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1.
Isr Med Assoc J ; 22(1): 53-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927807

RESUMO

BACKGROUND: Primary retroperitoneal neoplasms (PRN) arise from diverse retroperitoneal tissues. Soft tissue sarcomas (STS) comprise the majority and are well studied. Other non-sarcomatous PRN are very rare and less familiar. OBJECTIVES: To evaluate the clinicopathologic and radiologic features of non-sarcomatous PRN, as well as the outcome of complete tumor resection (TR). METHODS: Retrospective data were collected on consecutive patients (June 2006 to January 2015) who underwent resection of retroperitoneal lesions at our department. Final pathology of non-sarcomatous PRN was included. RESULTS: The study population included 36 patients (26% with PRN). PRN were neurogenic (17%), fat-containing (3%), and cystic (6%). The preoperative diagnosis was correct in only 28%. All patients underwent TR via laparotomy (72%) or laparoscopy (28%), for mean operative time of 120 ± 46 minutes. En bloc organ resection was performed in 11%. Complete TR was achieved in 97%. Intra-operative spillage occurred in 8%. Intra-operative, 90-day postoperative complications, and mortality rates were 11%, 36%, and 0%, respectively. The mean length of stay was 6.5 ± 5.5 days. The median overall survival was 53 ± 4.9 months. CONCLUSIONS: Familiarity with radiologic characteristics of PRN is important for appropriate management. Counter to STS, other PRN are mostly benign and have an indolent course. Radical surgery is not required, as complete TR confers good prognosis. Expectant management is reserved for small, asymptomatic, benign neoplasms.


Assuntos
Neoplasias Retroperitoneais/diagnóstico , Idoso , Feminino , Ganglioneuroma/diagnóstico , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/patologia , Ganglioneuroma/cirurgia , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagem , Lipoma/patologia , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neurilemoma/cirurgia , Neurofibroma/diagnóstico , Neurofibroma/diagnóstico por imagem , Neurofibroma/patologia , Neurofibroma/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/diagnóstico por imagem , Paraganglioma/patologia , Paraganglioma/cirurgia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
Anticancer Res ; 40(1): 459-464, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892601

RESUMO

BACKGROUND/AIM: This study compared the dose distributions of carbon ion radiotherapy (C-ion RT) and intensity-modulated radiotherapy (IMRT) in patients with locally advanced hepatocellular carcinoma (LAHCC). PATIENTS AND METHODS: A retrospective analysis was conducted in 10 consecutive patients with LAHCC who had undergone C-ion RT. The dose-volume histogram parameters of clinical plans using C-ion RT at 60 Gy and simulated plans using IMRT at 60 Gy and 50 Gy were compared. We measured the percentage of the normal liver volume that received at least 5 Gy (V5), 10 Gy (V10), 20 Gy (V20), 30 Gy (V30), 40 Gy (V40), and 50 Gy (V50). RESULTS: The V5, V10, V20, and the mean liver dose were significantly lower in patients who received 60 Gy of C-ion RT than in those who received 50 or 60 Gy of IMRT. CONCLUSION: C-ion RT exhibits a better liver dose distribution than IMRT in patients with LAHCC.


Assuntos
Carcinoma Hepatocelular/radioterapia , Radioterapia com Íons Pesados , Neoplasias Hepáticas/radioterapia , Radioterapia de Intensidade Modulada , Carcinoma Hepatocelular/diagnóstico por imagem , Relação Dose-Resposta à Radiação , Humanos , Fígado/patologia , Fígado/efeitos da radiação , Neoplasias Hepáticas/diagnóstico por imagem , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Carga Tumoral
3.
Medicine (Baltimore) ; 99(1): e18617, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895818

RESUMO

Development of patient-specific CT imaging phantoms with randomly incorporated lesions of various shapes and sizes for calibrating image intensity and validating quantitative measurement software is very challenging. In this investigation, a physical phantom that accurately represents a patient's specific anatomy and the intensity of lung CT images at the voxel level will be fabricated using fused deposition modeling (FDM) 3D printing. Segmentation and modeling of a patient's CT data were performed by an expert and the results were confirmed by a thoracic radiologist with more than 20 years of experience. This facilitated the extraction of the details of the patient's anatomy; various kinds of nodules with different shapes and sizes were randomly added to the modeled lung for evaluating the size-accuracy of the quantification software. To achieve these Hounsfield Units (HU) ranges for the corresponding voxels in acquired CT scans, the infill ratios of FDM 3D printing were controlled. Based on CT scans of the 3D printed phantoms, the measured HU for normal pulmonary parenchyma, ground glass opacity (GGO), and solid nodules were determined to be within target HU ranges. The accuracy of the mean absolute difference and the mean relative difference of nodules were less than 0.55 ±â€Š0.30 mm and 3.72 ±â€Š1.64% (mean difference ±â€Š95 CI), respectively. Patient-specific CT imaging phantoms were designed and manufactured using an FDM printer, which could be applied for the precise calibration of CT intensity and the validation of image quantification software.


Assuntos
Pulmão/diagnóstico por imagem , Imagens de Fantasmas , Impressão Tridimensional , Tomografia Computadorizada por Raios X/instrumentação , Humanos
4.
Medicine (Baltimore) ; 99(1): e18655, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895830

RESUMO

RATIONALE: Developmental dysplasia of the hip (DDH) has an incidence of 5 per 1000 newborns and its management depends on various factors. We present a rare case of DDH with soft tissue obliteration and a bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty. PATIENT CONCERNS: A 20-month-old girl presented to our clinic with right hip stiffness after undergoing open reduction and acetabuloplasty at another hospital. DIAGNOSES: The diagnosis of DDH was made using a computed tomography scan that revealed a right hip dislocation with soft tissue obliteration and a bony prominence in the center of the acetabulum. INTERVENTIONS: We used a novel technique for treating the rare presentation of complicated DDH with massive soft tissue obliteration and bony prominence in the center of the acetabulum after failed open reduction and acetabuloplasty. The right hip was surgically explored. The acetabulum was deepened and resurfaced. Bone cement was applied over the acetabulum to prevent future ankylosis. OUTCOMES: At the follow-up 7 years after the last surgery, the patient had regained full range of motion and a properly reduced right hip with optimal acetabular coverage on radiographs. LESSONS: Care must be taken in any patient with DDH who presents with hip redislocation after open reduction. If deepening and resurfacing of the acetabulum are required, bone cement could be used as a temporary spacer for 8 weeks; this was key in treating our patient.


Assuntos
Acetábulo/lesões , Luxação Congênita de Quadril/cirurgia , Acetábulo/diagnóstico por imagem , Cimentos para Ossos , Feminino , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Recidiva , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 99(1): e18363, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895770

RESUMO

INTRODUCTION: Duplication of the gallbladder (GB) is a rare congenital abnormality occurring in 1 in 4000 to 5000 births. Three types have been reported: type I (split primordial GB), type II (2 separate GBs with their own cystic ducts), and type III (triple GBs drained by 1 to 3 separate cystic ducts). Patients with a duplicated GB are usually asymptomatic and are sometimes not diagnosed on preoperative imaging, which might increase the difficulty and risk of cholecystectomy. The key to successful treatment is total removal of the duplicated GB to avoid the recurrence of disease. Intraoperative cholangiography is recommended for identifying and resecting duplicated GBs. The final diagnosis depends on the histopathology. PATIENT CONCERNS: A 62-year-old woman had recurrent upper abdominal pain and nausea for 1 year, with no fever, jaundice, or other symptoms. An ultrasound of the abdomen indicated polyps in the GB. Computed tomography (CT) revealed moderate dense structures attached to the wall of the GB and an unusual 47 × 21 mm elliptical structure with an extra tubule located above the main GB. DIAGNOSIS: A diagnosis of duplicated GB was made based on the histopathology. INTERVENTIONS: The patient underwent a laparoscopic cholecystectomy with total removal of the duplicated GB. OUTCOMES: The patient's postoperative course was uneventful and she was discharged from the hospital on the second postoperative day. She had no upper abdominal pain at the 6-month follow-up. CONCLUSION: Duplicated gallbladder is a rare congenital biliary anatomy, which is usually asymptomatic and sometimes cannot be diagnosed on preoperative imaging. With gallbladder disease, the duplicated GBs should be removed totally; a laparoscopic approach should be attempted first and cholangiography is recommended to aid in identifying and resecting the duplicated GBs. The final diagnosis depends on the histopathology. There is still insufficient evidence on the need to remove duplicated GBs found incidentally.


Assuntos
Colecistectomia Laparoscópica/métodos , Vesícula Biliar/anormalidades , Vesícula Biliar/cirurgia , Dor Abdominal/etiologia , Colangiografia , Feminino , Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Zhonghua Er Ke Za Zhi ; 58(1): 25-29, 2020 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-31905472

RESUMO

Objective: To improve the diagnosis and therapy of childhood pulmonary thromboembolism (PTE) by analyzing the clinical features of this rare condition. Methods: A total of 8 pediatric patients (4 males, 4 females) with PTE diagnosed in the Children's Hospital of Zhejiang University School of Medicine from March, 2014 to March, 2019 were enrolled. The clinical manifestation, laboratory results, imaging findings, diagnosis and treatment were summarized. Results: Among these 8 cases, aged from 9 hours to 14 years and 10 months. Fever was found in 4 cases, cough aggravation in 4, short of breath in 3, chest pain in 2, abdominal and back pain in one, hemoptysis in 2, cyanosis in 1, and edema of lower extremities in 2. Physical examination found decreased breath sound in 2 cases, phlegm rale in 3, and pleural friction rub in one. Pleural effusion was found in 5 cases by ultrasound. Plasma D-dimer increased in 6 cases (0.66-9.96 mg/L) and hypersensitive C-reactive protein elevated in 5 cases (10.78-78.00 mg/L). Chest enhanced CT showed pulmonary artery or venous filling defects, including pulmonary artery embolism in 7 cases and pulmonary vein embolism in one. The primary disease of these patients included Mycoplasma Pneumoniae pneumonia in 4 cases, nephritis in 2 and postoperative congenital heart disease in 2. Apart from one case who withdrew the treatment and was discharged, the other 7 patients received anticoagulant treatment had good outcome. Conclusions: For children with Mycoplasma pneumoniae pneumonia, immune disorders, long-term hormone therapy, cardiovascular invasive operation or other high-risk factors, PTE should be considered when fever, cough aggravation, short of breath, chest and back pain with pleural effusion are present. Chest enhanced CT scan should be performed as soon as possible, and anticoagulation should be started once the diagnosis is confirmed.


Assuntos
Pneumonia por Mycoplasma/complicações , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Adolescente , Dor no Peito/diagnóstico por imagem , Criança , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Masculino , Derrame Pleural , Pneumonia por Mycoplasma/diagnóstico , Embolia Pulmonar/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Anticancer Res ; 40(1): 271-280, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892576

RESUMO

BACKGROUND/AIM: To investigate whether a radiomic machine learning (ML) approach employing texture-analysis (TA) features extracted from primary tumor lesions (PTLs) is able to predict tumor grade (TG) and nodal status (NS) in patients with oropharyngeal (OP) and oral cavity (OC) squamous-cell carcinoma (SCC). PATIENTS AND METHODS: Contrast-enhanced CT images of 40 patients with OP and OC SCC were post-processed to extract TA features from PTLs. A feature selection method and different ML algorithms were applied to find the most accurate subset of features to predict TG and NS. RESULTS: For the prediction of TG, the best accuracy (92.9%) was achieved by Naïve Bayes (NB), bagging of NB and K Nearest Neighbor (KNN). For the prediction of NS, J48, NB, bagging of NB and boosting of J48 overcame the accuracy of 90%. CONCLUSION: A radiomic ML approach applied to PTLs is able to predict TG and NS in patients with OC and OP SCC.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Linfonodos/patologia , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/patologia , Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/patologia , Idoso , Algoritmos , Humanos , Aprendizado de Máquina , Gradação de Tumores , Tomografia Computadorizada por Raios X
8.
Adv Exp Med Biol ; 1232: 55-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893394

RESUMO

The aim was to investigate the feasibility of simultaneous comparison of cerebral circulation in major vessels and microvasculature in patients suffering traumatic brain injury (TBI) with or without intracranial hematomas (IH). METHODS: 170 patients were divided into two groups: Group 1 - diffuse TBI (75 patients); and Group 2 - TBI with IH (95 patients: 18 epidural, 65 subdural and 12 multiple). Perfusion computed tomography (PCT) for assessment of volumetric cerebral blood flow (CBF) was done 2-15 days after admission to hospital. Simultaneous assessment of cerebral blood flow velocity (CBFV) in both middle cerebral arteries was done by transcranial Doppler. RESULTS: In patients with diffuse TBI, CBF had statistically valid correlations with CBFV (r = 0.28, p = 0.0149 on the left side; r = 0.382, p = 0.00075 on the right side). In patients with TBI and IH, the analysis did not reveal any reliable correlations between the CBFV and CBF velocity in the temporal lobes, either on the side of the removed IH or on the opposite side. CONCLUSION: The greatest linear correlation was noted in patients with diffuse TBI without the development of a coarse shift of the midline structures and dislocation syndrome. This correlation decreases with the increase in injury severity and development of secondary complications in the acute period, which probably reflects impairment of the coupling of oxygen consumption by brain tissue and cerebral microcirculation.


Assuntos
Lesões Encefálicas Traumáticas , Circulação Cerebrovascular , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana , Velocidade do Fluxo Sanguíneo , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X/normas , Ultrassonografia Doppler Transcraniana/normas
9.
Br J Radiol ; 93(1105): 20190677, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31593485

RESUMO

The retrotympanic anatomy is complex and variable but has received little attention in the radiological literature. With advances in CT technology and the application of cone beam CT to temporal bone imaging, there is now a detailed depiction of the retrotympanic bony structures.With the increasing use of endoscopes in middle ear surgery, it is important for the radiologist to appreciate the nomenclature of the retrotympanic compartments in order to aid communication with the surgeon. For instance, in the context of cholesteatoma, clear imaging descriptions of retrotympanic variability and pathological involvement are valuable in pre-operative planning.The endoscopic anatomy has recently been described and the variants classified. The retrotympanum is divided into medial and lateral compartments with multiple described potential sinuses separated by bony crests.This pictorial review will describe the complex anatomy and variants of the retrotympanum. We will describe optimum reformatting techniques to demonstrate the structures of the retrotympanum and illustrate the associated anatomical landmarks and variants with CT. The implications of anatomical variants with regards to otologic surgery will be discussed.


Assuntos
Orelha Média/anatomia & histologia , Orelha Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Membrana Timpânica/anatomia & histologia , Membrana Timpânica/diagnóstico por imagem , Pontos de Referência Anatômicos , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia , Tomografia Computadorizada de Feixe Cônico , Humanos , Otoscopia
10.
Br J Radiol ; 93(1105): 20190596, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31625759

RESUMO

OBJECTIVE: This study aimed to compare the plan quality of non-coplanar partial arc (NPA) volumetric modulated arc therapy (VMAT) to that of coplanar partial arc (CPA) VMAT for stereotactic ablative radiotherapy (SABR) for lung cancer. METHODS: A total of 20 patients treated for lung cancer with the SABR VMAT technique and whose lung tumors were close to the heart were retrospectively selected for this study. For the CPA VMAT, three coplanar half arcs were used while two coplanar half arcs and one noncoplanar arc rotating 315°-45° with couch rotations of 315° ± 5° were used for the NPA VMAT. For each patient, identical CT image sets and identical structures were used for both the CPA and NPA VMAT plans. Dose-volumetric parameters of each plan were analyzed. RESULTS: For the planning target volume and both lungs, no statistically significant differences between the CPA and NPA VMAT plans were observed in general. For the heart, average values of D0.1cc of the CPA and NPA VMAT plans were 29.42 ± 13.37 and 21.71 ± 9.20 Gy, respectively (p < 0.001). For whole body, the mean dose and the gradient index of the CPA VMAT plans were 1.2 ± 0.5 Gy and 4.356 ± 0.608 while those of the NPA VMAT plans were 1.1 ± 0.5 Gy and 4.111 ± 0.480, respectively (both with p < 0.001). CONCLUSION: The NPA VMAT proposed in this study showed more favorable plan quality than the CPA VMAT plans for lung SABR with tumors located close to the heart. ADVANCES IN KNOWLEDGE: For lung SABR, NPA VMAT can reduce doses to the heart as well as whole-body irradiation.


Assuntos
Coração/efeitos da radiação , Neoplasias Pulmonares/radioterapia , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Algoritmos , Anisotropia , Fracionamento da Dose de Radiação , Humanos , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Br J Radiol ; 93(1105): 20190719, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670571

RESUMO

OBJECTIVE: To compare therapeutic outcomes between hepatic resection (HR) and radiofrequency ablation (RFA) for small hepatic masses diagnosed as hepatocellular carcinoma (HCC) on pre-treatment imaging study. METHODS: Our institutional review board approved this retrospective study, and informed consent was waived. Patients with a single (≤3 cm) mass diagnosed as HCC on pre-treatment imaging study between January 2008 and December 2009 who underwent HR (n = 145) or RFA (n = 178) were included. Recurrence-free survival (RFS) and overall survival (OS) were assessed. In the HR group, the false-positive rate for imaging diagnosis was calculated. For the RFA group, the local tumor progression rate was calculated. RESULTS: RFS rates at 5 years were 59.3% for the HR group and 32.2% for the RFA group. OS rates at 5 years were 85.4% for the HR group and 76.8% for the RFA group. In the RFA group, cumulative local tumor progression rates were 8.3 and 20.2% at 1 and 3 years. Treatment modality was not an independent prognostic factor for either RFS or OS on multivariate analysis. The false-positive rate for HCC diagnosis based on imaging criteria was 4.8% in the HR group. CONCLUSION: The imaging criteria for diagnosis of HCC have a high positive predictive value. Multivariate analysis showed that RFS and OS rates were not significantly different between HR and RFA for small hepatic masses diagnosed as HCC on pre-treatment imaging. ADVANCES IN KNOWLEDGE: Treatment modality (hepatic resection vs RFA) was not an independent prognostic factor for both RFS and OS for small masses (≤3 cm) diagnosed as hepatocellular carcinoma on pre-treatment imaging.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Biomarcadores Tumorais/sangue , Meios de Contraste , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
12.
Br J Radiol ; 93(1105): 20190375, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670572

RESUMO

OBJECTIVES: We aimed to identify dynamic CT features that can be used for prediction of local recurrence of hepatocellular carcinoma (HCC) after proton beam therapy (PBT). METHODS: We retrospectively retrieved CT scans of patients with PBT-treated HCC, taken between January 2004 and December 2016. 17 recurrent lesions and 34 non-recurrent lesions were retrieved. The attenuation difference between irradiated tumor and irradiated parenchyma (ADHCC-IP) was compared in the two groups by using the Mann-Whitney U test. Cut-off value of ADHCC-IP was estimated by using the Youden index. RESULTS: The follow-up time after PBT initiation ranged from 374 to 2402 days (median, 1069 days) in recurrent lesions, and 418 to 2923 days (median, 1091.5 days) in non-recurrent lesions (p = 0.892). The time until appearance of local recurrence after PBT initiation ranged from 189 to 2270 days (median, 497 days). ADHCC-IP of recurrent lesions [mean, -21.8 Hounsfield units (HU); from -95 to -31 HU] was significantly greater than that of non-recurrent lesions (mean, -51.7 HU; from -117 to -12 HU) at 1-2 years in portal venous phase (p = 0.039). 5-year local tumor control rates were 0.93 and 0.56 in lesions with ADHCC-IP at 1-2 years in PVP < -55 and ≥ -55 HU, respectively. CONCLUSION: The attenuation difference between irradiated HCC and irradiated liver parenchyma in portal venous phase at 1-2 years after PBT can predict long-term local recurrence of HCC after treatment. ADVANCES IN KNOWLEDGE: We identified a cut-off value for contrast enhancement of HCC after PBT that could predict future local recurrence.


Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Terapia com Prótons , Tomografia Computadorizada por Raios X/métodos , Idoso , Carcinoma Hepatocelular/patologia , Meios de Contraste , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Estudos Retrospectivos
13.
Br J Radiol ; 93(1105): 20190743, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670581

RESUMO

OBJECTIVES: Anatomic changes may occur during chemoradiation treatment for lung cancers, requiring adaptive replanning. Here we characterize these cases. METHODS: We retrospectively studied lung cancer cases that underwent resimulation and adaptive replanning during 1/2016-3/2019. We compared first and second CT-simulation regarding tumor location, timing of change, tumor volume, anatomical alteration and change in simulation technique. We also compared dosimetric parameters between the plans, recorded local control, and overall survival outcomes. RESULTS: Out of 281 patients, 58 underwent replanning (20.6%). Histology included small cell (22.4%) and non-small cell (77.6%). Stage III was in 91.4%. Mean radiation dose of 59.4 Gray (Gy) (range 50-66Gy).Tumor location was peribronchial in 53.5%. Timing of replanning was in the first, second and final third of the treatment course in 26%, 43% and 31% respectively. Changes in gross tumor volume were observed in 74%; mean gross tumor volume was 276.7cc vs 192.7 cc (first vs second simulation, p = 0.001). Anatomical changes were identified in 35.4% including pleural fluid accumulation, atelectasis or pneumothorax alteration. Change in simulation technique was performed in 25.9%, including breath-hold or continuous positive airway pressure.Changes in dosimetric parameters when the same technique was used: lung V20Gy 26% (standard deviation, SD 7.6) vs 25.3% (SD 6.6) (p = 0.36), mean lung dose 15.1 Gy (SD 3.7) vs 14.7Gy (SD 3.3) (p = 0.23), heart V40Gy 10.2% (SD13) vs 7.2% (SD 9.8) (p = 0.037). When simulation technique changed: lung V20Gy 30.8% (SD 8.2) vs 27.3% (SD 8) (p = 0.012), mean lung dose 17.3 Gy (SD 4.4) vs 15.3 Gy (SD 3.8) (p = 0.007), heart V40Gy 11.1% (SD 14.7) vs 6.5% (SD 6.7) (p = 0.014).2 year local control was 60.7% (95% confidence interval, 34.5-79.2%), and median overall survival was 19.7 months. CONCLUSION: Adaptive replanning of radiation was performed in a fifth of locally advanced lung cancer patients. In most cases tumor volume decreased, or atelectasis resolved, causing mediastinal shifts, which, if unidentified and left uncorrected, may have led to local failure and increased toxicity. The heart V40Gy was reduced significantly in all cases, but significant reduction in lung doses was evident only if simulation technique was altered. ADVANCES IN KNOWLEDGE: In locally advanced lung cancer image-guidance with cone beam CT can detect significant mediastinal shifts and gross tumor volume changes that raise the need for adaptive replanning. Image guidance-triggered adaptive replanning should be added to the armament of advanced radiation treatment planning in locally advanced lung cancer.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Quimiorradioterapia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Taxa de Sobrevida
14.
Br J Radiol ; 93(1105): 20181019, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31724436

RESUMO

OBJECTIVE: The aim of this phantom study was to investigate the effect of scan parameters and noise suppression techniques on the minimum radiation dose for acceptable image quality for CT emphysema densitometry. METHODS: The COPDGene phantom was scanned on a third generation dual-source CT system with 16 scan setups (CTDIvol 0.035-10.680 mGy). Images were reconstructed at 1.0/0.7 mm slice thickness/increment, with three kernels (one soft, two hard), filtered backprojection and three grades of third-generation iterative reconstruction (IR). Additionally, deep learning-based noise suppression software was applied. Main outcomes: overlap in area of the normalized histograms of CT density for the emphysema insert and lung material, and the radiation dose required for a maximum of 4.3% overlap (defined as acceptable image quality). RESULTS: In total, 384 scan reconstructions were analyzed. Decreasing radiation dose resulted in an exponential increase of the overlap in normalized histograms of CT density. The overlap was 11-91% for the lowest dose setting (CTDIvol 0.035mGy). The soft kernel reconstruction showed less histogram overlap than hard filter kernels. IR and noise suppression also reduced overlap. Using intermediate grade IR plus noise suppression software allowed for 85% radiation dose reduction while maintaining acceptable image quality. CONCLUSION: CT density histogram overlap can quantify the degree of discernibility of emphysema and healthy lung tissue. Noise suppression software, IR, and soft reconstruction kernels substantially decrease the dose required for acceptable image quality. ADVANCES IN KNOWLEDGE: Noise suppression software, IR, and soft reconstruction kernels allow radiation dose reduction by 85% while still allowing differentiation between emphysema and normal lung tissue.


Assuntos
Imagens de Fantasmas , Enfisema Pulmonar/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Humanos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos
15.
Br J Radiol ; 93(1105): 20190653, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31746635

RESUMO

OBJECTIVE: This study aims to assess the CT and MRI features of calvarium and skull base osteosarcoma (CSBO). METHODS: The CT and MRI features and pathological characteristics of 12 cases of pathologically confirmed CSBO were analyzed retrospectively. RESULTS: 12 patients (age range 9-67 years; 3 male, 9 female) were included in the study. Tumours occurred in skull base (7, 58.3%), temporal (4, 33.3%) and frontal (1, 8.3%). Among all, six patients received radiotherapy for nasopharyngeal carcinoma. According to pathology, 11 out of 12 tumours were high-grade (91.7%). On CT, all the tumours had soft tissue mass penetrated into cortical bone with invasion of surrounding soft tissue. Six tumours were shown to have lytic density and six were mixed density. Matrix mineralization was present in 10 cases (83.3%). On MRI, tumours presented as soft-tissue masses measuring 5.9 ± 2.4 (3.9-8.0) cm. Five tumours showed low signal intensities on T1 weighted imaging with seven having heterogeneous signal intensities. One showed low signal intensity on T2 weighted imaging, two showed high signal intensities and nine heterogeneous signal intensities. All the tumours showed low signal intensities on diffusion-weighted imaging. On contrast enhanced images, seven cases showed heterogeneous enhancement, three showed peripheral enhancementand and two showed homogeneous enhancement. Dural tail sign were detected in nine cases. CONCLUSION: CSBO is rare, and is commonly associated with previous radiation exposure. A presumptive diagnosis for osteosarcoma should be considered when calvarium and skull base tumours with osteoid matrix and duraltail sign are found. ADVANCES IN KNOWLEDGE: CT and MR features of CSBO have not been reported. The study helps to identify CSBO and other sarcomas.


Assuntos
Imagem por Ressonância Magnética/métodos , Osteossarcoma/diagnóstico por imagem , Neoplasias Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Criança , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Base do Crânio/diagnóstico por imagem
16.
Ann R Coll Surg Engl ; 102(1): e15-e19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31859521

RESUMO

Bouveret syndrome is a rare variant of gallstone ileus causing gastric outlet obstruction. It results from the formation of either a cholecystoduodenal or a cholecystogastric fistula and subsequent migration of gallstone into the duodenum or pylorus of stomach, causing obstruction. The first case was reported by Leon Bouveret in 1896. We report a case illustrating the rarity and severity of this condition, together with a review of the literature of the different methods of endoscopic and surgical treatment.


Assuntos
Cálculos Biliares/cirurgia , Obstrução da Saída Gástrica/cirurgia , Idoso de 80 Anos ou mais , Fístula Biliar/etiologia , Duodenopatias/etiologia , Cálculos Biliares/diagnóstico por imagem , Humanos , Fístula Intestinal/etiologia , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Ann R Coll Surg Engl ; 102(1): e12-e14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31859525

RESUMO

Malrotation is part of a spectrum of small and large bowel positional and fixational abnormalities caused by the failure of the fetal intestine to complete a 270-degree rotation around the superior mesenteric artery axis. Rarely, it presents in the adult as a cause of acute small bowel obstruction. Chronic symptoms of malrotation in adults are subtle, and include intermittent abdominal pain, nausea and vomiting. We present two cases of malrotation in octogenarian men presenting acutely with small bowel obstruction. Both patients were treated with emergency surgery. In one case the chronic symptoms resolved postoperatively. Malrotation and midgut volvulus should be considered as a rare differential diagnosis for small bowel obstruction in adults. Suspicions should be increased when there is a history of recurrent presentations with similar symptoms.


Assuntos
Obstrução Intestinal/cirurgia , Volvo Intestinal/congênito , Intestino Delgado/cirurgia , Idoso de 80 Anos ou mais , Constipação Intestinal/etiologia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Volvo Intestinal/diagnóstico por imagem , Volvo Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Masculino , Náusea/etiologia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologia
18.
Ann Otol Rhinol Laryngol ; 129(1): 12-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394908

RESUMO

OBJECTIVE: To define a new anatomic relationship in pediatric sinus surgery, assessing the maxillary roof as a constant safe landmark to avoid skull base injury in the pediatric population. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary care children hospital. SUBJECTS AND METHODS: A retrospective analysis was performed of all computed tomography scans of the sinuses and facial bones at the emergency department of a tertiary children's hospital over the course of a year. Radiographic measurements included the lowest cribriform plate and planum sphenoidale (PS) heights, or posterior skull base when not yet pneumatized, as well as the highest maxillary roof height. The nasal floor was used for reference. Statistics were performed via Shapiro-Wilks test with a P-value of .05 indicating statistical significance. RESULTS: Three hundred and seven unique scans were reviewed (38.9% female; n = 122; P = .58). Age stratification was based on previously described sinus growth patterns. In all patients, the maximum maxillary height was inferior to the lowest measured cribriform lamella and PS (P < .001; CI, 98.5%-99%). Inter- and intrarater reliability and accuracy were verified through blinded review and re-review (ρ = .99 and .98 respectively, P ≤ .001). The validity of sole coronal measurements due to incomplete sagittal reformatting was also confirmed (ρ = 1.00, P ≤ .001). CONCLUSION: Despite variation in sinus growth and development in children, the current study demonstrated the validity of the maxillary sinus roof as a constant safe landmark in the pediatric population, offering a novel anatomic relationship for teaching safety in performing pediatric sinus surgery. LEVEL OF EVIDENCE: 4.


Assuntos
Pontos de Referência Anatômicos , Endoscopia/métodos , Seio Maxilar/diagnóstico por imagem , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Base do Crânio/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Seio Maxilar/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
Ann Otol Rhinol Laryngol ; 129(1): 87-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31416334

RESUMO

OBJECTIVES: To highlight a severe case of rhinotillexomania (compulsive nasal picking) and its potential to manifest as empty nose syndrome (ENS). METHODS: A single case report with the presentation and management of a patient with severe rhinotillexomania who presented with chronic obstructive symptoms. We review the current literature on rhinotillexomania and ENS. RESULTS: This patient's manifestations mimic the obstructive symptoms of ENS, despite widely patent nasal passages. CONCLUSION: This is the first report of rhinotillexomania manifesting with features of ENS.


Assuntos
Comportamento Compulsivo/complicações , Perfuração do Septo Nasal/etiologia , Idoso , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Budesonida/uso terapêutico , Endoscopia , Humanos , Umidificadores , Masculino , Mupirocina/uso terapêutico , Obstrução Nasal , Perfuração do Septo Nasal/diagnóstico , Perfuração do Septo Nasal/terapia , Doenças Nasais/diagnóstico , Doenças Nasais/etiologia , Doenças Nasais/terapia , Síndrome , Irrigação Terapêutica , Tomografia Computadorizada por Raios X
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