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1.
Transplant Proc ; 51(7): 2379-2382, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474295

RESUMO

BACKGROUND: Hepatic steatosis carries a risk of postoperative liver dysfunction in donors and graft nonfunction in recipients. This article discusses the evaluation of fatty infiltration in donor liver parenchyma on multidetector computed tomography. MATERIALS AND METHODS: The methods of hepatic fat estimation include measurement of hepatic attenuation in HU and calculation of the liver attenuation index (LAI). Liver attenuation values reflect the degree of steatosis. Average attenuation of liver parenchyma is calculated by placing the circular region of interest of at least 1 cm2 area at multiple places in the liver on noncontrast CT images. Splenic attenuation is measured by placing the circular region of interest at its upper, middle, and lower poles. The LAI is the difference between mean hepatic attenuation and mean splenic attenuation. RESULTS: A total of 52 donors were evaluated as potential recipients (34 men, 18 women; mean age, 33.2 years; range, 23-55 years). In 34 donors liver attenuation index (LAI) values were from 2 HU to 22 HU. An LAI > 5 HU correctly predicted the absence of significant macrovesicular steatosis. These donors were acceptable for a liver transplant. The LAI values of -10 to 5 HU were suggestive of mild to moderate steatosis (6%-30%); 18 (34.6%) volunteers did not proceed to donation because of negative LAI < -5 HU. In 2 cases with LAI of -7 and LAI of -8 liver biopsy was performed, and 30% steatosis was confirmed in the pathohistologic examination. Unacceptable liver biopsy result was considered as contraindication for donation. The LAI values of < -10 HU were suggestive of moderate to severe hepatic steatosis of 30% or greater. In these cases liver biopsy is not needed, as such donors are not acceptable for liver transplant. CONCLUSION: Computed tomography imaging provides a detailed evaluation of fatty infiltration in donor liver parenchyma.


Assuntos
Fígado Gorduroso/etiologia , Hepatectomia/efeitos adversos , Doadores Vivos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Biópsia , Contraindicações , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Adulto Jovem
2.
Radiol Med ; 124(12): 1199-1211, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31407223

RESUMO

BACKGROUND: There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. AIM: To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. MATERIALS AND METHODS: We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. RESULTS: WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). CONCLUSION: The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.


Assuntos
Serviço Hospitalar de Admissão de Pacientes , Doenças Assintomáticas , Achados Incidentais , Tomografia Computadorizada Multidetectores/métodos , Abdome/diagnóstico por imagem , Adulto , Distribuição por Idade , Idoso , Doenças Assintomáticas/epidemiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Neoplasias/diagnóstico por imagem , Neoplasias/epidemiologia , Doses de Radiação , Estudos Retrospectivos , Distribuição por Sexo , Coluna Vertebral/diagnóstico por imagem , Doenças Torácicas/diagnóstico por imagem , Tomografia Computadorizada Espiral
3.
Transplant Proc ; 51(7): 2408-2412, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31402246

RESUMO

BACKGROUND: In the present study, we aimed to put forward the relationship between multidetector computed tomography findings and scores for liver function evaluation. METHOD: Included in the study were 51 patients with liver cirrhosis. Preoperative creatinine levels, international normalized ratio and alpha-fetoprotein values, albumin and sodium levels, the presence of ascites and varices, Model for End-Stage Liver Disease (MELD) scores, MELD-Sodium (MELD-Na) scores, and Child-Turcotte-Pugh Classification, the presence of ascites and varices, the size of liver, the size and diameter of the spleen, portal vein diameter, splenic artery diameter, and proper hepatic and right hepatic artery diameter were all determined. RESULTS: Although the correlation between the spleen diameter and the MELD scores (P <.001) and MELD-Na scores (P = .02) was strong, there was no association with the Child-Turcotte-Pugh Classification (P = .08). Despite the correlations between portal vein diameter (P = .04) and splenic artery diameter (P = .04) and MELD scores, no association was detected with MELD-Na scores and the Child-Pugh scores. Even though a negative correlation between proper hepatic artery diameter (P = .18) and MELD-Na scores was noted, no statistically significant correlation could be identified with any scoring systems. In the multivariate linear regression analyses, the correlation between the portal vein diameter and MELD scores was significant as a radiologic finding. In the multiple linear regression analyses, the negative correlation between the right hepatic artery and MELD-Na scores diameter was statistically significant. In the multiple linear regression analyses, there was no statistically significant correlation between preoperative radiologic findings and Child-Turcotte-Pugh Classification. CONCLUSION: We believe that preoperative multislice computed tomography imaging in patients with chronic liver disease may contribute to the diagnosis of disease, the determination of vascular anomalies, and the grading of the severity of the disease.


Assuntos
Cirrose Hepática/diagnóstico , Testes de Função Hepática/estatística & dados numéricos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Cirrose Hepática/cirurgia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico
4.
J Invasive Cardiol ; 31(5): E76-E82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034438

RESUMO

BACKGROUND: In transcatheter aortic valve implantation (TAVI), prosthesis over-sizing prevents paravalvular leak (PVL). Strategies of over-sizing for self-expanding bioprostheses are not well established at present. METHODS: Patients with aortic valve stenosis scheduled for TAVI underwent preprocedural multislice computed tomography. Based on the degree of over-sizing, a ROC curve was drawn to define the optimal value of valve sizing for reducing PVL after TAVI. RESULTS: A total of 152 consecutive patients were included in the study (mean age, 79.95 ± 7.71 years; log EuroScore: 23.87 ± 8.93%). Based on the ROC curve, sizing of 14% was the optimal that would lead to less moderate/severe PVL (P<.01). Group 1 was defined as sizing <14% (n = 49 patients) and group 2 was defined as sizing ≥14% (n = 103 patients). During a follow-up period of 36 ± 14 months, a total of 9 patients died from group 1 vs 4 patients from group 2 (P<.01). Two of the patients who died had moderate/severe PVL and 11 had no/mild PVL (P=.27). From the population, a total of 49 patients (32%) were found to be in the "borderline" zone. Patients who received the smaller valve had lower mean left ventricular outflow tract diameter (P=.048), higher rate of calcium load (mild: 10 [32%] vs 13 [72%]; moderate: 16 [52%] vs 3 [17%]; severe: 5 [16%] vs 2 [11%]; P=.02) and lower mean of sinus of Valsalva diameter (P=.046) compared with patients who received the bigger valve. CONCLUSIONS: In patients undergoing TAVI, over-sizing the prosthesis at least 14% reduces PVL. In borderline cases, taking into consideration additional anatomical parameters may result in low rates of PVL.


Assuntos
Insuficiência da Valva Aórtica , Valva Aórtica , Próteses Valvulares Cardíacas , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/prevenção & controle , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Feminino , Grécia , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/normas , Humanos , Masculino , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Falha de Prótese/etiologia , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos
5.
PLoS One ; 14(1): e0210410, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30633760

RESUMO

In this study, we investigate the feasibility of improving the imaging quality for low-dose multislice helical computed tomography (CT) via iterative reconstruction with tensor framelet (TF) regularization. TF based algorithm is a high-order generalization of isotropic total variation regularization. It is implemented on a GPU platform for a fast parallel algorithm of X-ray forward band backward projections, with the flying focal spot into account. The solution algorithm for image reconstruction is based on the alternating direction method of multipliers or the so-called split Bregman method. The proposed method is validated using the experimental data from a Siemens SOMATOM Definition 64-slice helical CT scanner, in comparison with FDK, the Katsevich and the total variation (TV) algorithm. To test the algorithm performance with low-dose data, ACR and Rando phantoms were scanned with different dosages and the data was equally undersampled with various factors. The proposed method is robust for the low-dose data with 25% undersampling factor. Quantitative metrics have demonstrated that the proposed algorithm achieves superior results over other existing methods.


Assuntos
Algoritmos , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Estudos de Viabilidade , Humanos , Imagens de Fantasmas , Doses de Radiação , Razão Sinal-Ruído
6.
J Comput Assist Tomogr ; 43(1): 61-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30211797

RESUMO

Statistical iterative reconstruction (SIR) using multidetector computed tomography (MDCT) is a promising alternative to standard filtered back projection (FBP), because of lower noise generation while maintaining image quality. Hence, we investigated the feasibility of SIR in predicting MDCT-based bone mineral density (BMD) and vertebral bone strength from finite element (FE) analysis. The BMD and FE-predicted bone strength derived from MDCT images reconstructed using standard FBP (FFBP) and SIR with (FSIR) and without regularization (FSIRB0) were validated against experimental failure loads (Fexp). Statistical iterative reconstruction produced the best quality images with regard to noise, signal-to-noise ratio, and contrast-to-noise ratio. Fexp significantly correlated with FFBP, FSIR, and FSIRB0. FFBP had a significant correlation with FSIRB0 and FSIR. The BMD derived from FBP, SIRB0, and SIR were significantly correlated. Effects of regularization should be further investigated with FE and BMD analysis to allow for an optimal iterative reconstruction algorithm to be implemented in an in vivo scenario.


Assuntos
Densidade Óssea , Análise de Elementos Finitos/estatística & dados numéricos , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada Multidetectores/métodos , Coluna Vertebral/diagnóstico por imagem , Idoso , Cadáver , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Razão Sinal-Ruído
7.
J Int Adv Otol ; 14(3): 464-471, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30325332

RESUMO

OBJECTIVES: To describe and quantify computed tomography (CT) findings of auto-evacuated (spontaneously drained) secondary acquired cholesteatoma (SAC). MATERIALS AND METHODS: This multicenter retrospective study included 69 patients with intermittent ear discharge diagnosed with SAC by autoscopy or automicroscopy who were surgically treated. Three independent radiologists measured the medial and lateral attic distance on coronal and axial planes using multidetector computed tomography (MDCT) in 75 ear CTs from 69 patients with intraoperatively verified diagnoses of pars flaccida cholesteatoma (n=36), pars tensa cholesteatoma (n=24), and auto-atticotomy or automastoidectomy (n=15) and compared them with contralateral healthy ears. RESULTS: A circular or elliptical air-filled cavity surrounded by granulation tissue was morphologically detected on MDCT in these patients. The lateral attic distance was significantly higher in pars flaccida cholesteatoma cases than in contralateral healthy ears on both coronal and axial planes (p<0.05). The medial attic distance was significantly higher in pars tensa cholesteatoma cases than in contralateral healthy ears in the axial pane, but with no difference in the coronal plane. CONCLUSION: In patients with chronic intermittent aural discharge, nonopacified areas surrounded by granulation tissue, which expands the medial or lateral attic in a CT scan, suggest an auto-evacuated cholesteatoma.


Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Adolescente , Adulto , Idoso , Colesteatoma da Orelha Média/classificação , Colesteatoma da Orelha Média/patologia , Orelha Média/diagnóstico por imagem , Orelha Média/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
8.
Medicine (Baltimore) ; 97(39): e12544, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278548

RESUMO

To assess the prevalence of tracheal diverticula (TD) in patients referred for thoracic Computed Tomography (CT).1679 consecutive patients subjected to thoracic CT examination for different causes, from January to June 2017, were included in this cohort study. CT was performed with a 64 slice CT, using a standard protocol and Multiplanar Reformat Images (MPR). A TD was defined as a thin-walled air sac at the paratracheal wall with a communication with the tracheal lumen. Congenital or acquired nature of TD was determined by the anatomical location, being usually the congenital ones located 4 to 5 cm below the vocal cords or a few centimeters above the carina in the right paratracheal area, whereas acquired ones were located at the level of the thoracic inlet, in the posterolateral tracheal wall. Presence of TD was assessed and their number and size recorded based on 2 axial diameters and size of neck.One or more TD were found in 96 patients (5.7% of sample), with a slight preponderance (65%) in male gender. Globally, 124 TD were detected; they were solitary in 75% of cases, double in 20.8%, and in about 4.2% they were triple. Average size of the TD was 1.3×4.9 mm with a mean width of the neck of 1.9 mm. The peak of prevalence (9%) was in patients belonging to the fourth-decade group (see ). According to their anatomical location, the majority (97.6%) of TD were acquired in nature and devoided of specific symptoms (see below).(Table is included in full-text article.)Acquired TD were detected in about 1 out of 20 of thoracic CTs and were usually incidentally. Our findings show a slightly higher frequency than previously reported. The most frequent presentation was in male and as a single entity. Clinically, TD was not associated with specific symptoms, in particular with chronic cough or Chronic Obstructive Pulmonary Disease (COPD).


Assuntos
Tomografia Computadorizada Multidetectores , Traqueia , Doenças da Traqueia , Adolescente , Idoso de 80 Anos ou mais , Tosse/epidemiologia , Divertículo/diagnóstico , Divertículo/epidemiologia , Divertículo/etiologia , Feminino , Humanos , Achados Incidentais , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Traqueia/anormalidades , Traqueia/diagnóstico por imagem , Traqueia/patologia , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/epidemiologia , Doenças da Traqueia/etiologia
9.
Med. clín (Ed. impr.) ; 151(7): 255-264, oct. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173945

RESUMO

Fundamento y objetivos: Comparar prospectivamente la exactitud diagnóstica de la tomografía computarizada de 64 detectores (TCMD64) y la tomografía por emisión de positrones/tomografía computarizada (18FDG PET/TC) con contraste intravenoso en pacientes con linfoma difuso de células grandes B (LDCGB) en la estadificación inicial y en la evaluación de la respuesta al final del tratamiento. Material y métodos: Ensayo clínico controlado multicéntrico que incluyó 72 pacientes de 5 hospitales de la Comunidad de Madrid entre enero de 2012 y junio de 2015, aleatorizados de forma ciega a una diferente prueba de imagen inicial y final, 36 a 18FDG PET/TC y 36 a TCMD64. Un médico nuclear y un radiólogo interpretaron la 18FDG PET/TC de manera independiente, llegando a un consenso post-hoc. Por otro lado, un radiólogo ajeno interpretó la TCMD64 por separado. El patrón de referencia incluyó datos clínicos, pruebas complementarias y seguimiento. El Comité Ético de cada hospital aprobó el estudio y los sujetos firmaron su consentimiento por escrito. Resultados: Se observó buena concordancia de ambas pruebas diagnósticas con el patrón de referencia en la estadificación inicial (18FDG PET/CT [k=0,5] y TCMD64 [k=0,6]), existiendo solo buena concordancia en la evaluación de la respuesta al final del tratamiento con la 18FDG PET/TC (k=0,7). Conclusión: En la estadificación inicial de pacientes con LDCGB existe un grado de acuerdo satisfactorio de la 18FDG PET/TC y la TCMD64 con el patrón de referencia, mientras que en la evaluación de la respuesta al final del tratamiento la 18FDG PET/TC es superior a la TCMD64


Background and objectives: To prospectively compare the accuracy in initial staging and end-of-treatment restaging of diffuse large B-cell lymphoma (DLBCL) between 64-slice multidetector computed tomography (64MDCT) and 18FDG positron emission tomography/computed tomography (18FGD PET/CT) with intravenous contrast injection. Material and methods: Randomised and blind controlled clinical multicentric trial that included biopsy-proven DLBCL patients. Seventy-two patients from five different hospitals in the region of Madrid, Spain, were enrolled in the study between January 2012 and June 2015. Thirty-six were randomly allocated to 18FDG PET/TC and the other 36 to 64MDCT for initial staging and end-of-treatment restaging. A nuclear medicine physician and a radiologist independently analysed 18FDG PET/TC images and reached an agreement post-hoc. 64MDCT images were separately evaluated by a different radiologist. Every set of images was compared to the reference standard that included clinical data, complementary tests and follow-up. The study was approved by participating centres’ ethics committees and written informed consent was obtained from all the participants. Results: A good agreement was observed between both diagnostic techniques and the reference standard in initial staging [18FDG PET/CT (k=0.5) and 64MDCT (k=0.6)], although only the 18FDG PET/TC showed a good agreement with the reference standard for the end-of-treatment restaging (k=0.7). Conclusion: In DLBCL, both 18FDG PET/TC and 64MDCT have shown good agreement with the reference standard in initial staging. Nevertheless, 18FDG PET/CT has shown to be superior to 64MDCT in end-of-treatment response assessment


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Estadiamento de Neoplasias/métodos , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Resultado do Tratamento , Estudos Prospectivos
10.
Radiology ; 285(1): 134-146, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28609205

RESUMO

Purpose To compare the diagnostic performance of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging with that of contrast material-enhanced multidetector computed tomography (CT) in the detection of borderline hepatocellular nodules in patients with liver cirrhosis and to determine the Liver Imaging Reporting and Data System (LI-RADS) categories of these detected nodules. Materials and Methods The institutional review board approved this retrospective study and waived the informed consent requirement. Sixty-eight patients with pathologically proven dysplastic nodules (DNs) (low-grade DNs, n = 20; high-grade DNs, n = 17), early hepatocellular carcinomas (HCCs) (n = 42), or progressed HCCs (n = 33) underwent gadoxetic acid-enhanced MR imaging and multidetector CT. An additional 57 patients without any DNs or HCCs in the explanted livers were included as control subjects. Three radiologists independently graded the presence of liver nodules on a five-point confidence scale and assigned LI-RADS categories by using imaging findings. Jackknife alternative free-response receiver operating characteristics (JAFROC) software was used to compare the diagnostic accuracy of each modality in lesion detection. Results Reader-averaged figures of merit estimated with JAFROC software to detect hepatocellular nodules were 0.774 for multidetector CT and 0.842 for MR imaging (P = .002). Readers had significantly higher detection sensitivity for early HCCs with MR imaging than with multidetector CT (78.6% vs 52.4% [P = .001], 71.4% vs 50.0% [P = .011], and 73.8% vs 50.0% [P = .001], respectively). A high proportion of overall detected early HCCs at multidetector CT (59.4%) and MR imaging (72.3%) were categorized as LI-RADS category 4. Most early HCCs (76.2%) and high-grade DNs (82.4%) demonstrated hypointensity on hepatobiliary phase images. In total, 30 more LI-RADS category 4 early HCCs were identified with MR imaging than with multidetector CT across all readers. Conclusion Gadoxetic acid-enhanced MR imaging performed significantly better in the detection of high-risk borderline nodules, especially early HCCs, than did multidetector CT. © RSNA, 2017 Online supplemental material is available for this article.


Assuntos
Gadolínio DTPA/uso terapêutico , Neoplasias Hepáticas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Adulto , Idoso , Feminino , Humanos , Fígado/patologia , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Curva ROC , Estudos Retrospectivos
11.
AJR Am J Roentgenol ; 208(4): 785-793, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28328258

RESUMO

OBJECTIVE: The purpose of this article is to assess the value of a large panel of clinical and MDCT variables in patients with suspected small-bowel obstruction (SBO) for predicting urgent surgical intervention (< 72 hours), bowel ischemia, and bowel resection. MATERIALS AND METHODS: MDCT studies performed at admission for 179 nonconsecutive adults (mean age, 55.8 years; 86 men and 93 women) with suspected SBO were retrospectively reviewed by three board-certified radiologists. In addition to assessing individual CT features, each radiologist scored the overall likelihood of each main outcome measure using a 5-point scale. All relevant clinical and laboratory data were abstracted from electronic medical record review. Univariate and multivariate analyses were performed. RESULTS: Among all 179 patients with suspected SBO, 56 (31.3%) underwent surgical intervention within 72 hours, 10 (5.6%) had ischemia at surgery, and nine (5.0%) required small-bowel resection. On univariate analysis, multiple CT findings were highly significant (p < 0.01) for predicting the main surgical outcomes, including degree of obstruction, 5-point radiology likelihood scores, and the presence of a transition point, closed loop, and mesenteric congestion. None of the objective clinical or laboratory variables (including serum lactate level) reached this level of significance. At multivariate analysis, forward stepwise logistic regression with 0.05 significance level cutoff included both degree of obstruction (p < 0.001) and closed loop (p < 0.01), with the presence of a transition point showing a trend toward significance (p = 0.081). CONCLUSION: A number of findings at abdominal MDCT are associated with the need for surgery and other important surgical outcomes in patients with suspected SBO. Overall radiologist impression of need for surgical intervention was a better predictor than any clinical or laboratory parameter.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Feminino , Humanos , Obstrução Intestinal/epidemiologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Cuidados Pré-Operatórios/estatística & dados numéricos , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Sensibilidade e Especificidade , Wisconsin/epidemiologia
12.
AJR Am J Roentgenol ; 208(4): 770-776, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28075624

RESUMO

OBJECTIVE: Five percent of cardiac implantable electric devices (CIEDs) are removed each year. Percutaneous extraction is preferred but can be complicated if the leads adhere to the vasculature or perforate. The goal of this study is to assess the frequency of findings on dedicated MDCT that alter preprocedural planning for percutaneous CIED extraction. MATERIALS AND METHODS: One hundred patients with CIEDs who underwent MDCT before percutaneous lead extraction were analyzed. Major findings that could preclude percutaneous removal, including lead course and termination, were distinguished from moderately significant findings that could alter but not preclude percutaneous removal, including endofibrosis of leads to the vasculature, lead termination abnormalities, central vein stenosis, or thrombus. Incidental findings were characterized separately. Findings were correlated with preprocedural decisions, the extraction procedure performed, and procedural outcomes. RESULTS: Twenty-six women and 74 men with 125 right ventricular leads, 84 right atrial leads, and 26 coronary venous leads were evaluated. Major findings were present in 7% of patients, including six patients with lead perforation and one with a lead coursing outside a tricuspid annuloplasty ring. Moderately significant findings of endothelial fibrosis were found in 78% of patients. The central veins were narrowed or occluded in 42% of patients, and thrombus was present in 2% of patients. Thirty-six percent of patients had incidental findings, and 4% of patients had unexpected findings requiring immediate inpatient attention. CONCLUSION: MDCT performed before CIED lead extraction is able to identify major and moderately significant findings that can alter either percutaneous extraction or preprocedural planning. The use of dedicated preprocedural MDCT can help to stratify patient risk, guide decision making by the proceduralist, and identify non-catheter-related findings that affect patient management.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Remoção de Dispositivo/estatística & dados numéricos , Eletrodos Implantados/estatística & dados numéricos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Cuidados Pré-Operatórios/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos
13.
Acta Clin Croat ; 56(2): 284-291, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29485796

RESUMO

The aim of the study was to examine the prevalence of head injuries, acute stroke and brain tumors obtained from computed tomography (CT) scans in the emergency department (ED) during a one-year period. We also assessed the potential effect of seasons on the occurrence of stroke, head trauma and tumors found on CT scans, expressed in monthly intervals. This retrospective review included all patients that underwent emergency head CT from the hospital database. A total of 3888 head CT examinations were performed in adult patients presenting to ED and 1424 CT scans had at least one pathologic finding meeting diagnostic criteria for the study. Of the total number of CT scans analyzed, acute stroke was identified in 552 (14.19%), head trauma in 660 (16.97%), and brain tumor in 212 (5.45%) patients. Head trauma was more commonly found in males (n=465, 70.45%) than in females (n=195, 29.54%). Acute stroke was slightly more common in males than in females. Brain tumors were more frequently found in female patients. There were monthly variations in the number of head injuries and acute stroke diagnosed during the study period. Men and elderly patients were found to account for the greatest number of traumatic head injuries and therefore are at the highest risk of possible brain injury.


Assuntos
Traumatismos Craniocerebrais/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/epidemiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Croácia/epidemiologia , Diagnóstico Precoce , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Estações do Ano , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto Jovem
14.
Yonsei Med J ; 58(1): 114-122, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27873503

RESUMO

PURPOSE: Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not. MATERIALS AND METHODS: This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (-) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses. RESULTS: During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (-) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (-) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172-8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (-) group seemed to also have a higher risk of recurrent stroke. CONCLUSION: Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Acidente Vascular Cerebral/complicações , Doenças Assintomáticas , Doença da Artéria Coronariana/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade
15.
Int J Radiat Biol ; 93(4): 416-425, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27921444

RESUMO

PURPOSE: The biological effects of ionizing radiation (BEIR VII) report estimates that the risk of getting cancer from radiation is increased by about a third from current regulation risk levels. The propose of this study was to estimate cancer induction risk from abdominopelvic computed tomography (CT) scanning of adult patients using 6- and 16-slice CT scanners. MATERIALS AND METHODS: A cross-sectional study on 200 patients with abdominopelvic CT scan in 6- and 16-slice scanners was conducted. The dose-length product (DLP) and volume CT Dose Index (CTDIvol) values from the scanners as well as the effective dose values from the ImPACT CT patient dosimetry calculator with the biological effects of ionizing radiation (BEIR VII) method were used to estimate the cancer induction risk. RESULTS: The mean (and standard deviation) values of CTDIvol and DLP were 6.9 (±1.07) mGy and 306.44 (± 60.57) mGy.cm for 6-slice, and 5.19 (±0.91) mGy and 219.7 (±49.31) mGy.cm for 16-slice scanner, respectively. The range of effective dose in the 6-slice scanner was 2.61-8.15 mSv and, in the 16-slice scanner, it was 1.47-4.72 mSv. The mean and standard deviation values of total cancer induction risk in abdominopelvic examinations were 0.136 ± 0.059% for men and 0.135 ± 0.063% for women in the 6-slice CT scanner. The values were 0.126 ± 0.051% for men and 0.127 ± 0.056% for women in the 16-slice scanner. CONCLUSIONS: The cancer induction risk of abdominopelvic scanning was noticeable. Therefore, radiation dose should be minimized by optimizing the protocols and applying appropriate methods.


Assuntos
Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Neoplasias Induzidas por Radiação/epidemiologia , Pelve/diagnóstico por imagem , Exposição à Radiação/estatística & dados numéricos , Radiografia Abdominal/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/diagnóstico , Pelve/efeitos da radiação , Dosagem Radioterapêutica , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
16.
Clin Radiol ; 72(2): 177.e1-177.e8, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27908443

RESUMO

AIM: To estimate the probability of malignancy in small pulmonary nodules (PNs) based on clinical and radiological characteristics in a non-screening population that includes patients with a prior history of malignancy using three validated models. MATERIALS AND METHODS: Retrospective data on clinical and radiological characteristics was collected from the medical records of 702 patients (379 men, 323 women; range 19-94 years) with PNs ≤12 mm in diameter at a single centre. The final diagnosis was compared to the probability of malignancy calculated by one of three models (Mayo, VA, and McWilliams). Model accuracy was assessed by receiver operating characteristics (ROC). The models were calibrated by comparing predicted and observed rates of malignancy. RESULTS: The area under the ROC curve (AUC) was highest for the McWilliams model (0.82; 95% confidence interval [CI]: 0.78-0.91) and lowest for the Mayo model (0.58; 95% CI: 0.55-0.59). The VA model had an AUC of (0.62; 95% CI: 0.47-0.64). Performance of the models was significantly lower than that in the published literature. CONCLUSIONS: The accuracy of the three models is lower in a non-screening population with a high prevalence of prior malignancy compared to the papers that describe their development. To the authors' knowledge, this is the largest study to validate predictive models for PNs in a non-screening clinically referred patient population, and has potential implications for the implementation of predictive models.


Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Tomografia Computadorizada Multidetectores/métodos , Modelos de Riscos Proporcionais , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/epidemiologia , Adulto , Idoso , Institutos de Câncer/estatística & dados numéricos , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Prevalência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Sensibilidade e Especificidade , Centros de Atenção Terciária/estatística & dados numéricos , Reino Unido/epidemiologia , Adulto Jovem
18.
Postgrad Med ; 128(7): 701-5, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27336836

RESUMO

OBJECTIVES: To evaluate the classification and diameter of left gastric vein (LGV) in healthy Chinese adults with multi-detector computed tomography (MDCT). METHODS: MDCT angiography was performed in 234 healthy adults for the portal venous system. CT cross-sectional thin-layer reconstruction combined with maximum intensity projection, volume rendering and multiplanar reconstruction were applied. The diameter of LGV was measured at the point within 2 cm from LGV origination. RESULTS: Of 234 subjects, 11 subjects (4.70%) who did not have clear images were excluded, and 223 subjects (95.30%) with excellent images were included. The LGV was originated from the portal vein in 46.15%, splenic vein in 30.77%, portal splenic angle in 14.53%, and the left branch of the portal vein in 3.85%. The maximal diameter of LGV was 4.74 ± 0.84 mm with a 95% confidence interval of 4.63-4.85 mm, and the LGV diameter was positively correlated with the weight of patients (R = 0.26, P = 0.006). No significant difference existed in the maximal diameter of LGV at different origination sites (P = 0.35). The diameter of LGV was significantly greater in males than in females (4.90 ± 0.85 vs. 4.56 ± 0.80 mm, P = 0.002), and the maximal diameter of LGV was significantly (P = 0.02) greater in the age range of 30-39 and 40-49 years than in the range of >70 years. No statistical significance (P = 0.36) was detected in the other groups. CONCLUSION: MDCT can clearly display the detailed anatomy and variation of LGV in healthy adults, providing a normal range of LGV diameter for clinical reference for diagnosing possible portal hypertension and for possible intervention.


Assuntos
Tomografia Computadorizada Multidetectores/métodos , Estômago/irrigação sanguínea , Veias , Adulto , Anatomia Transversal/métodos , China , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Valores de Referência , Fluxo Sanguíneo Regional , Veias/anatomia & histologia , Veias/diagnóstico por imagem
19.
Eur J Radiol ; 85(6): 1085-91, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27161056

RESUMO

PURPOSE: To investigate if 18F-FDG PET/MRI can improve the diagnostic performance of TNM staging and help make an accurate decision for resectability in patients with gastric cancer compared to MDCT. MATERIALS AND METHODS: Forty-two patients with histologically confirmed gastric cancers underwent preoperative MDCT and 18F-FDG PET/MRI. M-staging and resectability was assessed in all patients, and T- and N-staging was evaluated in 30 of 42 patients who underwent curative gastrectomy. Two abdominal radiologists independently assessed their MDCT images and 18F-FDG PET/MRI and determined preoperative TNM staging and resectability of gastric cancers. Diagnostic performance with MDCT and 18F-FDG PET/MRI were compared using McNemar's test and receiver operating characteristic analysis. RESULTS: Diagnostic accuracies for T and N staging were not significantly different between MDCT and 18F-FDG PET/MRI in both readers. However, 18F-FDG PET/MRI showed significantly improved diagnostic accuracy for M staging in one reader (P=0.008) and marginal improvement in the other reader (P=0.063) compared to MDCT. Regarding the resectability of gastric cancers, diagnostic accuracy (92.9% for both readers) of 18F-FDG PET/MRI was significantly higher than that (76.2% for reader 1 and 64.3% for reader 2) of MDCT in both readers (P<0.05). CONCLUSION: 18F-FDG PET/MRI may improve diagnostic accuracy for preoperative M staging as well as resectability of gastric cancers compared to MDCT.


Assuntos
Fluordesoxiglucose F18 , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada Multidetectores/métodos , Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Neoplasias Gástricas/patologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Confiabilidade dos Dados , Feminino , Seguimentos , Gastrectomia/métodos , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Imagem Multimodal/estatística & dados numéricos , Invasividade Neoplásica , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia
20.
PLoS One ; 11(4): e0154569, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27128524

RESUMO

To retrospectively determine the association between breast lesion morphology and malignancy and to determine the optimal value of lesion enhancement (HU, Hounsfield units) to improve the diagnostic accuracy of breast cancer in patients with incidental breast lesions (IBLs). A total of 97 patients with 102 IBLs detected from July 2009 to December 2012 were enrolled in this study. Two radiologists analyzed CT images for the presence of malignancy based on the morphology of the lesions alone and in combination with an enhancement value (HU) analysis. There were 36 malignant and 66 benign IBLs. When the morphology and enhancement values were combined, the sensitivity, specificity, and accuracy were 92%, 97%, and 95%, respectively, for reader 1 and 89%, 94%, and 92%, respectively, for reader 2. The addition of HU values led to correct changes in the diagnosis; specifically, the accuracy of the diagnosis of reader 1 and reader 2 improved by 6.9% and 11.8%, respectively. The addition of the enhancement value (HU) to the CT morphology improved the diagnostic accuracy in the differentiation of malignant from benign IBLs by using the region of interest (ROI) to measure the HU within the most suspicious part of the lesion.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Feminino , Fibroadenoma/diagnóstico por imagem , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Variações Dependentes do Observador , Intensificação de Imagem Radiográfica/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade
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