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1.
Isr Med Assoc J ; 23(9): 550-555, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472229

RESUMO

BACKGROUND: Medical imaging and the resultant ionizing radiation exposure is a public concern due to the possible risk of cancer induction. OBJECTIVES: To assess the accuracy of ultra-low-dose (ULD) chest computed tomography (CT) with denoising versus normal dose (ND) chest CT using the Lung CT Screening Reporting and Data System (Lung-RADS). METHODS: This prospective single-arm study comprised 52 patients who underwent both ND and ULD scans. Subsequently AI-based denoising methods were applied to produce a denoised ULD scan. Two chest radiologists independently and blindly assessed all scans. Each scan was assigned a Lung-RADS score and grouped as 1 + 2 and 3 + 4. RESULTS: The study included 30 men (58%) and 22 women (42%); mean age 69.9 ± 9 years (range 54-88). ULD scan radiation exposure was comparable on average to 3.6-4.8% of the radiation depending on patient BMI. Denoising increased signal-to-noise ratio by 27.7%. We found substantial inter-observer agreement in all scans for Lung-RADS grouping. Denoised scans performed better than ULD scans when negative likelihood ratio (LR-) was calculated (0.04--0.08 vs. 0.08-0.12). Other than radiation changes, diameter measurement differences and part-solid nodules misclassification as a ground-glass nodule caused most Lung-RADS miscategorization. CONCLUSIONS: When assessing asymptomatic patients for pulmonary nodules, finding a negative screen using ULD CT with denoising makes it highly unlikely for a patient to have a pulmonary nodule that requires aggressive investigation. Future studies of this technique should include larger cohorts and be considered for lung cancer screening as radiation exposure is radically reduced.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Exposição à Radiação
2.
Bone Joint J ; 103-B(9): 1497-1504, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465153

RESUMO

AIMS: Type 2 diabetes mellitus (T2DM) impairs bone strength and is a significant risk factor for hip fracture, yet currently there is no reliable tool to assess this risk. Most risk stratification methods rely on bone mineral density, which is not impaired by diabetes, rendering current tests ineffective. CT-based finite element analysis (CTFEA) calculates the mechanical response of bone to load and uses the yield strain, which is reduced in T2DM patients, to measure bone strength. The purpose of this feasibility study was to examine whether CTFEA could be used to assess the hip fracture risk for T2DM patients. METHODS: A retrospective cohort study was undertaken using autonomous CTFEA performed on existing abdominal or pelvic CT data comparing two groups of T2DM patients: a study group of 27 patients who had sustained a hip fracture within the year following the CT scan and a control group of 24 patients who did not have a hip fracture within one year. The main outcome of the CTFEA is a novel measure of hip bone strength termed the Hip Strength Score (HSS). RESULTS: The HSS was significantly lower in the study group (1.76 (SD 0.46)) than in the control group (2.31 (SD 0.74); p = 0.002). A multivariate model showed the odds of having a hip fracture were 17 times greater in patients who had an HSS ≤ 2.2. The CTFEA has a sensitivity of 89%, a specificity of 76%, and an area under the curve of 0.90. CONCLUSION: This preliminary study demonstrates the feasibility of using a CTFEA-based bone strength parameter to assess hip fracture risk in a population of T2DM patients. Cite this article: Bone Joint J 2021;103-B(9):1497-1504.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/etiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Medicine (Baltimore) ; 100(35): e26774, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477116

RESUMO

ABSTRACT: Umbilical Vein Recanalization (UVR) may occur in patients with long-standing portal hypertension and liver cirrhosis. This study aimed to investigate the clinical significance of UVR.Medical records of a cohort of patients with cirrhosis (n = 247) who were hospitalized at the Digestive Medicine Center of the Second Affiliated Hospital of Nanchang University from January 2012 to October 2015 were accessed. The UVR diagnosis was made by ultrasound examination and was confirmed by computerized tomography scan.The UVR incidence was 20.2% (50/247) in the cohort. The size of UVR was 9.9 ±â€Š4.7 mm (range: 5-26.5 mm) in diameter. The UVR and non-UVR groups showed no difference in grades of hepatic encephalopathy (P = .496), Child-Pugh classification (P = .401), the incidence of moderately severe ascites (26% vs 26%, P = 1), the esophageal variceal bleeding rate (32% vs 39%, P = .402), or portal vein thrombosis (8% vs 12%, P = .580). However, the incidence of cavernous transformation of the portal vein was statistically different, that there was 0 case in the UVR group and 8 cases in the non-UVR group (P < .05).Our results suggested that UVR had little impact on the clinical manifestations of patients with liver cirrhosis, the significance of UVR as an intervention method requires further studies.


Assuntos
Cateterismo/estatística & dados numéricos , Fibrose/fisiopatologia , Veias Umbilicais , Adulto , Cateterismo/métodos , Feminino , Fibrose/classificação , Fibrose/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
4.
Medicine (Baltimore) ; 100(35): e27040, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477134

RESUMO

ABSTRACT: To investigate the clinical and pathological characteristics in patients with pulmonary inflammatory pseudotumors (PIP).This retrospective study included 31 patients with PIP from 2001 to 2019. Preoperative computed tomography scan was performed in all patients. Clinical and pathological characteristics were collected and analyzed.Thirty-one patients (16 female and 15 male) were recruited, with a median age of 57 years (range, 11-72 years). Eight (25.8%) patients were asymptomatic, and the others had symptoms characterized by cough with sputum, chest and back pain, dry cough, fever and blood in sputum, or hemoptysis. All cases were single lesions, including 23 cases in the right lung, and 8 cases in the left lung. Computed tomography scan demonstrated irregular lobulated nodules or masses in 14 patients, and regular round or oval nodules or masses in 11 cases. The blurred edge of tumors and spiculation was found in 12 cases. Microscopic results were characterized by the collection of inflammatory mesenchymal cells. Immunohistochemical examination showed vimentin, smooth muscle actin, and anaplastic lymphoma kinase positive. Complete tumor resection was obtained in all cases. No recurrence or metastasis was observed during the follow-up period.PIP has a variety of manifestations. Preoperative diagnosis is difficult to reach. The final diagnosis still depends on the pathological and immunohistochemical examination. Complete surgical resection is the main treatment at present, and the overall prognosis is good.


Assuntos
Granuloma de Células Plasmáticas/patologia , Adolescente , Adulto , Idoso , Criança , Feminino , Granuloma de Células Plasmáticas/epidemiologia , Granuloma de Células Plasmáticas/fisiopatologia , Humanos , Pulmão/patologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Tomografia Computadorizada por Raios X/métodos
5.
Medicine (Baltimore) ; 100(35): e27058, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477137

RESUMO

ABSTRACT: The treatment for squamous cell lung cancer (SqCLC) is limited, and the prognosis of SqCLC is poor. In this article, we aimed to analyze and identify immune-related cells and competition endogenous RNA (ceRNA) that influence the prognosis of SqCLC. SqCLC and lung adenocarcinoma data were downloaded from TCGA-GDC. A total of 22 types of immune cell fractions were estimated using CIBERSORT. R software was used to identify any significantly different transcriptome data, including mRNA, LncRNA, and miRNA. The univariate cox regression method was applied to screen for prognosis-related lncRNA, miRNA, mRNA and tumor-infiltrating immune cells. There were 504 patients included in this study. There was a higher proportion of memory activated CD4+ T cells and CD8+ T cells in younger women. Follicular helper T (Tfh) cells were predictive of a good prognosis and reflected immune activation in SqCLC. The SFTA1P/NKX2-1-AS1, hsa-mir-503, GREM2 ceRNA axes and NKX2-1-AS1, hsa-mir-96, PROK2 ceRNA axes were found to be important for the immune function, pathogenesis, and prognosis of SqCLC. Collectively, the immune-related ceRNA and tumor-infiltrating immune cells in SqCLC are likely important determinants of SqCLC pathogenesis, prognosis, and immune status.


Assuntos
Neoplasias Pulmonares/imunologia , Neoplasias de Células Escamosas/imunologia , Adolescente , Idoso , Criança , Células Epiteliais/patologia , Feminino , Ontologia Genética , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias de Células Escamosas/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
6.
Med Sci Monit ; 27: e931162, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34453030

RESUMO

BACKGROUND This multiple-center retrospective study aimed to investigate computed tomography (CT) imaging findings in 72 patients with airway-invasive pulmonary aspergillosis. MATERIAL AND METHODS Seventy-two patients with airway-invasive pulmonary aspergillosis confirmed by pathology results were divided into 3 types according to image characteristics. Type I involved the trachea or the main bronchus. Type II involved the lobular and segmental bronchi, which manifested early as bronchial wall thickening, and later development was divided into types IIa and IIb. Type IIa manifested as bronchiectasis, and type IIb manifested as consolidation around the bronchus. Type III involved the bronchioles and pulmonary parenchyma, with tree-in-bud sign and acinar nodules around. CT signs of the various types and their differentiation were investigated. RESULTS The main clinical manifestations of the 72 patients with airway-invasive pulmonary aspergillosis were shortness of breath (55/72, 76.4%), cough (40/72, 55.6%), expectoration (35/72, 48.6%), dyspnea (8/72, 11.1%), weight loss (2/72, 2.8%), and fever (30/72, 41.7%). CT typing identified 3 types: 2 patients (2.8%) had type I, presenting as thickening of trachea or main bronchial walls; 3 patients (4.2%) had early type II, manifesting as thickening of lobular or segmental bronchial walls; 27 patients (37.5%) developed type IIa, manifesting as bronchiectasis; 22 patients (30.6%) had type IIb, manifesting as consolidation around the bronchus; and 18 patients (25.0%) had type III, presenting as nodules and patchy shadows with small cavities in the periphery of the lung. CONCLUSIONS Airway pulmonary aspergillosis has characteristic imaging findings, which can help early clinical diagnosis through classification according to CT imaging characteristics.


Assuntos
Aspergilose Pulmonar Invasiva/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Aspergilose Pulmonar Invasiva/classificação , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Aspergilose Pulmonar Invasiva/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
7.
BMC Infect Dis ; 21(1): 836, 2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412614

RESUMO

BACKGROUND: Corona Virus Disease 2019 (COVID-19) is currently a worldwide pandemic and has a huge impact on public health and socio-economic development. The purpose of this study is to explore the diagnostic value of the quantitative computed tomography (CT) method by using different threshold segmentation techniques to distinguish between patients with or without COVID-19 pneumonia. METHODS: A total of 47 patients with suspected COVID-19 were retrospectively analyzed, including nine patients with positive real-time fluorescence reverse transcription polymerase chain reaction (RT-PCR) test (confirmed case group) and 38 patients with negative RT-PCR test (excluded case group). An improved 3D convolutional neural network (VB-Net) was used to automatically extract lung lesions. Eight different threshold segmentation methods were used to define the ground glass opacity (GGO) and consolidation. The receiver operating characteristic (ROC) curves were used to compare the performance of various parameters with different thresholds for diagnosing COVID-19 pneumonia. RESULTS: The volume of GGO (VOGGO) and GGO percentage in the whole lung (GGOPITWL) were the most effective values for diagnosing COVID-19 at a threshold of - 300 HU, with areas under the curve (AUCs) of 0.769 and 0.769, sensitivity of 66.67 and 66.67%, specificity of 94.74 and 86.84%. Compared with VOGGO or GGOPITWL at a threshold of - 300 Hounsfield units (HU), the consolidation percentage in the whole lung (CPITWL) with thresholds at - 400 HU, - 350 HU, and - 250 HU were statistically different. There were statistical differences in the infection volume and percentage of the whole lung, right lung, and lobes between the two groups. VOGGO, GGOPITWL, and volume of consolidation (VOC) were also statistically different at the threshold of - 300 HU. CONCLUSIONS: Quantitative CT provides an image quantification method for the auxiliary diagnosis of COVID-19 and is expected to assist in confirming patients with COVID-19 pneumonia in suspected cases.


Assuntos
COVID-19 , Pneumonia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Inteligência Artificial , Humanos , Estudos Retrospectivos , SARS-CoV-2
8.
Br J Radiol ; 94(1125): 20201380, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415201

RESUMO

OBJECTIVE: There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings. METHODS: Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student's t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant. RESULTS: Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1-19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlation. CONCLUSIONS: Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity. ADVANCES IN KNOWLEDGE: Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.


Assuntos
COVID-19/fisiopatologia , Pulmão/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Adulto Jovem
9.
Br J Radiol ; 94(1125): 20210117, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415198

RESUMO

New treatment developments in ovarian cancer have led to a renewed interest in staging advanced ovarian cancer. The treatment of females with ovarian cancer patients has a strong multidisciplinary character with an essential role for the radiologist. This review aims to provide an overview of the current position of CT, positron emission tomography-CT, and MRI in ovarian cancer and how imaging can be used to guide multidisciplinary team discussions.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias Ovarianas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Ovário/diagnóstico por imagem
10.
Sci Prog ; 104(3): 368504211016204, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34424791

RESUMO

As the coronavirus disease 2019 (COVID-19) epidemic spreads around the world, the demand for imaging examinations increases accordingly. The value of conventional chest radiography (CCR) remains unclear. In this study, we aimed to investigate the diagnostic value of CCR in the detection of COVID-19 through a comparative analysis of CCR and CT. This study included 49 patients with 52 CT images and chest radiographs of pathogen-confirmed COVID-19 cases and COVID-19-suspected cases that were found to be negative (non-COVID-19). The performance of CCR in detecting COVID-19 was compared to CT imaging. The major signatures that allowed for differentiation between COVID-19 and non-COVID-19 cases were also evaluated. Approximately 75% (39/52) of images had positive findings on the chest x-ray examinations, while 80.7% (42/52) had positive chest CT scans. The COVID-19 group accounted for 88.4% (23/26) of positive chest X-ray examinations and 96.1% (25/26) of positive chest CT scans. The sensitivity, specificity, and accuracy of CCR for abnormal shadows were 88%, 80%, and 87%, respectively, for all patients. For the COVID-19 group, the accuracy of CCR was 92%. The primary signature on CCR was flocculent shadows in both groups. The shadows were primarily in the bi-pulmonary, which was significantly different from non-COVID-19 patients (p = 0.008). The major CT finding of COVID-19 patients was ground-glass opacities in both lungs, while in non-COVID-19 patients, consolidations combined with ground-glass opacities were more common in one lung than both lungs (p = 0.0001). CCR showed excellent performance in detecting abnormal shadows in patients with confirmed COVID-19. However, it has limited value in differentiating COVID-19 patients from non-COVID-19 patients. Through the typical epidemiological history, laboratory examinations, and clinical symptoms, combined with the distributive characteristics of shadows, CCR may be useful to identify patients with possible COVID-19. This will allow for the rapid identification and quarantine of patients.


Assuntos
COVID-19/diagnóstico por imagem , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Radiografia Torácica/normas , Tomografia Computadorizada por Raios X/normas
11.
BMC Pulm Med ; 21(1): 267, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404383

RESUMO

BACKGROUND: The aim of the study is to estimate the prevalence of atelectasis assessed with computer tomography (CT) in SARS-CoV-2 pneumonia and the relationship between the amount of atelectasis with oxygenation impairment, Intensive Care Unit admission rate and the length of in-hospital stay. PATIENTS AND METHODS: Two-hundred thirty-seven patients admitted to the hospital with SARS-CoV-2 pneumonia diagnosed by clinical, radiology and molecular tests in the nasopharyngeal swab who underwent a chest computed tomography because of a respiratory worsening from Apr 1 to Apr 30, 2020 were included in the study. Patients were divided into three groups depending on the presence and amount of atelectasis at the computed tomography: no atelectasis, small atelectasis (< 5% of the estimated lung volume) or large atelectasis (> 5% of the estimated lung volume). In all patients, clinical severity, oxygen-therapy need, Intensive Care Unit admission rate, the length of in-hospital stay and in-hospital mortality data were collected. RESULTS: Thirty patients (19%) showed small atelectasis while eight patients (5%) showed large atelectasis. One hundred and seventeen patients (76%) did not show atelectasis. Patients with large atelectasis compared to patients with small atelectasis had lower SatO2/FiO2 (182 vs 411 respectively, p = 0.01), needed more days of oxygen therapy (20 vs 5 days respectively, p = 0,02), more frequently Intensive Care Unit admission (75% vs 7% respectively, p < 0.01) and a longer period of hospitalization (40 vs 14 days respectively p < 0.01). CONCLUSION: In patients with SARS-CoV-2 pneumonia, atelectasis might appear in up to 24% of patients and the presence of larger amount of atelectasis is associated with worse oxygenation and clinical outcome.


Assuntos
COVID-19 , Hipóxia , Pneumonia Viral , Atelectasia Pulmonar , Tomografia Computadorizada por Raios X/métodos , Idoso , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/fisiopatologia , Teste para COVID-19/métodos , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Medidas de Volume Pulmonar/métodos , Masculino , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prevalência , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/epidemiologia , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/fisiopatologia , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Espanha/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos
12.
Medicine (Baltimore) ; 100(32): e26901, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397918

RESUMO

ABSTRACT: This study aimed to investigate the time trend variation in the surgical volume and prognostic outcome of patients with lung cancer after the gradual prolonged implementation of a low-dose computed tomography (LDCT) lung cancer screening program.Using the hospital-based cancer registry data on number of patients with lung cancer and deaths from 2008 to 2017, we conducted a retrospective study using a hospital-based cohort to investigate the relationship between changes in lung cancer surgical volume, the proportion of lung-sparing surgery, and prolonged prognostic outcomes after the gradual implementation of the LDCT lung cancer screening program in recent years.From 2008 to 2017, 3251 patients were diagnosed with lung cancer according to the hospital-based cancer registry. The 5-year mortality rate decreased gradually from 83.54% to 69.44% between 2008 and 2017. The volume of total lung cancer surgical procedures and proportion of lung-sparing surgery performed gradually increased significantly from 2008 to 2017, especially from 2014 to 2017 after implementation of a large volume of LDCT lung cancer screening examinations. In conclusion, our real-world data suggest that there will be an increase in cases of operable early-stage lung cancers, which in turn will increase the surgical volume and proportion of lung-sparing surgery, after the gradual implementation of the LDCT lung cancer screening program in recent years. These findings suggest the importance of a successful national policy regarding LDCT screening programs, regulation of shortage of thoracic surgeons, thoracic radiologist workforce training positions, and education programs.


Assuntos
Detecção Precoce de Câncer/métodos , Mão de Obra em Saúde/estatística & dados numéricos , Neoplasias Pulmonares/diagnóstico , Pulmão/diagnóstico por imagem , Programas de Rastreamento/métodos , Pneumonectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Doses de Radiação , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 100(32): e26904, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397921

RESUMO

RATIONALE: Persistent primitive hypoglossal artery (PPHA) is a rare and permanent carotid-vertebrobasilar anastomoses. Patients with PPHA usually have higher changes of developing intracranial aneurysms due the high intracranial hemodynamics. Although cases of PPHA alone and PPHA with aneurysms have been reported in literature, cases of fenestrated PPHA harboring a ruptured aneurysm have seldomly be reported in literature. We present a rare occurrence of a fenestrated PPHA harboring a reputed aneurysm. PATIENTS CONCERNS: A 43-year-old woman was presented with a sudden-onset severe headache and nausea. DIAGNOSIS: Computerized tomography scan showed third, fourth, and bilateral ventricular hemorrhages. Computed tomographic angiogram showed a PPHA with fenestration malformation and a cystic protrusion consistent with an aneurysm. INTERVENTION: The patient underwent a successful stent-assisted coil embolization via the trans-arterial route under general anesthesia. OUTCOMES: Two years follow-up revealed no recurrence of her symptomatology and she is currently well and go about her normal daily life. CONCLUSION: Fenestrated PPHAs harboring aneurysms may be more prone to rupture because of the fenestration and connective tissue weakness of the artery as well as changes in hemodynamics of the already malformed and weak artery.


Assuntos
Aneurisma Roto/diagnóstico , Artéria Basilar , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Anastomose Cirúrgica/métodos , Aneurisma Roto/cirurgia , Feminino , Humanos , Aneurisma Intracraniano/cirurgia
14.
Medicine (Baltimore) ; 100(29): e26513, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398006

RESUMO

ABSTRACT: In patients undergoing atrial fibrillation (AF) ablation, an enlarged left atrium (LA) is a predictor of procedural failure as well as AF recurrence on long term. The most used method to assess LA size is echocardiography-measured diameter, but the most accurate remains computed tomography (CT).The aim of our study was to determine whether there is an association between left atrial diameters measured in echocardiography and the left atrial volume determined by CT in patients who underwent AF ablation.The study included 93 patients, of whom 60 (64.5%) were men and 64 (68.8%) had paroxysmal AF, who underwent AF catheter ablation between January 2018 and June 2019. Left atrial diameters in echocardiography were measured from the long axis parasternal view and the LA volume in CT was measured on reconstructed three-dimensional images.The LA in echocardiography had an antero-posterior (AP) diameter of 45.0 ±â€Š6 mm (median 45; Inter Quartile Range [IQR] 41-49, range 25-73 mm), longitudinal diameter of 67.5 ±â€Š9.4 (median 66; IQR 56-88, range 52-100 mm), and transversal diameter of 42 ±â€Š8.9 mm (IQR 30-59, range 23-64.5 mm). The volume in CT was 123 ±â€Š29.4 mL (median 118; IQR 103-160; range 86-194 mL). We found a significant correlation (r = 0.702; P < .05) between the AP diameter and the LA volume. The formula according to which the AP diameter of the LA can predict the volume was: LA volume = AP diam3 + 45 mL.There is a clear association between the left atrial AP diameter measured on echocardiography and the volume measured on CT. The AP diameter might be sufficient to determine the increase in the volume of the atrium and predict cardiovascular outcomes.


Assuntos
Fibrilação Atrial/classificação , Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo/fisiologia , Volume Sanguíneo , Ablação por Cateter/métodos , Adulto , Idoso , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/estatística & dados numéricos , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Sci Rep ; 11(1): 16280, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34381079

RESUMO

COVID-19 is a serious ongoing worldwide pandemic. Using X-ray chest radiography images for automatically diagnosing COVID-19 is an effective and convenient means of providing diagnostic assistance to clinicians in practice. This paper proposes a bagging dynamic deep learning network (B-DDLN) for diagnosing COVID-19 by intelligently recognizing its symptoms in X-ray chest radiography images. After a series of preprocessing steps for images, we pre-train convolution blocks as a feature extractor. For the extracted features, a bagging dynamic learning network classifier is trained based on neural dynamic learning algorithm and bagging algorithm. B-DDLN connects the feature extractor and bagging classifier in series. Experimental results verify that the proposed B-DDLN achieves 98.8889% testing accuracy, which shows the best diagnosis performance among the existing state-of-the-art methods on the open image set. It also provides evidence for further detection and treatment.


Assuntos
COVID-19/diagnóstico por imagem , Aprendizado Profundo , Diagnóstico por Computador , Tomografia Computadorizada por Raios X , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
16.
Medicine (Baltimore) ; 100(30): e26375, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397683

RESUMO

RATIONALE: Besides the T790 M mutation, it may coexist with bypass pathway activation in real clinical cases for patients with EGFR mutations who resisted to the first- and second-generation tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). There are limited clinical trial data describing the efficacy of osimertinib combined with MET inhibition in EGFR T790M-mutant NSCLC patients with Met amplification. PATIENT CONCERNS: A non-smoking 53-year-old male patient with lung adenocarcinoma underwent gefitinib, afatinib, and osimertinib combined with crizotinib treatment and developed different EGFR resistance mutations. DIAGNOSES: The patient was diagnosed with lung adenocarcinoma (stage cT4N2M0, IIIB). After resistance to the therapy targeting EGFR exon 21 L858R point mutation, T790 M mutation was detected in liquid biopsy and Met amplification was detected via tissue biopsy by next-generation sequencing (NGS). INTERVENTIONS: The patient received systemic treatments, including chemotherapy, gefitinib, afatinib, and osimertinib combined with crizotinib. OUTCOMES: The patient died of multisystem organ failure and had an overall survival of 24 months. LESSONS: Although osimertinib combined with crizotinib therapy showed dramatic tumor shrinkage in both the primary tumor and bone metastasis to an EGFR T790M-mutant NSCLC patient with MET amplification, the progression-free survival (PFS) was only two months.


Assuntos
Acrilamidas/efeitos adversos , Compostos de Anilina/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Crizotinibe/efeitos adversos , Acrilamidas/uso terapêutico , Compostos de Anilina/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Crizotinibe/uso terapêutico , Receptores ErbB/efeitos dos fármacos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
17.
Medicine (Baltimore) ; 100(30): e26434, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397685

RESUMO

ABSTRACT: This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3+ CD4+ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.


Assuntos
Influenza Humana/complicações , Aspergilose Pulmonar/etiologia , Adulto , Idoso , Aspergillus fumigatus/efeitos dos fármacos , Aspergillus fumigatus/patogenicidade , Líquido da Lavagem Broncoalveolar , Distribuição de Qui-Quadrado , China , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/patogenicidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Aspergilose Pulmonar/diagnóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
18.
Medicine (Baltimore) ; 100(30): e26680, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397694

RESUMO

RATIONALE: Approximately 20% of patients with non-small cell lung cancer (NSCLC) are diagnosed with brain metastasis, which is related to poor survival outcomes. The ability of tyrosine kinase inhibitor drugs to penetrate the blood-brain barrier makes them a potential option for intracranial metastases. Dacomitinib, an irreversible second-generation pan-HER tyrosine kinase inhibitor, has become a standard therapy for patients with epidermal growth factor receptor mutations. However, its efficacy in patients with brain metastases (BMs) is not yet established. Here, we present 2 patients with epidermal growth factor receptor-mutant NSCLC with brain metastasis. After initiation of dacomitinib as first-line treatment, a significant clinical response was achieved, and a long-lasting complete remission was achieved in 1 patient up to this date. PATIENT CONCERN: Case 1 was a 47-year-old man who was admittedtothe hospital because of recurrent cough and expectoration for >1 year. Chest computed tomography scans revealed a high-density shadow in the left upper lobe. Cranial magnetic resonance imaging indicated an abnormal nodular enhancement in the right cerebellar hemisphere. Case 2 was a 55-year-old man with a chief complaint of intermittent cough and expectoration for >1 month. Chest computed tomography revealed a high-density mass in the left superior lobe. Magnetic resonance imaging of the central nervous system revealed 2 abnormal nodular enhancements in the left frontal lobe. DIAGNOSIS: Both patients were diagnosed with lung adenocarcinoma by bronchoscopy and lymph node biopsy. INTERVENTIONS: Both patients received dacomitinib 30 mg once daily as first-line therapy for 8 and 11 months, respectively until disease progression. OUTCOME: After treatment with dacomitinib, both patients achieved complete response in BMs. Progression-free survival was 11 and 8 months, respectively. LESSONS: Dacomitinib strongly controlled BMs in patients with advanced NSCLC, and the adverse reactions were tolerable. Dacomitinib may be considered a new treatment option for these patients. Further prospective studies are recommended to confirm this conclusion.


Assuntos
Neoplasias Encefálicas/etiologia , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Genes erbB-1/genética , Neoplasias Encefálicas/genética , Broncoscopia/métodos , Carcinoma Pulmonar de Células não Pequenas/genética , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Quinazolinonas/efeitos adversos , Quinazolinonas/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
19.
Theranostics ; 11(16): 7755-7766, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34335962

RESUMO

Background: Myocardial infarction (MI) evokes an organized remodeling process characterized by the activation and transdifferentiation of quiescent cardiac fibroblasts to generate a stable collagen rich scar. Early fibroblast activation may be amenable to targeted therapy, but is challenging to identify in vivo. We aimed to non-invasively image active fibrosis by targeting the fibroblast activation protein (FAP) expressed by activated (myo)fibroblasts, using a novel positron emission tomography (PET) radioligand [68Ga]MHLL1 after acute MI. Methods: One-step chemical synthesis and manual as well as module-based radiolabeling yielded [68Ga]MHLL1. Binding characteristics were evaluated in murine and human FAP-transfected cells, and stability tested in human serum. Biodistribution in healthy animals was interrogated by dynamic PET imaging, and metabolites were measured in blood and urine. The temporal pattern of FAP expression was determined by serial PET imaging at 7 d and 21 d after coronary artery ligation in mice as percent injected dose per gram (%ID/g). PET measurements were validated by ex vivo autoradiography and immunostaining for FAP and inflammatory macrophages. Results: [68Ga]MHLL1 displayed specific uptake in murine and human FAP-positive cells (p = 0.0208). In healthy mice the tracer exhibited favorable imaging characteristics, with low blood pool retention and dominantly renal clearance. At 7 d after coronary artery ligation, [68Ga]MHLL1 uptake was elevated in the infarct relative to the non-infarcted remote myocardium (1.3 ± 0.3 vs. 1.0 ± 0.2 %ID/g, p < 0.001) which persisted to 21 d after MI (1.3 ± 0.4 vs. 1.1 ± 0.4 %ID/g, p = 0.013). Excess unlabeled compound blocked tracer accumulation in both infarct and non-infarct remote myocardium regions (p < 0.001). Autoradiography and histology confirmed the regional uptake of [68Ga]MHLL1 in the infarct and especially border zone regions, as identified by Masson trichrome collagen staining. Immunostaining further delineated persistent FAP expression at 7 d and 21 d post-MI in the border zone, consistent with tracer distribution in vivo. Conclusion: The simplified synthesis of [68Ga]MHLL1 bears promise for non-invasive characterization of fibroblast activation protein early in remodeling after MI.


Assuntos
Endopeptidases/metabolismo , Radioisótopos de Gálio/farmacologia , Proteínas de Membrana/metabolismo , Tomografia por Emissão de Pósitrons/métodos , Animais , Autorradiografia/métodos , Linhagem Celular Tumoral , Endopeptidases/fisiologia , Fibroblastos/metabolismo , Fibrose/diagnóstico por imagem , Radioisótopos de Gálio/metabolismo , Humanos , Masculino , Proteínas de Membrana/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Imagem Molecular/métodos , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/fisiopatologia , Miocárdio/patologia , Distribuição Tecidual/fisiologia , Tomografia Computadorizada por Raios X/métodos
20.
Theranostics ; 11(16): 7813-7828, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34335966

RESUMO

Non-invasive monitoring of hemodynamic tumor responses to chemotherapy could provide unique insights into the development of therapeutic resistance and inform therapeutic decision-making in the clinic. Methods: Here, we examined the longitudinal and dynamic effects of the common chemotherapeutic drug Taxotere on breast tumor (KPL-4) blood volume and oxygen saturation using eigenspectra multispectral optoacoustic tomography (eMSOT) imaging over a period of 41 days. Tumor vascular function was assessed by dynamic oxygen-enhanced eMSOT (OE-eMSOT). The obtained in vivo optoacoustic data were thoroughly validated by ex vivo cryoimaging and immunohistochemical staining against markers of vascularity and hypoxia. Results: We provide the first preclinical evidence that prolonged treatment with Taxotere causes a significant drop in mean whole tumor oxygenation. Furthermore, application of OE-eMSOT showed a diminished vascular response in Taxotere-treated tumors and revealed the presence of static blood pools, indicating increased vascular permeability. Conclusion: Our work has important translational implications and supports the feasibility of eMSOT imaging for non-invasive assessment of tumor microenvironmental responses to chemotherapy.


Assuntos
Neoplasias da Mama/metabolismo , Hemodinâmica/fisiologia , Tomografia Óptica/métodos , Animais , Neoplasias da Mama/diagnóstico por imagem , Linhagem Celular Tumoral , Docetaxel/farmacologia , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Hipóxia/metabolismo , Camundongos , Camundongos SCID , Oxigênio/metabolismo , Técnicas Fotoacústicas/métodos , Tomografia/métodos , Tomografia Computadorizada por Raios X/métodos , Microambiente Tumoral/fisiologia
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