Two radiomics pipeline, Moddicom (v. 0.51) and Pyradiomics (v. 2.1.2) were used to extract radiomics features of CT and MRI. Segmentation of primary gross tumour volume was performed using Velocity v. 4.0 by consensus agreement between three radiation oncologists. Intraclass correlation between common features of the two pipelines was analysed by Spearman's rank correlation. Unsupervised hierarchical clustering was used to determine association between radiomics features and clinical parameters. RESULTS: We observed a high proportion of correlated features in the CT data set, but not for MRI; 76.1% (51 of 67 common between Moddicom and Pyradiomics) of CT features and 28.6% (20 of 70 common) of MRI features were significantly correlated. Of these, 100% were shape-related for both CT and MRI, 100 and 23.5% were first-order-related, 61.9 and 19.0% were texture-related, respectively. This interpipeline heterogeneity affected the downstream clustering with known prognostic clinical parameters of cTN-status and GTVp. Nonetheless, shape features were the most reproducible predictors of clinical parameters among the different radiomics modules. CONCLUSION: Here, we highlighted significant heterogeneity between two publicly available radiomics pipelines that could affect the downstream association with prognostic clinical factors in NPC. ADVANCES IN KNOWLEDGE: The present study emphasized the broader importance of selecting stable radiomics features for disease phenotyping, and it is necessary prior to any investigation of multicentre imaging datasets to validate the stability of CT-related radiomics features for clinical prognostication.


Assuntos
Imagem por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Carcinoma Nasofaríngeo/diagnóstico por imagem , Neoplasias Nasofaríngeas/diagnóstico por imagem , Adulto , Algoritmos , Conjuntos de Dados como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Fenótipo , Prognóstico , Radioterapia de Intensidade Modulada
4.
Br J Radiol ; 92(1103): 20180734, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31430185

RESUMO

OBJECTIVE: The purpose of our study was to evaluate the visibility of the hilar lymph nodes (LNs) using advanced virtual monoenergetic low-keV images compared with early-phase contrast-enhanced CT. METHODS: Dual energy contrast-enhanced CT was performed for pre-operative evaluation of lung cancer at 20 and 60 s after administration of contrast media in 50 patients (32 males and 18 females; mean age, 69 years). Five kinds of images (A: 20 s/120 kV; B: 60 s/40 keV; C: 60 s/50 keV; D: 60 s/120 kV; E: 60 s/100 kV) were reconstructed. We measured the CT number of the bilateral main pulmonary arteries (PAs), pulmonary veins (PVs) and hilar LNs, and evaluated the differences in CT number (Hounsfield units, HUs) between the PA/PV and LNs (PA-LN and PV-LN contrast). Artifacts from the superior vena cava (SVC) were also evaluated. RESULTS: The mean PA-LN contrast (HU) was 415 in image group A, 299 in B, 180 in C, 80 in D, and 100 in E. The mean PV-LN contrasts in each group were 306, 287, 177, 78, and 99, respectively. Image group B showed the second highest PA-LN contrast following image group A. There was no significant difference in the PV-LN contrast between image groups A and B. The PA-LN and PV-LN contrasts of image groups B and C were significantly higher than those of E. SVC artifacts were lower in the delayed-phase images (Group B-E) than in Group A. CONCLUSION: To evaluate the hilar LNs with a single image series, advanced virtual monoenergetic 40-keV imaging at the delayed 60-s phase seems to be the most valuable. ADVANCES IN KNOWLEDGE: Advanced virtual monoenergetic image is useful for evaluation of both hilar LNs and tumors in the delayed phase without artifact derived from the streak artifact from dense contrast media in the SVC.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Linfonodos/efeitos dos fármacos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Cuidados Pré-Operatórios/métodos , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
5.
J Comput Assist Tomogr ; 43(5): 811-816, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31453979

RESUMO

OBJECTIVE: Knowledge-based iterative model reconstruction (IMR) yields diagnostically acceptable image quality in low-dose static computed tomography (CT). We aimed to evaluate the feasibility of IMR in dynamic myocardial computed tomography perfusion (CTP). METHODS: We enrolled 24 patients who underwent stress dynamic CTP using a 256-slice CT. Images were reconstructed using filtered back projection (FBP), hybrid IR, and IMR. Image quality and hemodynamic parameters were compared among three algorithms. RESULTS: Qualitative image quality and contrast-to-noise ratio were significantly higher by IMR than by FBP or hybrid IR (visual score: 4.1 vs. 3.0 and 3.5; contrast-to-noise ratio: 12.4 vs. 6.6 and 8.4; P < 0.05). No significant difference was observed among algorithms in CTP-derived myocardial blood flow (1.68 vs. 1.73 and 1.70 mL/g/min). CONCLUSIONS: The use of knowledge-based iterative model reconstruction improves image quality without altering hemodynamic parameters in low-dose dynamic CTP, compared with FBP or hybrid IR.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Hemodinâmica/fisiologia , Bases de Conhecimento , Tomografia Computadorizada Multidetectores/métodos , Idoso , Algoritmos , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Teste de Esforço , Estudos de Viabilidade , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos
6.
Br J Radiol ; 92(1103): 20190448, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31335170

RESUMO

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disorder characterized by the infiltration of one or more organs with IgG4-positive plasma cells resulting in inflammatory lesions and fibrosis. Although the pancreas is the most commonly affected organ, involvement of extrapancreatic organs is an increasingly recognized manifestation of the disease. Patients may be asymptomatic and serum IgG4 concentrations may be elevated or normal. Treatment consists of glucocorticosteroid treatment, with excellent response. A definitive diagnosis requires histopathology with imaging playing a key role in avoiding treatment delays. This pictorial review will focus on the most current knowledge regarding IgG4-RD including its common and less common manifestations and the roles of multidetector CT, MRI and ultrasound in the diagnosis and management of suspected IgG4-RD. Knowledge of the varied imaging findings of this multi systemic disease is essential for radiologists to avoid misdiagnosis and assist with timely and effective treatment.


Assuntos
Doença Relacionada a Imunoglobulina G4/complicações , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Dacriocistite/diagnóstico , Dacriocistite/etiologia , Feminino , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/etiologia , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Nefropatias/diagnóstico , Nefropatias/etiologia , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Imagem por Ressonância Magnética , Masculino , Mastite/diagnóstico , Mastite/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Pseudotumor Orbitário/diagnóstico , Pseudotumor Orbitário/etiologia , Pancreatopatias/diagnóstico , Pancreatopatias/etiologia , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/etiologia , Sialadenite/diagnóstico , Sialadenite/etiologia , Ultrassonografia
7.
Br J Radiol ; 92(1101): 20180945, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31322906

RESUMO

OBJECTIVE: This study aimed to evaluate the relationship between heart rate (HR) and optimal reconstruction phase in prospectively electrocardiogram (ECG)-triggered coronary CT angiography (CCTA) performed on a newly introduced 256-slice multidetector CT (MDCT). METHODS: All the cases were selected retrospectively from the patients scheduled for CCTA in our department between January and April 2017. The scanner selected the optimal exposure phase based on 10 s ECG recordings. To ensure the success of CCTA, the operator also checked patient's age, breathing control, emotional status and past medical history to decide whether the automatically selected scan phase needs manual adjustment or not. Images were reconstructed in 1% steps of the R-R interval to determine the cardiac phase with least coronary motion. If CCTA images showed moderate motion blurring or discontinuity in the course of coronary segments, a cardiac motion correction algorithm was applied to the reconstructed images. Subjective diagnostic image quality was evaluated with 4-point grading scale. RESULTS: A total of 87 consecutive CCTA examinations were investigated in this study. Diastolic reconstruction was applied to all vessel segments in patients with HR <63 bpm, where 36.5 and 77.8% of vessel segments were reconstructed with the use of motion correction in HR ≤57 and 58-62 bpm, respectively. As for patients with HR ≥63 bpm, 89.3 and 71.7% of vessel segments were reconstructed in diastole in HR 63-67 and ≥68 bpm, respectively, while 81 and 100% of vessel segments were reconstructed with the use of motion correction in the same HR groups. CONCLUSION: Based on our results, a HR less than 67 bpm can be used to identify appropriate patients for diastolic reconstruction. Although the motion correction algorithm is an effective approach to reduce the impact of cardiac motion in CCTA, HR control is still important to optimize the image quality of CCTA. The relationship between HR and optimal reconstruction phase established in this study could be further used to tailor the ECG pulsing window for dose reduction in patients undergoing CCTA performed on the 256-slice MDCT. ADVANCES IN KNOWLEDGE: The HR thresholds to identify patients who are the best suitable candidates for diastolic or systolic reconstruction are scanner specific. This study investigated the relationship between HR and optimal reconstruction phase in prospectively ECG-triggered CCTA for a newly introduced 256-slice MDCT. Once the relationship is established, it could be used to tailor the ECG pulsing window for radiation dose reduction.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Frequência Cardíaca/fisiologia , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
8.
Ann Otol Rhinol Laryngol ; 128(11): 1054-1060, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31288548

RESUMO

OBJECTIVES: To present a systematic checklist to improve diagnosing otosclerosis (OS) on high-resolution computed tomography (HRCT) of the temporal bones and review this protocol's efficacy in diagnosing OS on HRCT. METHODS: A retrospective case series was performed at a University Referral Hospital in urban Chicago, Illinois. High-resolution computed tomographies of the temporal bone were reviewed including 17 ears in the test group with surgically confirmed OS and 21 ears in the control group surgically confirmed to not have OS. Preoperative HRCTs were evaluated by a single neuroradiologist using a systematic protocol created to assist in diagnosing OS. This looked for radiolucency at the fissula ante fenestram and pericochlear region, and new bone formation around the oval and round windows. RESULTS: The radiologist accurately diagnosed OS in all 17 test group ears and ruled out OS in all 21 control group ears using the protocol. All 17 test ears were read to have lucency at the fissula ante fenestram, 9 (53.0%) to have new bone formation, and 8 (47.1%) to have cochlear lucency. The radiologist was more confident in diagnosing OS when cochlear lucency was present with the fissula ante fenestram lucency. CONCLUSIONS: This HRCT checklist is a highly accurate tool for evaluating the presence of OS when images are reviewed in the systematic fashion described. Imaging prior to surgery aids in counseling patients, preparing surgically, and excluding other pathologies.


Assuntos
Cóclea/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Otosclerose/diagnóstico , Osso Temporal/diagnóstico por imagem , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cirurgia do Estribo/métodos
9.
Br J Radiol ; 92(1102): 20190487, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271536

RESUMO

OBJECTIVES: The purpose of the study was to assess the incidence of hepatic vein variations on multidetector CT (MDCT) for abdominal examinations. METHODS: A retrospective analysis of 534 MDCT scans was performed in patients sent for various abdominal pathologies between January 2017 and April 2019. After excluding 34 patients, finally total of 500 patients (N = 500) were included in the study. For simplification, we classified the hepatic vein variations as classified by Soyer et al, Fang et al and Cheng et al. RESULTS: Single right hepatic vein was seen in 458 (91.6%) out of 500 patients in our study. Two right hepatic veins were seen in 36 patients out of which 27 had common trunk and nine had independent drainage into the inferior vena cava (IVC). Common trunk of middle hepatic vein (MHV) and left hepatic vein (LHV) was seen in 405 (81%) and independent drainage of MHV and LHV into the IVC was seen in 95 (19%) of patients in our study. Amongst the segmental hepatic vein variations, most common drainage of segment IV vein was into LHV (333,66.6%) followed by MHV (148,29.6%) and IVC (19,3.8%). CONCLUSION: Hepatic vein variations are commonly seen similar to variations in hepatic artery, portal vein and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists. ADVANCES IN KNOWLEDGE: Awareness of the hepatic vein variations is essential for intervention radiologists and surgeons to reduce iatrogenic complications.


Assuntos
Veias Hepáticas/anatomia & histologia , Veias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
J Craniofac Surg ; 30(5): 1605-1608, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299779

RESUMO

This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n = 46) and on the left in 50.5% (n = 47) of the study participants. Deviation angles were in the range from 7.2° to 22.4° and the mean value was 13.2°â€Š±â€Š5.0°. The measured volumes were in the range from 1.8 cm to 9.6 cm with a mean of 4.8 ±â€Š1.5 cm. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm (0.80-8.90 cm) on the right and 4.20 cm (0.90-8.70 cm) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus.


Assuntos
Septo Nasal/diagnóstico por imagem , Deformidades Adquiridas Nasais/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Adulto Jovem
11.
Medicine (Baltimore) ; 98(27): e16220, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277133

RESUMO

Pulmonary sequestrations (PS) are typically supplied by a vessel originating from thoracic aorta, or abdominal aorta. Differences in imaging features between these PS subtypes have not been described.To analyze the imaging features of PS with arterial supply from the thoracic and abdominal aorta.Retrospectively, 23 pathologically proven cases of pulmonary sequestration were analyzed and compared based on the site of feeding artery origin.In 21 cases (21/23), the PS was soft tissue density. 1 (1/23) PS was purely cystic and another heterogeneous with both cystic and solid components (1/23). In 16/23 cases, the feeding vessel(s) arose from the thoracic aorta (male:female ratio 1:7) and in 7/23 cases from the abdominal aorta (male:female ratio 4:3). Feeding vessels from the thoracic aorta were duplicated in 7/16 cases. PS location (P <.05) and size (P <.001) differed based on the origin of the feeding vessel (thoracic aorta: 14/16 left lower lobe, mean volume 962.97 mL; abdominal aorta: 3/7 left lower lobe, mean volume 1120.89 mL). The feeding arteries themselves differed in size depending on their site of origin (thoracic aorta: mean diameter 7.0mm ±â€Š2.7 mm, mean length 44.6mm ±â€Š10.9 mm; abdominal aorta: mean diameter 3.3mm ±â€Š0.6 mm, mean length 103.6mm ±â€Š34.5 mm).PS size and distribution differ depending upon the site of feeding vessel origin as does the size of the feeding vessel itself.


Assuntos
Aorta Abdominal/anormalidades , Aorta Torácica/anormalidades , Sequestro Broncopulmonar/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Pulmão/irrigação sanguínea , Tomografia Computadorizada Multidetectores/métodos , Adolescente , Adulto , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
12.
Medicine (Baltimore) ; 98(27): e16224, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277134

RESUMO

Pneumothorax is a common complication in computed tomography (CT)-guided percutaneous lung biopsy (CPLB). Whether the lobar location of lesions contributes to the incidence of pneumothorax should be further clarified.A total of 1452 consecutive patients who underwent CPLB between January 2010 and March 2018 were retrospectively analyzed. The incidence of pneumothorax was compared among 5 different lobe biopsies. Minor pneumothorax was defined as pneumothorax without chest tube placement and major pneumothorax was defined as pneumothorax with chest tube placement.The positive diagnosis rate of pathology for this cohort was approximately 84%, with 22.5% (326/1452) of the patients experiencing pneumothorax. The rates of pneumothorax were 19.5%, 24.5%, 33.9%, 21.4%, and 23.9% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively (P = .09). Chest tube placement was necessary in 19.0% (62/326) of the patients with pneumothorax. The rates of major pneumothorax were 5.3%, 2.6%, 10.2%, 4.7%, and 2.6% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe biopsies, respectively (P = .02). This result was further confirmed by the propensity score-matching method. Moreover, 8.7% (127/1452) of the patients experienced puncture of fissure, the rates of which were 13.5%, 5%, 10.2%, 9.1%, and 4.3% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively (P < .001). Within the pneumothorax patient group, the rate of lobe fissure puncture (15.2%) was significantly lower in patients with minor pneumothorax than (51.6%) in those with major pneumothorax (P < .001).Upper and middle lobe lesion biopsies show a significantly high rate of major pneumothorax, which may be due to more puncture of fissure. It is crucial to carefully distinguish the fissure around lesions and bypass it to avoid major pneumothorax.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pneumopatias/diagnóstico , Pulmão/patologia , Tomografia Computadorizada Multidetectores/efeitos adversos , Pneumotórax/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnóstico , Pneumotórax/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
Br J Radiol ; 92(1102): 20190231, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271542

RESUMO

Viscero-atrial situs encompasses the laterality, relative position and configuration of the abdominal viscera, the atria of the heart and the tracheobronchial tree. Determining the situs and cardiac position is the first step in the commonly used sequential, segmental approach to the imaging evaluation of congenital heart defects (CHD). Abnormalities of visceroatrial situs and cardiac position are frequently associated with the presence of complex CHDs and accurate assessment of situs abnormalities can help predict the probability and type of the defect. Multidetector CT (MDCT) angiography, with its multiplanar reformatting and volume rendering techniques, offers accurate information about the morphology and three-dimensional relationships of the various cardiac and extra cardiac structures. In this pictorial essay, we present the MDCT imaging findings of the spectrum of abnormalities of visceroatrial situs and cardiac position, using a third generation dual source CT scanner.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Vísceras/diagnóstico por imagem , Brônquios/anormalidades , Brônquios/diagnóstico por imagem , Coração/embriologia , Átrios do Coração/anormalidades , Átrios do Coração/diagnóstico por imagem , Cardiopatias Congênitas/embriologia , Humanos , Levocardia/diagnóstico por imagem , Fígado/anormalidades , Fígado/diagnóstico por imagem , Estômago/anormalidades , Estômago/diagnóstico por imagem , Traqueia/anormalidades , Traqueia/diagnóstico por imagem , Vísceras/anormalidades
14.
Int Heart J ; 60(4): 822-829, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257338

RESUMO

Atrial fibrillation (AF) is an independent risk factor for intracranial hemorrhage in patients receiving recombinant-tissue-type plasminogen activator (rt-PA) thrombolytic therapy. Research showed that patients with acute ischemic stroke (AIS) could benefit from multimode computed-tomography- (CT-) guided intravenous thrombolysis over 4.5 hours. The medical data of patients with AIS in our center were retrospectively reviewed, and the data of the multimode CT-guided thrombolytic therapy or nonthrombolytic therapy within different time windows (3-9 hours) were evaluated. 134 AIS cases were selected successfully and divided into three groups: patients with AF treated by rt-PA (AF rt-PA), patients with AF not treated by rt-PA (AF non-rt-PA), and patients without AF treated by rt-PA (non-AF rt-PA). After correcting for the baseline NIH Stroke Scale (NIHSS), sex, age, and hypertension data, the comparison results showed that the NIHSS improved significantly at hospital discharge for rt-PA-treated patients (n = 47) compared to non-rt-PA-treated patients with AIS (n = 31) with AF (P = 0.0156). The NIHSS evaluation at 90 days of follow-up also improved in rt-PA-treated patients (P = 0.0157). The NIHSS at hospital discharge was higher in AF rt-PA-treated patients compared to non-AF rt-PA-treated patients (P = 0.0167) after correction; the difference was not statistically significant at 90 days of follow-up (P = 0.091). Our research showed that the neural function improved after 3-9 hours of thrombolytic therapy with rt-PA in patients with AIS and AF. If there is no thrombolytic taboo, the patients could benefit from the thrombolytic therapy, although the onset time window has been extended to 9 hours.


Assuntos
Fibrilação Atrial/complicações , Isquemia Encefálica/tratamento farmacológico , Tomografia Computadorizada Multidetectores/métodos , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Administração Intravenosa , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Feminino , Fibrinolíticos/administração & dosagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Int Heart J ; 60(4): 849-853, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308325

RESUMO

The diagnostic performance of 320-detector cardiac computed tomography (CCT) for the detection of thrombi in the left atrial appendage (LAA), relative to transesophageal echocardiography (TEE) as the gold standard, has not yet been evaluated. A total of 91 consecutive patients who were scheduled to undergo pulmonary vein isolation and underwent TEE and CCT were enrolled in this study. Delayed scanning on CCT was performed following early scanning, at 60 seconds after the start of the contrast injection. The radiation dose was estimated for both scans. The early scans showed a contrast medium filling defect (FD) in the LAA in 27 patients, whereas the delayed scans showed an FD in the LAA in six patients. Of these, five patients were confirmed to have a thrombus in the LAA by TEE. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100, 74.4, 18.5, 100, and 75.8% for early scanning and 100, 98.8, 83.3, 100, and 98.9% for delayed scanning, respectively. The area under the curve for the detection of a thrombus in the LAA on the delayed scans was significantly larger than that for the detection on the early scans (0.99 versus 0.87, P < 0.001). The estimated median radiation doses for the early and delayed scans were 2.86 and 0.42 mSv, respectively. Addition of delayed scanning to early scanning improved the diagnostic performance for the detection of a thrombus in the LAA and may obviate unnecessary TEE, with minimal additional radiation exposure.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Cardiopatias/diagnóstico , Tomografia Computadorizada Multidetectores/métodos , Trombose/diagnóstico , Idoso , Fibrilação Atrial/complicações , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Trombose/etiologia
16.
Wien Klin Wochenschr ; 131(19-20): 475-484, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31190096

RESUMO

OBJECTIVE: The aim of this study was to assess pulmonary venous anatomy and to determine the frequency of each drainage pattern in a large cohort using multidetector computed tomography (MDCT) and three-dimensional (3D) imaging. MATERIAL AND METHODS: The chest CT images of 550 patients were retrospectively reviewed for pulmonary venous anatomy and variant patterns. All CT scans were performed using a 128 detectors row CT scanner after intravenous contrast administration. Pulmonary venous drainage pattern was documented for each patient and frequency of each drainage type was calculated. A useful classification system was used to simplify complex pulmonary venous anatomy. RESULTS: The expected typical anatomy was observed in 239 (43.5%) patients. The remaining 311 (56.5%) patients had anatomic variations on the right, left, or both sides. The most common variation was left common vein, seen in 177 (32.2%) patients, followed by accessory right middle lobe vein(s), seen in 112 (20.4%) patients. In the present study the frequency of variant anatomy on the right (34%) and left (33.3%) sides were similar. CONCLUSION: The use of MDCT with 3D imaging is a preferable imaging tool for demonstrating pulmonary venous anatomy in detail, which shows significant variability. Considering the high prevalence of variations in the population, performing preprocedural MDCT may facilitate higher success rates in radiofrequency catheter ablation (RFCA) and help to perform safe and accurate surgery especially in video-assisted thoracic surgery (VATS).


Assuntos
Ablação por Cateter , Tomografia Computadorizada Multidetectores/métodos , Veias Pulmonares , Humanos , Pulmão , Veias Pulmonares/anatomia & histologia , Veias Pulmonares/diagnóstico por imagem , Estudos Retrospectivos
17.
Br J Radiol ; 92(1101): 20170980, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31199672

RESUMO

Resternotomy (RS) is a common occurrence in cardiac surgical practice. It is associated with an increased risk of injury to old conduits, cardiac structures, catastrophic hemorrhage and subsequent high morbidity and mortality rate in the operating room or during the recovery period. To mitigate this risk, we evaluated the role of multidetector CT (MDCT) in planning repeat cardiac surgery. We evaluated sternal compartment abnormalities, sternal/ascending aorta distance, pre-reoperative assessment of the aorta (wall, diameters, lumen, valve), sternal/right ventricle distance, diaphragm insertion, pericardium and cardiac chambers, sternal/innominate vein distance, connection of the grafts to the predicted median sternotomy cut, graft patency and anatomic course, possible aortic cannulation and cross-clamping sites and additional non-cardiovascular significant findings. Based on the MDCT findings, surgeons employed tailored operative strategies, including no-touch technique, clamping strategy and cardiopulmonary bypass (CPB) via peripheral cannulation assisted resternotomy. Our experience suggests that MDCT provides information which contributes to the safety of re-operative heart surgery reducing operative mortality and adverse outcomes. The radiologist must be aware of potential surgical options, including in the report any findings relevant to possible resternotomy complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Tomografia Computadorizada Multidetectores/métodos , Cuidados Pré-Operatórios/métodos , Reoperação/métodos , Esternotomia/métodos , Humanos , Esterno/diagnóstico por imagem , Esterno/cirurgia
18.
Ann R Coll Surg Engl ; 101(8): 552-557, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31219321

RESUMO

INTRODUCTION: The clinical significance of isolated free fluid on abdominal computed tomography (CT) in patients with blunt abdominal trauma is unclear. This audit reviews our unit's experience with isolated free fluid and attempts to refine our clinical algorithms for the assessment of patients with blunt abdominal trauma. MATERIALS AND METHODS: All patients who sustained blunt abdominal trauma between December 2012 and December 2017 who were subjected to multidetector CT of the abdomen as part of their initial investigation were included in this study. RESULTS: During the five-year period under review, a total of 1066 patients underwent abdominal CT following blunt poly trauma. A total of 84 (7.9%) patients died. There were 148 (14%) patients with CT finding of isolated free fluid. Of these, 128 (67%) were selected for non-operative management, which included a period of serial abdominal examinations. In this non-operative group, five patients failed their abdominal observations and underwent laparotomy. Findings in these five cases were negative (1), non-therapeutic (1), splenic injury (1), Pancreatic and splenic injury (1) and bladder injury (1). Thirteen patients (10%) died, none of whom had surgery. The causes of death were exsanguination from a major traumatic lower limb injury (1), multiple organ failure (1), traumatic brain injury (10) and spinal cord injury (1). The remaining 20 patients underwent laparotomy. The indications were failed non-operative management (5), abdominal distension (1) and suspicion of a missed hollow viscus injury (14). In this group there were 11 therapeutic and 6 non-therapeutic surgeries and three negative laparotomies. For the 15 patients selected for operative management, the findings were as follows: hollow viscus injury (3), mesenteric bleeds (2), splenic and pancreatic injury (1), liver and bladder injury (1), splenic and bladder injury (1), non-therapeutic (4), negative (3). The finding of isolated free fluid on CT is 98% sensitive and 96% specific for true isolated free fluid (chi square 331.598; P = 0.000). This finding predicts successful non-operative management with a positive predictive value of 93% and a negative predictive value of 96%. DISCUSSION: In patients with blunt abdominal trauma, the finding of isolated free fluid on abdominal CT alone is no longer an indication for laparotomy. Other clinical factors must be taken into account when deciding on the need for laparotomy, such as haemodynamic status, clinical abdominal findings and the ability to reliably assess the abdomen. In the absence of a clinical indication for urgent laparotomy, patients with isolated free fluid may be observed.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Líquidos Corporais/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adulto , Algoritmos , Ascite/diagnóstico por imagem , Ascite/etiologia , Tomada de Decisão Clínica , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Masculino , Auditoria Médica/métodos , Tomografia Computadorizada Multidetectores/métodos , Valor Preditivo dos Testes , Radiografia Abdominal/métodos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
19.
J Craniofac Surg ; 30(4): 1298-1302, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166268

RESUMO

This study determined the effect of electrohydraulic extracorporeal shockwave therapy (ESWT) on the healing of mandible defects repaired using particulate allogenic bone grafts. This study included 20 male Wistar rats aged 12 weeks. In all the animals, a critical-sized defect of 4-mm diameter was created in the mandible and the defect area was filled with particulate allograft. Next, the rats were divided into 2 groups, allograft (G) (n = 10) and allograft + ESWT (GE) (n = 10). On days 3, 5, and 7 after the grafting, rats in the GE group received ESWT involving 200 pulses with an energy flux density of 0.19 mJ/mm. Five rats in each group were sacrificed at the end of week 4 and at the end of week 8. Defect areas were examined radiologically by performing high-resolution computed tomography and stereologically by using the Cavalieri method. Obtained data were compared by performing statistical analysis. Radiological evaluation showed that bone density was higher in rats in the G group than in those in the GE group at week 4. In contrast, bone density was higher in rats in the GE group than in those in the G group at week 8. Stereological examination showed that new bone, connective tissue, and capillary volumes were higher in rats in the GE group than in those in the G group at both weeks 4 and 8. The authors' results indicate that repeated doses of ESWT accelerate the healing of bone defects repaired using allogenic bone grafts.


Assuntos
Substitutos Ósseos/administração & dosagem , Tratamento por Ondas de Choque Extracorpóreas , Mandíbula/cirurgia , Cicatrização , Aloenxertos , Animais , Densidade Óssea , Masculino , Mandíbula/diagnóstico por imagem , Modelos Animais , Tomografia Computadorizada Multidetectores , Ratos Wistar
20.
Int J Cardiovasc Imaging ; 35(9): 1721-1731, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250161

RESUMO

To compare planned and achieved device position in patients undergoing left atrial appendage occlusion (LAAO). It is unclear how devices used for LAAO position themselves compared to what is planned. All patients undergoing LAAO at our institution had pre- and post-procedural multi detector-row computed tomography (MDCT) at 3 months (N = 52). Using dedicated software, both datasets were fused to superimpose the left atria in all planes. The effective device position was traced on the post-procedural MDCT and then imported in the pre-procedural dataset to allow comparisons. Planned and effective landing zones were compared with respect to size, location and orientation. The device's final position was in a significantly larger landing zone than planned (452 ± 174 vs. 351 ± 112 mm2 for effective and planned landing zones, respectively, paired t-test: p < 0.0001), resulting in significantly less-than-intended area oversizing (41 ± 31 vs. 12 ± 28%, p < 0.0001). In terms of device orientation, there was a difference of 19.7° between the planned and effective landing zones (p < 0.0001). The Amplatzer device had a shallower-than-planned position in 70% of cases, whereas the Watchman device had a deeper-than-planned position in 75% of cases (p = 0.04). Incomplete occlusion was found in 17 patients (33%). In a multivariable model, oversizing at the effective landing zone was the only MDCT independent predictor of incomplete occlusion (OR: 0.96 per 1% increment, 95% CI 0.95-0.98, p = 0.009). MDCT fusion showed that LAAO device position and orientation are different than planned, and this is associated with incomplete occlusion of the LAA.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Cateterismo Cardíaco/instrumentação , Imagem Tridimensional/métodos , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Terapia Assistida por Computador/instrumentação , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Cateterismo Cardíaco/efeitos adversos , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudo de Prova de Conceito , Estudos Retrospectivos , Software , Resultado do Tratamento
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