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1.
Br J Radiol ; 94(1118): 20200716, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33471553

RESUMO

OBJECTIVES: Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data. METHODS: We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann-Whitney U test. RESULTS: Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules (p < 0.001). Vessel enlargement was associated with longer history of fever (p = 0.035) and lower admission oxygen saturation (p = 0.014); dependent subpleural atelectasis with lower oxygen saturation (p < 0.001) and higher respiratory rate (p < 0.001); mediastinal lymph nodes with shorter history of cough (p = 0.046); centrilobular solid nodules with lower prevalence of cough (p = 0.023), lower oxygen saturation (p < 0.001), and higher respiratory rate (p = 0.032), and pericardial effusion with shorter history of cough (p = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines (p = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission (p = 0.01). CONCLUSION: Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity. ADVANCES IN KNOWLEDGE: Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.


Assuntos
/diagnóstico por imagem , Achados Incidentais , Pulmão/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Pulmão/irrigação sanguínea , Linfonodos/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Variações Dependentes do Observador , Derrame Pleural/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Estudos Retrospectivos
2.
Am J Case Rep ; 21: e926781, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32952147

RESUMO

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


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico , Intensificação de Imagem Radiográfica , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Corticosteroides/administração & dosagem , Idoso , Antibacterianos/administração & dosagem , Técnicas de Laboratório Clínico , Meios de Contraste , Infecções por Coronavirus/complicações , Tosse/diagnóstico , Tosse/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Seguimentos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/terapia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Medição de Risco , Síndrome Respiratória Aguda Grave/virologia , Resultado do Tratamento
3.
Eur J Nucl Med Mol Imaging ; 47(11): 2525-2532, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32666395

RESUMO

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) is an emerging worldwide threat to public health. While chest computed tomography (CT) plays an indispensable role in its diagnosis, the quantification and localization of lesions cannot be accurately assessed manually. We employed deep learning-based software to aid in detection, localization and quantification of COVID-19 pneumonia. METHODS: A total of 2460 RT-PCR tested SARS-CoV-2-positive patients (1250 men and 1210 women; mean age, 57.7 ± 14.0 years (age range, 11-93 years) were retrospectively identified from Huoshenshan Hospital in Wuhan from February 11 to March 16, 2020. Basic clinical characteristics were reviewed. The uAI Intelligent Assistant Analysis System was used to assess the CT scans. RESULTS: CT scans of 2215 patients (90%) showed multiple lesions of which 36 (1%) and 50 patients (2%) had left and right lung infections, respectively (> 50% of each affected lung's volume), while 27 (1%) had total lung infection (> 50% of the total volume of both lungs). Overall, 298 (12%), 778 (32%) and 1300 (53%) patients exhibited pure ground glass opacities (GGOs), GGOs with sub-solid lesions and GGOs with both sub-solid and solid lesions, respectively. Moreover, 2305 (94%) and 71 (3%) patients presented primarily with GGOs and sub-solid lesions, respectively. Elderly patients (≥ 60 years) were more likely to exhibit sub-solid lesions. The generalized linear mixed model showed that the dorsal segment of the right lower lobe was the favoured site of COVID-19 pneumonia. CONCLUSION: Chest CT combined with analysis by the uAI Intelligent Assistant Analysis System can accurately evaluate pneumonia in COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Aprendizado Profundo , Pulmão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pandemias , Pneumonia Viral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Criança , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Software , Adulto Jovem
4.
Eur Radiol ; 30(12): 6788-6796, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32613287

RESUMO

OBJECTIVE: To explore the value of CT texture analysis (CTTA) for determining coronavirus disease 2019 (COVID-19) severity. METHODS: The clinical and CT data of 81 patients with COVID-19 were retrospectively analyzed. The texture features were extracted using LK2.1. The two-sample t test or Mann-Whitney U test was used to find the significant features. Minimum redundancy and maximum relevance (MRMR) method was performed to find the features with maximum correlation and minimum redundancy. These features were then used to construct a radiomics texture model to discriminate the severe patients using multivariate logistic regression method. Besides, a clinical model was also built. ROC analyses were conducted to evaluate the performance of two models. The correlations of clinical features and textural features were analyzed using the Spearman correlation analysis. RESULTS: Of the total cases included, 60 were common and 21 were severe. (1) For textural features, 20 radiomics features selected by MRMR showed good performance in discriminating the two groups (AUC > 70%). (2) For clinical features, chi-square tests or Mann-Whitney U tests identified 16 clinical features as significant, and 12 were discriminative (p < 0.05) between two groups analyzed by univariate logistic analysis. Of these, 10 had an AUC > 70%. (3) Prediction models for textural features and clinical features were established, and both showed high predictive accuracy. The AUC values of textural features and clinical features were 0.93 (0.86-1.00) and 0.95 (0.95-0.99), respectively. (4) The Spearman correlation analysis showed that most textural and clinical features had above-moderate correlations with disease severity (> 0.4). CONCLUSION: Texture analysis can provide reliable and objective information for differential diagnosis of COVID-19. KEY POINTS: • CT texture analysis can well differentiate common and severe COVID-19 patients. • Some textural features showed above-moderate correlations with clinical factors. • CT texture analysis can provide useful information to judge the severity of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pulmão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
5.
J Comput Assist Tomogr ; 44(4): 511-518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697521

RESUMO

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


Assuntos
Pancreatite Autoimune/diagnóstico por imagem , Carcinoma Ductal Pancreático/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Anticancer Res ; 40(6): 3401-3410, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487637

RESUMO

BACKGROUND/AIM: In local staging of gastric adenocarcinoma CT is the modality of choice. Less frequently used in a few selected patients is echo-endoscopy. Aim of this study was to evaluate the accuracy of hydro-multidetector-computed tomography (hydro-MDCT) in the evaluation of gastric adenocarcinomas with subsequent surgical and histopathological correlation to select cases for echo-endoscopy. PATIENTS AND METHODS: A total of 65 patients with gastric adenocarcinomas, diagnosed by endoscopy and biopsy, underwent contrast-enhanced hydro-MDCT with subsequent tumor, nodes, metastases (TNM) classification. The distension of the gastric lumen was obtained after the oral administration of 500 ml of water. RESULTS: Hydro-MDCT always detected gastric cancer and in 49/65 patients the assessment of T-parameter was identical to the histopathological results (accuracy: 75%). We found overstaging in 12 and understaging in 4 cases. N-parameter with MDCT was in agreement with histo-pathology in 69%of patients; in metastatic disease hydro-MDCT had an accuracy of 99%. Hydro-MDCT has proven to be a reliable diagnostic technique in evaluating gastric cancer T3-T4 stages in comparison to T1 and T2: in defining T2-stage we found the highest number of errors (37%). CONCLUSION: Hydro-MDCT is a reliable technique in the preoperative staging of gastric adenocarcinoma. Echo-endoscopy could be particularly useful in doubtful cases to evaluate the muscularis propria infiltration (T2 vs. T3) and characterize the peri-gastric lymph nodes.


Assuntos
Tomografia Computadorizada Multidetectores , Estadiamento de Neoplasias , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Meios de Contraste , Endossonografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada Multidetectores/normas , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias/normas , Seleção de Pacientes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
7.
BMC Pediatr ; 20(1): 227, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423435

RESUMO

BACKGROUND: Recently, the World Health Organization has declared the coronavirus disease 2019 (COVID-19) outbreak a public health emergency of international concern. So far, however, limited data are available for children. Therefore, we aimed to investigate the clinical and chest CT imaging characteristics of COVID-19 in preschool children. METHODS: From January 26, 2020 to February 20, 2020, the clinical and initial chest CT imaging data of eight preschool children with laboratory-confirmed COVID-19 from two hospitals were retrospectively collected. The chest CT imaging characteristics, including the distribution, shape, and density of lesions, and the pleural effusion, pleural changes, and enlarged lymph nodes were evaluated. RESULTS: Two cases (25%) were classified as mild type, and they showed no obvious abnormal CT findings or minimal pleural thickening on the right side. Five cases (62.5%) were classified as moderate type. Among these patients, one case showed consolidation located in the subpleural region of the right upper lobe, with thickening in the adjacent pleura; one case showed multiple consolidation and ground-glass opacities with blurry margins; one case displayed bronchial pneumonia-like changes in the left upper lobe; and two cases displayed asthmatic bronchitis-like changes. One case (12.5%) was classified as critical type and showed bronchial pneumonia-like changes in the bilateral lungs, presenting blurred and messy bilateral lung markings and multiple patchy shadows scattered along the lung markings with blurry margins. CONCLUSIONS: The chest CT findings of COVID-19 in preschool children are atypical and various. Accurate diagnosis requires a comprehensive evaluation of epidemiological, clinical, laboratory and CT imaging data.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Coronavirus , Pulmão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico por imagem , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Masculino , Pandemias , Derrame Pleural , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Tórax
8.
Radiography (Lond) ; 26(3): e189-e194, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32423842

RESUMO

Due to the wide availability, rapid execution, low cost, and possibility of being acquired at the patient's bed, chest X-Ray is a fundamental tool in the diagnosis, follow-up and evaluation of the treatment effectiveness of patients with pneumonia, also in the context of COVID-19 infection. However, false negative cases are possible. We report 4 cases of false negative chest X-Rays, in patients who were diagnosed positive for COVID-19 by real-time transverse-transcript-polymerase chain reaction (RT-PCR), and executed chest unenhanced CTs just after the X-Rays, demonstrating signs of COVID-19 pneumonia.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico por imagem , Radiografia Torácica/métodos , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Adulto , Infecções por Coronavirus/diagnóstico , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Medição de Risco , Amostragem , Sensibilidade e Especificidade , Síndrome Respiratória Aguda Grave/diagnóstico
9.
J Cancer Res Ther ; 16(1): 60-65, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32362610

RESUMO

Objective: The objective of this study is to review the multidetector computed tomography (MDCT) findings of synchronous lymphoma and other solid malignancies. Patients and Methods: This retrospective study included 18 patients confirmed with diagnosis of lymphoma and other solid malignancies. They were 8 women and 10 men (mean age, 62.5 year; range, 44-73 years). CT scanning was performed on one of the two systems: 64 MDCT in 11 patients and 6 MDCT in 7 patients. All 36 malignancies were underwent pathological evaluation. Results: All cases were confirmed pathologically. Lymphomas were Hodgkin disease ( n = 5 patients) and non-Hodgkin lymphoma ( n = 13 patients). Hepatocellular carcinoma was detected in five patients. Bronchogenic carcinoma was detected in two patients. Renal cell carcinoma was detected in two patients. Breast carcinoma was detected in two patients. Prostatic carcinoma was detected in two patients. Gastric carcinoma was detected in two patients. Endometrial carcinoma was detected in one patient. Colonic carcinoma was detected in one patient. Thyroid carcinoma was detected in one patient. Conclusions: MDCT scanning is accurately imaging modality for the evaluation of synchronous lymphoma and other solid malignancies. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon, and may lead to a new treatment strategy for synchronous lymphoma and other solid malignancies.


Assuntos
Linfoma/patologia , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Primárias Múltiplas/patologia , Neoplasias/patologia , Adulto , Idoso , Feminino , Humanos , Achados Incidentais , Linfoma/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Estudos Retrospectivos
10.
Radiol Med ; 125(12): 1249-1259, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32367320

RESUMO

BACKGROUND: As one of the most frequent risk factors for cardiovascular disease, type 2 diabetes mellitus (T2DM) is one of the largest causes of death. However, an acute cardiac presentation is not uncommon in diabetic patients, and the current investigative approach remains often inadequate. The aim of our study was to retrospectively stratify the risk of asymptomatic T2DM patients using low-dose 640-slice coronary computed tomography angiography (CCTA). MATERIALS AND METHODS: CCTA examinations of 62 patients (mean age, 65 years) with previous diagnosis of type 2 diabetes and without cardiac symptoms were analyzed. Image acquisition was performed using a 640-slice CT. Per-patient, per-vessel and per-plaque analyses were performed. Stratification risk was evaluated according to the ESC guidelines. The patients were followed up after 2.21 ± 0.56 years from CCTA examination. RESULTS: Coronary artery disease (CAD) was found in 58 patients (93.55%) presenting 290 plaques. Analysis of all samples showed severe-to-occlusive atherosclerosis in 24 patients (38.7% of cases). However, over the degree of stenosis, 23 patients were evaluated at high risk considering the extension of CAD. Good agreement was shown by the correlation of CAD extension/risk estimation and MACE incidence, according to a Kaplan-Meier survival analysis (p value = 0.001), with a 7.25-fold increased risk (HR 7.25 CI 2.13-24.7; p value = 0.002). CONCLUSION: Our study confirms the high capability of CCTA to properly stratify the CV risk of asymptomatic T2DM patients. Its use could be recommended if we consider how current investigative strategies to correctly assess these patients often seem inadequate.


Assuntos
Doenças Assintomáticas , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Diabetes Mellitus Tipo 2/complicações , Placa Aterosclerótica/diagnóstico por imagem , Idoso , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/etiologia , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Placa Aterosclerótica/etiologia , Doses de Radiação , Estudos Retrospectivos , Medição de Risco
11.
Radiol Med ; 125(12): 1301-1310, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32415474

RESUMO

OBJECTIVES: To evaluate thyroid, arytenoid, and cricoid cartilage invasion on computed tomography (CT) imaging in patients undergoing total laryngectomy for both primary and recurrent laryngeal carcinoma. Secondary endpoint was to compare laryngeal cartilage invasion between primary and recurrent tumours. METHODS: Pre-treatment CT of 40 patients who had undergone total laryngectomy was retrospectively evaluated and compared with histology. Focal erosions of thyroid cartilage were accounted for neoplastic invasion of the inner cortex. Full-thickness thyroid cartilage invasion was defined as a tumour-like tissue replacing thyroid cartilage or extended in extra-laryngeal soft tissues. Sclerosis and erosion of arytenoid and cricoid cartilages were assessed as signs of neoplastic invasion. RESULTS: CT erosion showed perfect agreement for thyroid inner cortex and cricoid cartilage invasion and almost perfect agreement (87%) for arytenoid cartilage invasion. For tumours in contact with thyroid cartilages, the absence of CT erosion underestimated inner cortex infiltration. CT showed perfect agreement in predicting full-thickness thyroid cartilage invasion only in the case of extra-laryngeal neoplastic extension. Arytenoid sclerosis showed poor correlation with neoplastic invasion. For primary tumours, CT demonstrated good (inner cortex 75%; full-thickness 85%), substantial (67.5%), and perfect (100%) accuracy in thyroid, arytenoid, and cricoid cartilage invasion, respectively. No CT differences were observed between primary and recurrent laryngeal tumours. CONCLUSION: Tumour-like tissue extension in the extra-laryngeal soft tissues was accurate in predicting thyroid cartilage full-thickness invasion. Erosions of arytenoid, cricoid, and thyroid cartilages' inner cortex on CT were highly indicative of neoplastic infiltration. No CT difference in cartilage infiltration between primary and recurrent tumours was observed.


Assuntos
Cartilagens Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/patologia , Meios de Contraste/administração & dosagem , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/patologia , Feminino , Humanos , Iohexol/administração & dosagem , Iohexol/análogos & derivados , Cartilagens Laríngeas/patologia , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/patologia
12.
Radiol Med ; 125(12): 1225-1232, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32415477

RESUMO

PURPOSE: To determine the intra- and extralesional factors that predict sclerotic degeneration of hepatic hemangiomas in the cirrhotic liver on long-term follow-up computed tomography (CT) examinations. MATERIALS AND METHODS: Fifty-seven hepatic hemangiomas (> 5 mm in diameter) in 41 cirrhotic patients, recruited over a 5-year period (January 2005-December 2009), were subjected to CT to determine which factors predict sclerotic contraction or degeneration in hemangiomas. Prior and follow-up CT examinations (from 2000 to 2018) were included to observe time-related changes. The patients' gender, age, cause of cirrhosis, progression of background liver cirrhosis, lesion size/location/contrast enhancement pattern, and serum aspartate transaminase to platelet ratio index were correlated with sclerotic changes of each lesion. RESULTS: According to the dynamic CT features, 36 of 57 (63%) hemangiomas were determined to have sclerotic changes during the follow-up period (1.1-14.4 years, median: 7.8 years), including 28 lesions (49%) reduced by ≥ 20% in diameter. In univariate analysis, age (p = 0.047) and morphological progression of background cirrhosis (p = 0.013) were significantly related to sclerotic change of hemangiomas. In the logistic regression analysis, only morphological progression of background liver cirrhosis independently predicted sclerotic change (odds ratio: 4.88, p = 0.007). With the exception of exophytic location free from size reduction (p = 0.023 in multivariate analysis), no other analyzed factors were significantly correlated with sclerotic changes. CONCLUSION: Overall, sclerotic changes of hepatic cavernous hemangioma followed the morphological progression of background liver cirrhosis, while exophytic lesions tended to be free of size reduction.


Assuntos
Meios de Contraste , Hemangioma Cavernoso/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Análise de Variância , Análise de Dados , Progressão da Doença , Feminino , Seguimentos , Hemangioma Cavernoso/patologia , Humanos , Fígado/patologia , Cirrose Hepática/patologia , Neoplasias Hepáticas/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Intensificação de Imagem Radiográfica , Esclerose , Fatores de Tempo , Carga Tumoral
13.
AJR Am J Roentgenol ; 215(1): 39-49, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32319796

RESUMO

OBJECTIVE. The purpose of this study was to determine the prevalence and demographic distribution of colonic diverticulitis (CD) and alternative diagnoses (AD), as well as the diagnostic accuracy of MDCT in patients with suspected CD. MATERIALS AND METHODS. This study retrospectively included 1069 patients (560 women) undergoing MDCT for the evaluation of suspected CD. The prevalence of CD and AD was determined and the diagnostic accuracy of MDCT calculated. The final clinical diagnosis derived from the discharge report served as the standard of reference. Prevalence of diagnoses by age, sex, and admission status were compared using Cochran-Armitage, chi-square, and Fisher exact tests. RESULTS. Prevalence of CD was 52.5% (561/1069) and of AD was 39.9% (427/1069). In the remaining 7.6% (81/1069) no final clinical diagnosis was established. The most frequent AD were appendicitis (12.6%, 54/427), infectious colitis (10.5%, 45/427), infectious gastroenteritis (8.2%, 35/427), urolithiasis (6.1%, 26/427), and pyelonephritis (4.9%, 21/427). The prevalence of diverticulitis and AD varied statistically significantly according to both age (p < 0.001) and admission status (p < 0.001). Also, the prevalence of the 10 most frequent specific AD varied statistically significantly according to sex (p = 0.022). CT had a sensitivity and specificity of 99.1% and 99.8% for diagnosing CD and 92.7% and 98.8% for AD, respectively. CONCLUSION. In about 40% of patients with suspected diverticulitis a broad spectrum of AD is causative for symptoms. MDCT provides high diagnostic accuracy in the diagnosis of diverticulitis and AD. The prevalence of diagnoses is related to admission status and demographic data; in particular age-related AD have to be considered in patients with clinically suspected diverticulitis.


Assuntos
Doença Diverticular do Colo/diagnóstico por imagem , Doença Diverticular do Colo/epidemiologia , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Feminino , Alemanha/epidemiologia , Humanos , Iopamidol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Updates Surg ; 72(2): 413-421, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32323164

RESUMO

Non-invasive diagnosis of hepatocellular carcinoma (HCC) in cirrhotic patients requires demonstration of wash-in and wash-out on contrast-enhanced imaging. Recent studies have reported misclassification of mass-forming intrahepatic cholangiocarcinoma (MFCCC) as HCC. We aimed to analyze the contrast enhancement patterns of MFCCC, focusing especially on lesions mimicking HCC. We retrospectively evaluated all consecutive patients with MFCCC who underwent surgery between 2007 and 2017. Patients with mixed HCC-MFCCC were excluded. Two expert radiologists reviewed preoperative CT and MRI. Full-nodule hyperenhancement in the arterial phase in conjunction with hypoenhancement in the portal/late phase was classified as an "HCC-like pattern". Imaging of MFCCCs with an HCC-like pattern was reviewed by an additional radiologist blinded to clinical data. Ninety-two patients were analyzed. All patients were investigated with multiphase CT and 85 with MRI. Twelve tumors (13%) showed full-nodule arterial hyperenhancement. Of these, four were hypoenhancing in the portal/late phase. Overall, 4/92 (4%) MFCCCs (4/45 in patients with cirrhosis/hepatitis, 9%) showed an HCC-like pattern accounting for misclassification as HCC on imaging review. HCC-like MFCCCs accounted for 9% of single tumors ≤ 50 mm. All HCC-like MFCCCs occurred in patients with cirrhosis or hepatitis, whereas only 47% of non-HCC-like MFCCCs did so (p = 0.053). After a median follow-up of 29 months, all patients with HCC-like MFCCCs are alive and disease free (median 64 months). In conclusion, MFCCC was misdiagnosed as typical HCC in 4% of all cases and in 9% of patients with single tumors ≤ 50 mm or with cirrhosis/hepatitis. The risk of misdiagnosis should be considered prior to treatment planning.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico , Colangiocarcinoma/diagnóstico por imagem , Aumento da Imagem/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada Multidetectores/métodos , Idoso , Meios de Contraste , Diagnóstico Diferencial , Erros de Diagnóstico/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Vet Radiol Ultrasound ; 61(4): 444-452, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32329949

RESUMO

Chiari-like malformation (CM) and syringomyelia (SM) are common illnesses that can cause debilitating neuropathic pain in Cavalier King Charles spaniels (CKCS). The current imaging modality to screen CKCS for CM/SM is MRI of the brain and cervical spine. Magnetic resonance imaging provides good soft tissue detail and contrast of the cerebellum and cervical spinal cord. Computed tomography (CT) is another cross-sectional imaging technique that facilitates brain and neck evaluation; however, soft tissue resolution does not match that of MRI. Computed tomography benefits include identification of concurrent craniocervical junction anomalies (atlantooccipital overlap) and shorter imaging/anesthesia times with the ability to use only sedation. The aim of this retrospective, method comparison study is to assess the utility of multidetector CT for screening CM and SM in CKCS as compared to high-field MRI. Three groups of observers with different levels of experience graded CM and SM based on the British Veterinary Association/Kennel Club CM/SM classification criteria. Thirty CKCS underwent multidetector CT and 3 Tesla MRI studies. Computed tomography and MRI studies were reviewed at different timepoints to minimize bias. Computed tomography has lower Cohen's Kappa agreement for each observer group compared to MRI. The intraclass correlation coefficient averaging CM and SM for all groups was excellent using MRI, while CT was poor for SM and moderate for cerebellar herniation. Greater observer experience resulted in a higher agreement for CT and MRI. Magnetic resonance imaging should remain the standard for screening of CM and SM as CT can result in misclassification and greater disagreement.


Assuntos
Malformação de Arnold-Chiari/veterinária , Doenças do Cão/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Tomografia Computadorizada Multidetectores/veterinária , Siringomielia/veterinária , Animais , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/patologia , Cerebelo/patologia , Cães , Encefalocele/patologia , Encefalocele/veterinária , Feminino , Imagem por Ressonância Magnética/métodos , Masculino , Tomografia Computadorizada Multidetectores/métodos , Estudos Retrospectivos , Siringomielia/diagnóstico por imagem , Siringomielia/patologia
16.
Br J Radiol ; 93(1111): 20190827, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32242741

RESUMO

OBJECTIVE: To assess the accuracy of a combination of CT texture analysis (CTTA) and nodal axial ratio to detect metastatic lymph nodes (LNs) in esophageal squamous cell carcinoma (ESCC). METHODS: The contrast-enhanced chest CT images of 78 LNs (40 metastasis, 38 benign) from 38 patients with ESCC were retrospectively analyzed. Nodal axial ratios (short-axis/long-axis diameter) were calculated. CCTA parameters (kurtosis, entropy, skewness) were extracted using commercial software (TexRAD) with fine, medium, and coarse spatial filters. Combinations of significant texture features and nodal axial ratios were entered as predictors in logistic regression models to differentiate metastatic from benign LNs, and the performance of the logistic regression models was analyzed using the area under the receiver operating characteristic curve (AUROC). RESULTS: The mean axial ratio of metastatic LNs was significantly higher than that of benign LNs (0.81 ± 0.2 vs 0.71 ± 0.1, p = 0.005; sensitivity 82.5%, specificity 47.4%); namely, significantly more round than benign. The mean values of the entropy (all filters) and kurtosis (fine and medium) of metastatic LNs were significantly higher than those of benign LNs (all, p < 0.05). Medium entropy showed the best performance in the AUROC analysis with 0.802 (p < 0.001; sensitivity 85.0%, specificity 63.2%). A binary logistic regression analysis combining the nodal axial ratio, fine entropy, and fine kurtosis identified metastatic LNs with 87.5% sensitivity and 65.8% specificity (AUROC = 0.855, p < 0.001). CONCLUSION: The combination of CTTA features and the axial ratio of LNs has the potential to differentiate metastatic from benign LNs and improves the sensitivity for detection of LN metastases in ESCC. ADVANCES IN KNOWLEDGE: The combination of CTTA and nodal axial ratio has improved CT sensitivity (up to 87.5%) for the diagnosis of metastatic LNs in esophageal cancer.


Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Idoso , Área Sob a Curva , Entropia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/secundário , Carcinoma de Células Escamosas do Esôfago/cirurgia , Feminino , Humanos , Modelos Logísticos , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Software , Fatores de Tempo
17.
Medicine (Baltimore) ; 99(16): e19815, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312001

RESUMO

RATIONALE: Meandering pulmonary vein is a rare congenital pulmonary vascular anomaly. It presents unilateral single pulmonary vein that takes a circuitous route in the lung and drains normally into the left atrium. Most cases of meandering pulmonary vein have been reported to be right-sided. A few of them coincided with features of scimitar syndrome. PATIENT CONCERNS: A 71-year-old woman and a 20-year-old man presented with incidentally found abnormal findings on chest radiographs. DIAGNOSIS: Through multi-detector chest computed tomography, the 71-year-old woman was diagnosed as left-sided meandering pulmonary vein without any other anomalies while the 20-year-old man was diagnosed as having right-sided meandering pulmonary vein with features of scimitar syndrome. INTERVENTIONS: Specific intervention was not performed for either patient. OUTCOMES: These patients were reassured and discharged. They are doing well without any respiratory symptoms. LESSONS: Meandering pulmonary veins can occur on the left side and coincide with features of scimitar syndrome. Multi-detector computed tomography with 3D reconstruction allows clear depiction of vascular connections and associated anomalies, obviating the need for invasive procedures.


Assuntos
Pulmão/irrigação sanguínea , Veias Pulmonares/anormalidades , Síndrome de Cimitarra/diagnóstico por imagem , Idoso , Feminino , Humanos , Achados Incidentais , Pulmão/patologia , Masculino , Tomografia Computadorizada Multidetectores/métodos , Alta do Paciente/normas , Veias Pulmonares/diagnóstico por imagem , Radiografia Torácica/métodos , Adulto Jovem
18.
Radiología (Madr., Ed. impr.) ; 62(2): 148-159, mar.-abr. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194212

RESUMO

OBJETIVOS: Conocer la anatomía de las venas pulmonares (VVPP) mediante tomografía computarizada multidetector (TCMD) en pacientes con fibrilación auricular (FA) antes de la ablación. MATERIAL Y MÉTODOS: Realizamos TCMD a 89 pacientes con FA analizando número, variantes y venas accesorias pulmonares, diámetro y forma ostia, distancia a la primera bifurcación y trombo en la orejuela izquierda. RESULTADOS: El patrón venoso pulmonar más frecuente fue 4 VVPP (dos derechas y dos izquierdas) en 49 pacientes (55,1%). Las VVPP superiores presentaron mayor diámetro ostial que las inferiores [vena pulmonar superior derecha (VPSD)> vena pulmonar inferior derecha (VPID); p = 0,001 y vena pulmonar superior izquierda (VPSI)> vena pulmonar inferior izquierda (VPII); p <0,001]. El diámetro ostial de las VVPP derechas era mayor que el de las izquierdas (VPSD> VPSI; p <0,001 y VPID> VPII; p <0,001). El ostium más circular lo presentó la VPID (ratio: 0,885) respecto a la VPII (p <0,001) y a la VPSI (p <0,001). La distancia a la primera bifurcación ha sido mayor en las venas superiores (VPSD> VPID; p = 0,008 y VPSI> VPII; p = 0,038). La distancia a la primera bifurcación fue mayor en las VVPP izquierdas (VPSI> VPSD; p <0,001 y VPII> VPID; p <0,001). Otros hallazgos fueron: divertículos (30), apéndices auriculares accesorios (5), aneurismas septales (8), bolsas septales (6) y 1 trombo en la orejuela izquierda. CONCLUSIÓN: La TCMD antes de la ablación demuestra la anatomía de la aurícula izquierda (AI) y de las VVPP con diferencias significativas entre los diámetros y morfología de los ostia venosos


OBJECTIVE: To know the anatomy of the pulmonary veins (PVs) by multidetector computed tomography (MDCT) in patients with atrial fibrillation (AF) prior to ablation. MATERIALS AND METHODS: MDCT was performed in 89 patients with AF, analyzing the number of PVs, accessory variants and veins, diameter and ostial shape, distance to the first bifurcation and thrombus in the left atrial appendage. RESULTS: The most frequent venous pattern was 4 PVs (two right and two left) in 49 patients (55.1%). The superior veins had a statistically significant greater mean ostial diameter than the inferior veins (Right Superior Pulmonary Vein (RSPV)> Right Inferior Pulmonary Vein (RIPV); p = 0.001 and Left Superior Pulmonary Vein (LSPV)> Left Inferior Pulmonary Vein (LIPV); p < 0.001). The right pulmonary veins ostial diameters were significantly larger than the left pulmonary veins ostial diameters (RSPV> LSPV; p < 0.001 and RIPV> LIPV; p < 0.001). The most circular ostium was presented by the VPID (ratio: 0.885) compared to the LIPV (p<00.1) and LSPV (p < 0.001). The superior veins had a statistically significant greater mean distance to first bifurcation than the inferior veins (RSPV> RIPV; p = 0.008 and LSPV> LIPV; p = 0.038). Mean distance to first bifurcation has been greater in left PVs respect to the right PVs (LSPV> RSPV; p < 0.001and LIPV> RIPV; p < 0.001). Other findings found in AI: diverticula (30), accessory auricular appendages (5), septal aneurysms (8), septal bags (6) and 1 thrombus in the left atrial appendage. CONCLUSION: MDCT prior to ablation demonstrates the anatomy of the left atrium (LA) and pulmonary veins with significant differences between the diameters and morphology of the venous ostia


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tomografia Computadorizada Multidetectores/métodos , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Veias Pulmonares/diagnóstico por imagem , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Apêndice Atrial/diagnóstico por imagem
19.
Rev. argent. radiol ; 84(2): 61-67, abr. 2020. tab, graf, il.
Artigo em Espanhol | LILACS | ID: biblio-1125857

RESUMO

Resumen La inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad. El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.


Abstract Aortic inflammation (aortitis) is a rare pathology, with infectious (fungal pseudoaneurysm, syphilis) and noninfectious etiology (arteritis, idiopathic aortitis, ankylosing spondylitis, among others), it has a difficult clinical diagnosis and a variable prognosis. The use of various imaging methods such as multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and ultrasound (US) facilitate the identification, monitoring and treatment of this entity. The following paper aims to perform a literature review and update about aortitis and its various etiologies, exemplifying cases of our institution.


Assuntos
Aortite/etiologia , Aortite/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Arterite de Células Gigantes/diagnóstico por imagem , Angiografia/métodos , Arterite de Takayasu/etiologia , Arterite de Takayasu/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos
20.
Can Assoc Radiol J ; 71(3): 371-387, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32157893

RESUMO

Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.


Assuntos
Abdome Agudo/diagnóstico por imagem , Traumatismos Abdominais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Ultrassonografia/métodos , Meios de Contraste , Humanos , Interpretação de Imagem Assistida por Computador , Sistemas Automatizados de Assistência Junto ao Leito
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