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1.
Eur Rev Med Pharmacol Sci ; 25(2): 1080-1086, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33577064

RESUMO

OBJECTIVE: This study aimed to explore the atypical imaging findings of the novel coronavirus pneumonia (COVID-19) and its evolution. MATERIALS AND METHODS: The atypical imaging data of ten patients in our hospital who tested positive for COVID-19 were analyzed retrospectively, and the distribution, morphology, and image evolution of the lesions were analyzed. High-resolution computed tomography (HRCT) was performed in all cases, and the imaging features were analyzed and summarized by two senior radiologists. RESULTS: Of these ten patients, three were male, and seven were female. The age of these patients ranged from 21-53 years, with an average age of 36.3 ± 3.6. The first symptom was fever in nine cases and dry cough in one case. A total of 17 lesions were detected in these ten patients. Five patients had a single lesion, and five patients had multiple lesions, for a total of 12 lesions. Ten lesions (58.82%) were located in the inferior lobe of the right lung, four lesions (23.53%) in the left inferior lobe, two lesions (11.76%) in the left upper lobe, and one lesion (5.88%) in the right middle lobe. Among the five single lesions, two were solid lesions, two were mixed ground-glass lesions, and one was a pure ground-glass lesion. Among the 12 multiple lesions, eight were solid lesions, two were mixed ground-glass lesions, and two were pure ground-glass lesions. Atypical manifestations in image signs: five lesions (29.41%) had single solid and sub-solid nodules, and four lesions (23.53%) had cavitary nodules. Typical manifestation (the presence of "white lung"): three lesions (17.65%) had an air bronchogram, two lesions (11.76%) had crazy-paving signs, two lesions (11.76%) had vascular thickening, and one lesion (5.88%) had halo signs. At reexamination 2-6 days later, 15 lesions (88.24%) had enlarged or increased, and two lesions (11.76%) had decreased or absorbed. CONCLUSIONS: Patients with COVID-19 may have atypical imaging findings. Radiologists should improve their understanding of the novel coronavirus pneumonia to avoid any missed diagnoses.


Assuntos
/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/tendências , Adulto Jovem
2.
Respir Res ; 22(1): 13, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435973

RESUMO

BACKGROUND: It is essential to avoid admission of patients with undetected corona virus disease 2019 (COVID-19) to hospitals' general wards. Even repeated negative reverse transcription polymerase chain reaction (RT-PCR) results do not rule-out COVID-19 with certainty. The study aimed to evaluate a rule-out strategy for COVID-19 using chest computed tomography (CT) in adults being admitted to the emergency department and suspected of COVID-19. METHODS: In this prospective, single centre, diagnostic accuracy cohort study, consecutive adults (≥ 18 years) presenting with symptoms consistent with COVID-19 or previous contact to infected individuals, admitted to the emergency department and supposed to be referred to general ward were included in March and April 2020. All participants underwent low-dose chest CT. RT-PCR- and specific antibody tests were used as reference standard. Main outcome measures were sensitivity and specificity of chest CT. Predictive values were calculated based on the theorem of Bayes using Fagan's nomogram. RESULTS: Of 165 participants (56.4% male, 71 ± 16 years) included in the study, the diagnosis of COVID-19 was confirmed with RT-PCR and AB tests in 13 participants (prevalence 7.9%). Sensitivity and specificity of chest CT were 84.6% (95% confidence interval [CI], 54.6-98.1) and 94.7% (95% CI, 89.9-97.7), respectively. Positive and negative likelihood ratio of chest CT were 16.1 (95% CI, 7.9-32.8) and 0.16 (95% CI, 0.05-0.58) and positive and negative predictive value were 57.9% (95% CI, 40.3-73.7) and 98.6% (95% CI, 95.3-99.6), respectively. CONCLUSION: At a low prevalence of COVID-19, chest CT could be used as a complement to repeated RT-PCR testing for early COVID-19 exclusion in adults with suspected infection before referral to hospital's general wards. Trial registration ClinicalTrials.gov: NCT04357938 April 22, 2020.


Assuntos
/diagnóstico por imagem , Serviço Hospitalar de Emergência/tendências , Admissão do Paciente/tendências , Quarentena/tendências , Tomografia Computadorizada por Raios X/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Quarentena/métodos , Tomografia Computadorizada por Raios X/métodos
4.
Neurology ; 95(11): e1445-e1460, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32817178

RESUMO

OBJECTIVE: To identify biotypes in patients with newly diagnosed Parkinson disease (PD) and to test whether these biotypes could explain interindividual differences in longitudinal progression. METHODS: In this longitudinal analysis, we use a data-driven approach clustering PD patients from the Parkinson's Progression Markers Initiative (n = 314, age 61.0 ± 9.5, years 34.1% female, 5 years of follow-up). Voxel-level neuroanatomic features were estimated with deformation-based morphometry (DBM) of T1-weighted MRI. Voxels with deformation values that were significantly correlated (p < 0.01) with clinical scores (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale Parts I-III and total score, tremor score, and postural instability and gait difficulty score) at baseline were selected. Then, these neuroanatomic features were subjected to hierarchical cluster analysis. Changes in the longitudinal progression and neuroanatomic pattern were compared between different biotypes. RESULTS: Two neuroanatomic biotypes were identified: biotype 1 (n = 114) with subcortical brain volumes smaller than heathy controls and biotype 2 (n = 200) with subcortical brain volumes larger than heathy controls. Biotype 1 had more severe motor impairment, autonomic dysfunction, and much worse REM sleep behavior disorder than biotype 2 at baseline. Although disease durations at the initial visit and follow-up were similar between biotypes, patients with PD with smaller subcortical brain volume had poorer prognosis, with more rapid decline in several clinical domains and in dopamine functional neuroimaging over an average of 5 years. CONCLUSION: Robust neuroanatomic biotypes exist in PD with distinct clinical and neuroanatomic patterns. These biotypes can be detected at diagnosis and predict the course of longitudinal progression, which should benefit trial design and evaluation.


Assuntos
Progressão da Doença , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/metabolismo , Idoso , Análise por Conglomerados , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/classificação , Tomografia por Emissão de Pósitrons/tendências , Tomografia Computadorizada por Raios X/tendências
6.
Magy Onkol ; 64(2): 139-144, 2020 Jun 10.
Artigo em Húngaro | MEDLINE | ID: mdl-32520007

RESUMO

Modern imaging processes, with CT and MRI diagnostics among them, play an increasingly important role in the early diagnosis and determination of the extent and nature of illnesses and the evaluation of their response to therapy. The authors review the technical and technological improvements that have recently been realised in CT and MRI diagnostics and are being adopted in clinical practice. Relying on the results achieved so far, they are analysing the potential for further development. In both modalities, the primary aim is incessant hardware and software upgrades, the implementation of cost-efficient solutions by increasing efficiency and cutting back maintenance and operational costs. The reduction in examination time, the ever-improving image quality and the increased comfort level of the examination environment are of outstanding significance to both the patient and the staff. The interpretation of the generated data is highly dependent on the level of expertise and experience and the knowledge of clinical data and technical opportunities of the person issuing the findings. This process is going to be assisted by artificial intelligence (AI) that the authors also discuss in terms of CT and MRI diagnostics.


Assuntos
Inteligência Artificial , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Imagem por Ressonância Magnética/tendências , Software , Tomografia Computadorizada por Raios X/tendências
7.
Recent Results Cancer Res ; 216: 905-918, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32594412

RESUMO

During the last decade, positron emission tomography/computed tomography (PET/CT) and single-photon emission computed tomography/computed tomography (SPECT/CT) have procured advances in research and clinical application of fusion imaging. The recent introduction of digital PET/CT opens new horizons for multimodality molecular imaging. This system offers more precise, simultaneous morphologic, functional, and molecular information of a living system. Moreover, other combinations of anatomic and functional imaging modalities hold promise in basic medical research or in clinical medicine. These developments are paralleled by advances in the field of biomolecules and particles that will provide new agents useful for more than one imaging modality and will facilitate the study of the same target by different imaging devices. Digital PET/CT may emerge as a powerful multimodality technique with great clinical impact on the diagnosis and therapy assessment of oncological diseases due to its enhanced sensitivity.


Assuntos
Imagem Multimodal/tendências , Tomografia Computadorizada por Raios X/tendências , Humanos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada de Emissão de Fóton Único
8.
J Clin Neurosci ; 78: 273-276, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402617

RESUMO

Subdural hygroma (SDG) represents a common complication following decompressive craniectomy (DC). To our knowledge we present the first meta-analysis investigating the role of clinical and technical factors in the development of SDG after DC for traumatic brain injury. We further investigated the impact of SDG on the final prognosis of patients. The systematic review of the literature was done according to the PRISMA guidelines. Two different online medical databases (PubMed/Medline and Scopus) were screened. Four articles were included in this meta-analysis. Data regarding age, sex, trauma dynamic, Glasgow Coma Scale (GCS), pupil reactivity and CT scan findings on admission were collected for meta-analysis in order to evaluate the possible role in the SDG formation. Moreover we studied the possible impact of SDG on the outcome by evaluating the rate of patients dead at final follow-up and the Glasgow Outcome Scale (GOS) at final follow-up. Among the factors available for meta-analysis only the basal cistern involvement on CT scan was associated with the development of a SDG after DC (p < 0.001). Moreover, patients without SDG had a statistically significant better outcome compared with patients who developed SDG after DC in terms of GOS (p < 0.001). The rate of patients dead at follow-up was lower in the group of patients without SDH (8.25%) compared with patients who developed SDG (11.51%). SDG after DC is a serious complication affecting the prognosis of patients. Further studies are needed to define the role of some adjustable technical aspect of DC in preventing such a complication.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/efeitos adversos , Craniectomia Descompressiva/tendências , Complicações Pós-Operatórias/diagnóstico por imagem , Derrame Subdural/diagnóstico por imagem , Escala de Coma de Glasgow/tendências , Escala de Resultado de Glasgow/tendências , Humanos , Complicações Pós-Operatórias/etiologia , Derrame Subdural/etiologia , Tomografia Computadorizada por Raios X/tendências
11.
Medicine (Baltimore) ; 99(17): e19870, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332652

RESUMO

Bronchoscopy has a lower diagnostic yield for peripheral lung lesions (PLL). Endobronchial ultrasound guide sheath transbronchial lung biopsy (EBUS GS TBLB) has been used to overcome such limitation. Recent studies revealed that combined methods (e.g., EBUS GS TBLB plus electromagnetic navigation [EMN] or virtual bronchoscopic navigation [VBN]) further improve the diagnostic yield. However, those systems are associated with a high cost burden. Accordingly, we attempted to use VBN by computed tomography (CT) workstation (Aquarius iNtuition, TeraRecon) not dedicated only for VBN as an adjunctive tool for EBUS GS TBLB. We performed a prospective registry study to investigate whether VBN by CT workstation could improve the diagnostic yield of PLL.Between February 2017 and February 2018, 128 patients with PLL were divided into 2 groups (VBN and non-VBN [NVBN]). In NVBN group (n = 64), EBUS GS TBLB was performed using a hand-drawn bronchial map based on CT images. VBN group (n = 64) underwent EBUS GS TBLB using VBN images.VBN using CT workstation did not improve the diagnostic yield of EBUS GS TBLB for PLL (VBN vs NVBN, 72% vs 80%, P = .284). VBN slightly reduced procedure time (minute [mean ±â€ŠSD], 25.31 ±â€Š10.33 vs 25.81 ±â€Š9.22), navigation time (time to find the lesion) (9.10 ±â€Š7.88 vs 9.50 ±â€Š7.14), and fluoroscopy time (2.23 ±â€Š2.39 vs 2.86 ±â€Š4.61), while these differences were not statistically significant.The diagnostic yield of EBUS GS TBLB was not improved with VBN (compared with using a hand-drawn bronchial map). Although VBN slightly shortened the procedure-related times, which were not significantly different.


Assuntos
Broncoscopia/métodos , Neoplasias Pulmonares/diagnóstico , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Biópsia/métodos , Broncoscopia/normas , Broncoscopia/tendências , Feminino , Humanos , Pulmão/anormalidades , Pulmão/fisiopatologia , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/tendências
13.
Aust J Gen Pract ; 49(1-2): 12-15, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32008272

RESUMO

BACKGROUND: Medical imaging has an increasing role in the early diagnosis and management of sports injuries. Post-injury management decisions are becoming more heavily dependent on imaging findings. Timely use of appropriate imaging for sports injuries is required for optimal outcomes. OBJECTIVE: The aims of this article are to discuss a range of imaging options that are available in the clinical setting of sports injury, and to provide an insight into the role of each imaging modality and image-guided procedures in enabling early return to activity for the athlete. DISCUSSION: Although imaging is playing an increasing part in the diagnosis and management of sports injuries, the role of each modality is not usually clear because of a considerable overlap of roles of these modalities. A succinct summary of imaging modalities commonly used in the clinical setting of sporting injuries is presented in this article, including the relative merits for choosing the correct imaging modality.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Diagnóstico por Imagem/tendências , Traumatismos em Atletas/diagnóstico , Diagnóstico por Imagem/métodos , Humanos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/tendências , Radiografia/métodos , Radiografia/tendências , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia/métodos , Ultrassonografia/tendências
14.
J Cardiovasc Comput Tomogr ; 14(5): 382-385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32057708

RESUMO

The vision for the Journal of Cardiovascular Computed Tomography's social media efforts is to amplify the impact of the Journal while driving engagement, increasing journal visibility and disseminating content to new audiences globally. Serving as "the front door" to the Journal, this digital evolution represents an important step forward for a field in which advancements in hardware, image processing and clinical evidence have evolved rapidly. However, is social media the panem et circenses of cardiovascular computed tomography (CT), that of superficial appeasement, or of sine qua non; an essential ingredient to the acceleration of the Journal and of the field of cardiovascular CT? This paper aims to present the initial impact of social media within a dedicated cardiovascular CT journal.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Publicações Periódicas como Assunto/tendências , Mídias Sociais/tendências , Tomografia Computadorizada por Raios X/tendências , Difusão de Inovações , Previsões , Humanos , Valor Preditivo dos Testes
15.
Stroke ; 51(4): 1120-1127, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078498

RESUMO

Background and Purpose- Definitions of significant hematoma expansion traditionally focus on changes in intraparenchymal volume. The presence of intraventricular hemorrhage (IVH) is a predictor of poor outcome, but current definitions of hematoma expansion do not include IVH expansion. We evaluated whether including IVH expansion to current definitions of hematoma expansion improves the ability to predict 90-day outcome. Methods- Using data from the PREDICT-ICH study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT), we compared a standard definition of hematoma expansion (≥6 mL or ≥33%) to revised definitions that includes new IVH development or expansion (≥6 mL or ≥33% or any IVH; ≥6 mL or ≥33% or IVH expansion ≥1 mL). The primary outcome was poor clinical outcome (modified Rankin Scale score, 4-6) at 90 days. Diagnostic accuracy measures were calculated for each definition, and C statistics for each definition were compared using nonparametric methods. Results- Of the 256 patients eligible for primary analysis, 127 (49.6%) had a modified Rankin Scale score of 4 to 6. Sensitivity and specificity for the standard definition (n=80) were 45.7% (95% CI, 36.8-54.7) and 82.9% (95% CI, 75.3-88.9), respectively. The revised definition, ≥6 mL or ≥33% or any IVH (n=113), possessed a sensitivity of 63.8% (95% CI, 54.8-72.1) and specificity of 75.2% (95% CI, 66.8-82.4). Overall accuracy was significantly improved with the revised definition (P=0.013) and after adjusting for relevant covariates, was associated with a 2.55-fold increased odds (95% CI, 1.31-4.94) of poor outcome at 90 days. A second revised definition, ≥6 mL or ≥33% or IVH expansion ≥1 mL, performed similarly (sensitivity, 56.7% [95% CI, 47.6-65.5]; specificity, 78.3% [95% CI, 40.2-85.1]; aOR, 2.40 [95% CI, 1.23-4.69]). Conclusions- In patients with mild-to-moderate ICH, including IVH expansion to the definition of hematoma expansion improves sensitivity with only minimal decreases to specificity and improves overall prediction of 90-day outcome.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/epidemiologia , Tomografia Computadorizada por Raios X/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
16.
J Neurointerv Surg ; 12(3): 252-255, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31352374

RESUMO

BACKGROUND: Debate continues as to whether patients with acute ischemic stroke with (suspected) large vessel occlusion benefit from direct referral versus secondary transportation. AIMS: To analyze the change in early infarct signs, collaterals, and acute ischemia volume and their association with transfer time and functional outcome. METHODS: We retrospectively analyzed consecutive transfers between 2013 and 2016 for patients with anterior circulation stroke transported from referring hospitals to our center as potential candidates for thrombectomy. Alberta Stroke Programme Early CT Scores (ASPECTS) were automatically calculated on external and in-house CT using the Brainomix e-ASPECTS software, and collaterals were assessed using the e-CTA tool. Functional status after stroke using the modified Rankin scale (mRS) was obtained. RESULTS: 102 patients with CT scans both at the referring hospital and our center were identified. During patient transfer, e-ASPECTS declined by a median of 1 point (0-2). Functional outcome correlated with the change in e-ASPECTS (decline, n=54) (Spearman rs =0.322, 95% CI 0.131 to 0.482, p=0.001). The median image-to-image time was 149 min (IQR 113-190), but did not correlate with change in e-ASPECTS (p=0.754) and mRS score at 3 months (p=0.25). Preserved good collateral status assessed at the comprehensive stroke center was associated with better functional outcome (rs =-0.271, 95% CI -0.485 to -0.037, p=0.02). CONCLUSIONS: Patient transfer in a drip-and-ship network was associated with declines in e-ASPECTS associated with worse functional outcome. Image-to-image time did not influence this association, but worsening collateral status did.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Transferência de Pacientes/tendências , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Tomografia Computadorizada por Raios X/tendências , Idoso , Idoso de 80 Anos ou mais , Circulação Colateral/efeitos dos fármacos , Circulação Colateral/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes/métodos , Estudos Retrospectivos , Trombectomia/métodos , Trombectomia/tendências , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
J Neurointerv Surg ; 12(2): 132-135, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31273073

RESUMO

OBJECTIVE: The rate of progression of the ischemic lesion is variable in patients with stroke. We tested the hypothesis that the tissue saving effect of mechanical thrombectomy (MT) is greater in fast progressors. METHODS: A single-center cohort of consecutive patients (n=242) with occlusions of the terminal internal carotid or M1 segment of the middle cerebral artery treated with MT (n=195) or best medical treatment (n=47), known time from onset, and full imaging (baseline CT perfusion and follow-up MRI) available was studied. The estimated infarct progression rate (eIPR) was calculated at baseline and patients were categorized as fast/slow progressors according to the median eIPR of 4.8 mL/hour. The primary outcome measure was the interaction between eIPR category and MT on infarct growth. The secondary outcomes assessed the effect of MT on final infarct volume and functional status in relation to the eIPR category. The safety outcomes were mortality and symptomatic intracranial hemorrhage. RESULTS: The eIPR category had a modifying effect (Pi=0.017) of MT on infarct growth that was significantly reduced with MT only in fast progressors (median (IQR) 3.8 mL (-11-55) vs 41 mL (11-107) with medical treatment; p=0.009, adjusted p=0.045). There was also a significant interaction on final infarct volume (Pi=0.005), with a greater reduction after MT in fast progressors. The functional status improved with MT both in fast and slow progressors, with no significant modifying effect of eIPR category (Pi=0.201). There were also no significant interactions on safety outcomes. CONCLUSION: MT in stroke patients with large vessel occlusion limits infarct growth more significantly in fast progressors.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Progressão da Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Trombectomia/tendências , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências , Resultado do Tratamento
18.
Spine (Phila Pa 1976) ; 45(4): 234-243, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31513119

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to elucidate the progression of ossification of the posterior longitudinal ligament (OPLL) in conservatively managed patients and determine its risk factors SUMMARY OF BACKGROUND DATA.: Although several studies have demonstrated how OPLL progresses after laminoplasty or fusion, its progression in conservatively managed patients remains unclear. METHODS: The vertical length of the ossified mass and its thickness at each segment were evaluated on sagittal computed tomography images. Patients with vertical growth >2 mm were included in the vertical progression group. Segments with a thickness progression >1 mm were classified as thickness progressed segments, and patients who had at least one progressed segment were included in the thickness progression group. Based on the characteristics at each disc level, the ossified mass at each segment was classified into four types: type 1, no disc space involvement; type 2, involving the disc space, but not crossing; type 3, crossing the disc space, but not fused; and type 4, completely fused. RESULTS: The progression of ossified mass was observed in younger patients (P < 0.01) and in C2-C3 involvement (P < 0.01) cases. Moreover, progression in both directions was observed more frequently in the mixed-type OPLL (P < 0.01). Progression occurred most often in type 3 segments (72.0%, P < 0.01). In type 3 segments, thickness progression was found more frequently in segments with segmental range of motion (ROM) ≥5° (55.6% vs. 27.8%, P = 0.04). The proportion of segments whose initial thickness was >5 mm was significantly higher among progressed segments (60.0% vs. 35.2%, P = 0.03). CONCLUSION: Young age, C2-C3 involvement, and mixed-type OPLL are risk factors for OPLL progression. Segments with morphology of crossing the segment, but without fusion (type 3), segmental ROM ≥5°, and initial thickness >5 mm need special attention. LEVEL OF EVIDENCE: 3.


Assuntos
Tratamento Conservador/tendências , Progressão da Doença , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Tratamento Conservador/métodos , Feminino , Humanos , Ligamentos Longitudinais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências , Resultado do Tratamento
19.
Pediatr Emerg Care ; 36(4): e217-e221, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29298244

RESUMO

OBJECTIVES: The aim of this study was to examine computed tomography (CT) and ultrasound (US) utilization trends in incident and prevalent pediatric emergency department (ED) urolithiasis patients before and after imaging guideline release. METHODS: We reviewed imaging modalities for children with 2 or more ED encounters between January 1, 2006, and September 1, 2013, for urolithiasis using the Pediatric Health Information System database. Z scores compared the proportion of patient encounters receiving CT and US before (January 1, 2006, to December 31, 2010) and after (January 1, 2011, to September 1, 2013) the release of imaging guidelines. McNemar test for paired proportions compared the percentage of US and CT use between initial versus subsequent visits. Piecewise logistic regression was used to determine the probability of US use and CT use over time before and after the implementation of imaging guidance. RESULTS: Analysis was completed on 2041 patients with 4930 unique encounters for urolithiasis. During 1758 encounters (35.7%), CT was performed initially. Ultrasound was performed 1585 times (32.2%). Fourteen percent fewer CT procedures were performed during first urolithiasis visits after guideline release (P < 0.01), whereas US use increased by 15% (P < 0.01). Fewer CT procedures were performed at later visits compared with the first (P < 0.05), and US was used more during second or later visits than the first (P < 0.05). CONCLUSIONS: Medical providers at large academic pediatric EDs have decreased use of CT and increased use of US over the study time frame to diagnose urolithiasis and are now similar during initial visits (US 36.4% vs CT 36.2%, P = 0.94). Physicians are still more likely to use US as the initial urolithiasis imaging modality during second and later encounters.


Assuntos
Serviço Hospitalar de Emergência , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia/tendências , Urolitíase/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Feminino , Humanos , Incidência , Lactente , Modelos Logísticos , Masculino , Guias de Prática Clínica como Assunto , Recidiva , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Urolitíase/epidemiologia
20.
J Cardiovasc Comput Tomogr ; 14(2): 124-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31843522

RESUMO

The 2019 Society of Cardiovascular Computed Tomography (SCCT) Annual Scientific Meeting (ASM) was perhaps the most impactful meeting in recent memory for the field of cardiovascular CT. Beyond just being the highest attended ASM meeting in the society's history, the virtual impact of the meeting extended farther than ever before due to coordinated social media coverage and participation. As a result, the ASM reinforced the fact that the educational paradigm and audience of scientific meetings has changed. Bound through the hashtag #SCCT2019, social media allowed the research, education, networking and trends from this year's ASM to extend beyond the walls of the meeting with a record setting level of digital global reach. Using posts from Twitter as a prism of interests and response of the global cardiovascular CT community, this article presents the topics with the highest social media engagement from the 14th ASM.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Disseminação de Informação , Comunicação Acadêmica/tendências , Mídias Sociais/tendências , Tomografia Computadorizada por Raios X/tendências , Congressos como Assunto , Difusão de Inovações , Humanos , Valor Preditivo dos Testes
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