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1.
J Clin Anesth ; 84: 110995, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36371943

RESUMO

STUDY OBJECTIVE: Determine if psoas muscle area measured in routine preoperative computed tomography scans (CT) can be used to identify patients at increased risk of adverse postoperative outcomes after major elective abdominal surgery. DESIGN: Retrospective analysis of data from a single-centre cohort study conducted in York Hospital between the 1st August of 2015 and the 31st of august of 2020. SETTING: Preoperative clinic. PATIENTS: 639 patients who attended the preoperative assessment clinic prior to major elective colorectal surgery and had an abdominal CT scan done up to 120 days before surgery. INTERVENTIONS: None. MEASUREMENTS: Psoas muscle area at the L3 level was measured in preoperative CT scans and normalised to patient height (psoas muscle index). The lowest sex-stratified tertile of psoas muscle index (PMI) was classed as sarcopenic. The primary outcome was 2-year mortality. Secondary outcomes included postoperative complications assessed using Clavien-Dindo graded major and minor complications, comprehensive complication index (CCI), and length of stay. MAIN RESULTS: Multivariable regression analysis showed that sarcopenia was associated with 2-year mortality (aOR 1.79, 95% CI 1.03-3.10; p = 0.037) and survival at 2-years was significantly reduced in sarcopenic patients (log-rank test, p = 0.012). Sarcopenia was the only statistically significant predictor of major complications in multivariable logistic regression analysis (aOR 1.69, 95% CI 1.04-2.74, p = 0.034) and associated with an estimated increase of 16.6% in the comprehensive complication index (CCI) score of patients that had complications in multivariable linear regression analysis. Sarcopenia was not associated with length of stay. CONCLUSIONS: Sarcopenia defined by psoas muscle mass is an independent predictor of 2-year mortality, major complications and severity of complications after major colorectal surgery and may be used for preoperative risk assessment.


Assuntos
Cirurgia Colorretal , Sarcopenia , Humanos , Músculos Psoas/diagnóstico por imagem , Estudos Retrospectivos , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Estudos de Coortes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
3.
Clin Imaging ; 93: 14-22, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36356382

RESUMO

AIM: To assess the prevalence, clinical significance, and outcomes of incidental findings in CT studies performed for rectal cancer staging. METHOD: This retrospective study was performed at a tertiary colorectal imaging institution. Institutional review board approval was obtained. Consecutive patients who had a CT of the chest, abdomen and pelvis for rectal cancer staging between March 2014 and March 2021 were identified. Patients with a pathologically confirmed primary rectal cancer were included. The imaging reports were reviewed for incidental findings (IFs), which were classified into high, moderate, and low categories, according to their clinical significance. Medical records were reviewed to assess the clinical outcomes of the highly significant IFs. RESULTS: There were 241 eligible patients with a mean age of 67 years (92 females). A total of 942 IFs were found in 235 patients (97.5 %). There were 91 IFs (10 %) of high clinical significance, 371 (39 %) of moderate clinical significance, and 480 (51 %) of low clinical significance. There were 8 synchronous malignancies, all of which were highly clinically significant IFs. There were 4 lung adenocarcinomas, 1 bladder urothelial carcinoma, and 3 renal cell carcinomas. Six patients did not have any IFs (2.5 %). CONCLUSION: IFs were seen in 97.5 % of staging CT scans for rectal cancer, 10 % of which were of high clinical significance. Importantly, these included 8 synchronous malignancies. The results highlight the wide range of potential IFs, which can be encountered in staging rectal cancer scans, and raise awareness as to their potential clinical relevance and impact on the healthcare system.


Assuntos
Carcinoma de Células de Transição , Neoplasias Primárias Múltiplas , Neoplasias Retais , Neoplasias da Bexiga Urinária , Feminino , Humanos , Idoso , Achados Incidentais , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/epidemiologia , Estadiamento de Neoplasias
4.
Clin Imaging ; 93: 31-33, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36371851

RESUMO

Contrast-enhanced mammography (CEM) may provide an alternative to magnetic resonance imaging as a diagnostic exam in women with known or suspected breast cancer or as a screening exam in women at increased risk of breast cancer. Women with breast augmentation, either for oncologic or cosmetic reasons, may fall into this increased risk population and need safe and effective screening and diagnostic imaging tools. Here, we present our clinical practice data in order to demonstrate the feasibility of CEM in women with breast implants. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective review of our tertiary cancer center's database yielded 104 women with breast implants who underwent 198 CEM exams from November 2014 to March 2020. All 198/198 (100%) exams were successfully completed in 104 women. Exam indications included: 174/198 (88%) screening due to increased risk, 10/198 (5%) to evaluate a palpable abnormality, 9/198 (<5%) to evaluate disease extent following neoadjuvant chemotherapy for a known breast malignancy, and 5/198 (<3%) for a 6-month follow-up. 97/104 (93%) women had dense breasts. Routine and implant-displaced low-energy views were obtained with contrast-enhanced images obtained on displaced views for all patients. 197/198 (99.5%) exams yielded no complications. In one exam, the patient experienced mild vasovagal symptoms following the administration of contrast. In conclusion, it is feasible to utilize CEM in both diagnostic and screening capacities in women with breast implants.


Assuntos
Implantes de Mama , Neoplasias da Mama , Humanos , Feminino , Masculino , Implantes de Mama/efeitos adversos , Estudos de Viabilidade , Meios de Contraste , Mamografia/métodos , Neoplasias da Mama/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos
5.
Clin Imaging ; 93: 34-38, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36371852

RESUMO

PURPOSE: To determine what patient factors are associated with a high or an accurate perceived personal risk (PPR) for breast cancer. METHODS: An IRB-approved survey study of women with dense breasts presenting for annual screening mammography was previously conducted from March 2017 to February 2018. Patients were asked to estimate their personal risk for breast cancer and to answer questions about prior breast care-related medical interactions. Survey data were combined post hoc with demographic and clinical data, including breast cancer risk status, and socioeconomic data imputed for each patient from census data. Logistic regression was used to determine which patient factors were associated with a high or accurate PPR. RESULTS: Surveys were completed by 508 women with dense breasts (median age 59.0 years). A high PPR was independently associated with younger age (AOR, 1.71 [95% CI, 1.13, 2.60]), family history of breast cancer (AOR 4.27 [95% CI, 2.81-7.34]), having a clinical "high-risk" designation (AOR, 3.43 [95% CI, 1.13-10.39], and having been called back from screening (AOR, 1.94 [95% CI, 1.14-3.32]). A lower accuracy of PPR was independently associated with a family history of breast cancer (AOR, 0.25 [95% CI, 0.14-0.42]) and having been called back from screening (AOR, 0.58 [95% CI, 0.35-0.98]). CONCLUSION: Women with dense breasts who had a family history of breast cancer or who had been called back from screening had a higher but less accurate PPR. Women with a "high-risk" clinical designation had a higher PPR, even when controlling for family history.


Assuntos
Neoplasias da Mama , Mamografia , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Densidade da Mama , Detecção Precoce de Câncer , Mama/diagnóstico por imagem , Programas de Rastreamento , Fatores de Risco
6.
Clin Imaging ; 93: 39-45, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36375362

RESUMO

PURPOSE: To evaluate the agreement between pathological and radiological staging in oropharyngeal cancer by comparing the 7th and the 8th edition of the AJCC TNM system. METHODS: This retrospective cohort study included 57 cases of oropharyngeal cancer with lymph node metastases staged with the 7th and 8th editions of the AJCC TNM system. Comparison between clinical and radiological features and differences in agreement rates were calculated between radiological and pathological staging for the primary tumor (T) and lymph nodes (N) in HPVpos and HPVneg cases. RESULTS: Comparison of HPVpos and HPVneg revealed a significantly different distribution between early and advanced stages in the 8 th edition, with a relevant number of HPVpos patients redefined from advanced stages whit the 7 th ed. to early stages with 8 th ed. (p < 0.01); no significant differences were found when comparing all diagnostic methods for T and N. CONCLUSIONS: The 8th edition of the AJCC TNM seems to lead to better pretreatment staging. For both HPVpos and HPVneg, the agreement between pretreatment radiological and pathological staging.


Assuntos
Neoplasias Orofaríngeas , Infecções por Papillomavirus , Humanos , Estadiamento de Neoplasias , Infecções por Papillomavirus/diagnóstico por imagem , Infecções por Papillomavirus/patologia , Estudos Retrospectivos , Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Prognóstico
7.
Clin Imaging ; 93: 46-51, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36375363

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is an integral component of the treatment algorithm for proximal hamstring avulsion injuries. OBJECTIVE: The purpose of this study was to survey orthopedic surgeons and musculoskeletal radiologists on the reporting and analysis of proximal hamstring avulsions on MRI. METHODS: Two online surveys were developed to evaluate musculoskeletal radiologists' and orthopedic surgeons' perceptions of MRI-reporting for proximal hamstring avulsion injuries. Each survey was designed to provide information on physicians' best practices with respect to four primary questions (1) ischial tuberosity landmark determination (2) difficulties associated with measuring tendon retraction, (3) important ancillary findings, and (4) perceived clinical impact of measured retraction. Descriptive statistics were calculated for all categorical variables, which were reported as frequencies with percentages. Chi-squared test was utilized to compare rates of responses between surgeons and radiologists. Statistically significant differences were analyzed with post-hoc Fisher's exact tests; p < 0.05 considered statistically significant. RESULTS: 218-Musculoskeletal radiologists and 33-orthopedic surgeons responded to their respective surveys. There were statistically significant differences with responses to two of the questions asked in both surveys; (1) in cases of complete hamstring avulsion (avulsion of both the semimembranosus and conjoint tendon), which arrow represents the tendon gap measurement used for planning surgery? p = 0.028; (2) in cases of avulsion of only the conjoint tendon, which arrow represents the tendon gap measurement used for planning surgery? p = 0.013. Post-hoc testing demonstrated that for either partial or complete hamstring avulsions, more surgeons use the conjoint tendon origin to measure tendon retraction than radiologists (p < 0.05 for both). Significantly more radiologists use the semimembranosus origin to measure hamstring retraction for partial or complete hamstring tears (p < 0.05 for both). However, for each of these questions, both radiologists and surgeons most frequently stated that the conjoint tendon landmark should be used for surgical planning. CONCLUSION: Musculoskeletal radiologists and orthopedists frequently utilize the conjoint tendon origin as an anatomic landmark for measuring complete and partial proximal hamstring avulsion injuries; though, orthopedists are more likely to utilize this landmark. Additionally, the broad surface area of the ischial tuberosity may lead to variability in measurement. CLINICAL IMPACT: Standard landmarks at the ischial tuberosity and/or detailed descriptions of tendon retractions would improve communication between radiologists and surgeons for proximal hamstring avulsions.


Assuntos
Músculos Isquiossurais , Traumatismos da Perna , Cirurgiões Ortopédicos , Lesões dos Tecidos Moles , Traumatismos dos Tendões , Humanos , Músculos Isquiossurais/diagnóstico por imagem , Músculos Isquiossurais/lesões , Músculos Isquiossurais/patologia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/patologia , Ruptura , Imageamento por Ressonância Magnética , Radiologistas
8.
Artigo em Inglês | MEDLINE | ID: mdl-36376097

RESUMO

BACKGROUND AND OBJECTIVES: Neurodegeneration and astrocytic activation are pathologic hallmarks of progressive multiple sclerosis (MS) and can be quantified by serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP). We investigated sNfL and sGFAP as tools for stratifying patients with progressive MS based on progression and disease activity status. METHODS: We leveraged our Comprehensive Longitudinal Investigation of MS at the Brigham and Women's Hospital (CLIMB) natural history study, which includes clinical, MRI data and serum samples collected over more than 20 years. We included patients with MS with a confirmed Expanded Disability Status Scale (EDSS) score ≥3 that corresponds with our classifier for patients at high risk of underlying progressive pathology. We analyzed sNfL and sGFAP within 6 months from the confirmed EDSS score ≥3 corresponding with our baseline visit. Patients who further developed 6-month confirmed disability progression (6mCDP) were classified as progressors. We further stratified our patients into active/nonactive based on new brain/spinal cord lesions or relapses in the 2 years before baseline or during follow-up. Statistical analysis on log-transformed sGFAP/sNfL assessed the baseline association with demographic, clinical, and MRI features and associations with future disability. RESULTS: We included 257 patients with MS who had an average EDSS score of 4.0 and a median follow-up after baseline of 7.6 years. sNfL was higher in patients with disease activity in the 2 years before baseline (adjusted ß = 1.21; 95% CI 1.04-1.42; p = 0.016), during the first 2 years of follow-up (adjusted ß = 1.17; 95% CI = 1.01-1.36; p = 0.042). sGFAP was not increased in the presence of disease activity. Higher sGFAP levels, but not sNfL levels, were associated with higher risk of 6mCDP (adjusted hazard ratio [HR] = 1.71; 95% CI = 1.19-2.45; p = 0.004). The association was stronger in patients with low sNfL (adjusted HR = 2.44; 95% CI 1.32-4.52; p = 0.005) and patients who were nonactive in the 2 years prior or after the sample. DISCUSSION: Higher levels of sGFAP correlated with subsequent progression, particularly in nonactive patients, whereas sNfL reflected acute disease activity in patients with MS at high risk of underlying progressive pathology. Thus, sGFAP and sNfL levels may be used to stratify patients with progressive MS for clinical research studies and clinical trials and may inform clinical care.


Assuntos
Proteína Glial Fibrilar Ácida , Esclerose Múltipla Crônica Progressiva , Proteínas de Neurofilamentos , Humanos , Biomarcadores/sangue , Proteína Glial Fibrilar Ácida/sangue , Imageamento por Ressonância Magnética , Esclerose Múltipla Crônica Progressiva/diagnóstico por imagem , Progressão da Doença , Proteínas de Neurofilamentos/sangue
9.
Clin Imaging ; 93: 60-69, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36395576

RESUMO

Coronavirus disease 2019 (COVID-19) is associated with pneumonia and has various pulmonary manifestations on computed tomography (CT). Although COVID-19 pneumonia is usually seen as bilateral predominantly peripheral ground-glass opacities with or without consolidation, it can present with atypical radiological findings and resemble the imaging findings of other lung diseases. Diagnosis of COVID-19 pneumonia is much more challenging for both clinicians and radiologists in the presence of pre-existing lung disease. The imaging features of COVID-19 and underlying lung disease can overlap and obscure the findings of each other. Knowledge of the radiological findings of both diseases and possible complications, correct diagnosis, and multidisciplinary consensus play key roles in the appropriate management of diseases. In this pictorial review, the chest CT findings are presented of patients with underlying lung diseases and overlapping COVID-19 pneumonia and the various reasons for radiological lung abnormalities in these patients are discussed.


Assuntos
COVID-19 , Radiologia , Humanos , COVID-19/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tórax , Radiologistas
10.
Ultrasonics ; 128: 106882, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36402116

RESUMO

We investigate the role of leaky guided waves in transcranial ultrasound transmission in temporal and parietal bones at large incidence angles. Our numerical and experimental results show that the dispersion characteristics of the fundamental leaky guided wave mode with longitudinal polarization can be leveraged to estimate the critical angle above which efficient shear mode conversion takes place, and below which major transmission drops can be expected. Simulations that employ a numerical propagator matrix and a Semi-Analytical approach establish the transcranial dispersion characteristics and transmission coefficients at different incident angles. Experimental transmission tests conducted at 500 kHz and radiation tests performed in the 200-800 kHz range confirm the numerical findings in terms of transmitted peak pressure and frequency-radiation angle spectra, based on which the connection between critical angles, dispersion and transmission is demonstrated. Our results support the identification of transcranial ultrasound strategies that leverage shear mode conversion, which is less sensitive to phase aberrations compared to normal incidence ultrasound. These findings can also enable higher transmission rates in cranial bones with low porosity by leveraging dispersion information extracted through signal processing, without requiring measurement of geometric and mechanical properties of the cranial bone.


Assuntos
Processamento de Sinais Assistido por Computador , Crânio , Crânio/diagnóstico por imagem , Ultrassonografia , Porosidade
11.
Clin Imaging ; 93: 86-92, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36417792

RESUMO

PURPOSE: This study aims to evaluate qualitative and quantitative imaging metrics along with clinical features affecting overall survival in glioblastomas and to classify them into high survival and low survival groups based on 12, 19, and 24 months thresholds using machine learning. METHODS: The cohort consisted of 98 adult glioblastomas. A standard brain tumor magnetic resonance (MR) imaging protocol, was performed on a 3T MR scanner. Visually Accessible REMBRANDT Images (VASARI) features were assessed. A Kaplan-Meier survival analysis followed by a log-rank test and multivariate Cox regression analysis were used to investigate the effects of VASARI features along with the age, gender, the extent of resection, pre- and post-KPS, ki67 and P53 mutation status on overall survival. Supervised machine learning algorithms were employed to predict the survival of glioblastoma patients based on 12, 19, and 24 months thresholds. RESULTS: Tumor location (p<0.001), the proportion of non-enhancing component (p=0.0482), and proportion of necrosis (p=0.02) were significantly associated with overall survival based on Kaplan-Meier analysis. Multivariate Cox regression analysis revealed that increases in proportion of non-enhancing component (p=0.040) and proportion of necrosis (p=0.039) were significantly associated with overall survival. Machine-learning models were successful in differentiating patients living longer than 12 months with 96.40% accuracy (sensitivity=97.22%, specificity=95.55%). The classification accuracies based on 19 and 24 months survival thresholds were 70.87% (sensitivity=83.02%, specificity=60.11%) and 74.66% (sensitivity=67.58%, specificity=82.08%), respectively. CONCLUSION: Employing clinical and VASARI features together resulted in a successful classification of glioblastomas that would have a longer overall survival.


Assuntos
Neoplasias Encefálicas , Glioblastoma , Adulto , Humanos , Glioblastoma/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Necrose , Aprendizado de Máquina , Algoritmos
12.
Ultrasound Med Biol ; 49(1): 309-317, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441032

RESUMO

Accurate assessment of radiation-induced breast toxicity is crucial for the management of breast radiation therapy (RT). Standard assessment of breast toxicity based on clinicians' visual inspection and palpation has considerable inter- and intra-observer variability. To overcome this challenge, we present an ultrasound histogram method that objectively evaluates radiation-induced breast toxicity longitudinally. In a prospective study, patients enrolled (n = 67) received ultrasound scans at four time points: prior to RT, last day of RT, 3-4 wk post-RT and 9-12-wk post-RT. Ultrasound scans were acquired at five locations (tumor bed and 3, 6, 9 and 12 o'clock) on both breasts. Two hundred sixty-four ultrasound scans and 2640 B-mode images were analyzed. The histogram differences between irradiated and contralateral breasts were calculated to evaluate radiation-induced breast changes. On the basis of the B-mode images, the severity of breast toxicity was graded as absent, mild, moderate or severe. The performance of the histogram method was assessed with the receiver operating characteristic (ROC) curve. The areas under the ROC curve ranged from 0.78 to 0.9 (sensitivity: 0.88-0.96, specificity: 0.53-0.83) at the lower quadrant for differentiating absent/mild from moderate/severe toxicity at various time points. This study provides preliminary evidence that ultrasound histogram differences can serve as an imaging biomarker to longitudinally assess radiation-induced acute toxicity.


Assuntos
Neoplasias da Mama , Lesões por Radiação , Humanos , Feminino , Estudos Prospectivos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Estudos Longitudinais , Mama/diagnóstico por imagem , Ultrassonografia , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia
13.
Ultrasound Med Biol ; 49(1): 318-332, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441033

RESUMO

Methods for patient-specific abdominal aortic aneurysm (AAA) progression monitoring and rupture risk assessment are widely investigated. Three-dimensional ultrasound can visualize the AAA's complex geometry and displacement fields. However, ultrasound has a limited field of view and low frame rate (i.e., 3-8 Hz). This article describes an approach to enhance the temporal resolution and the field of view. First, the frame rate was increased for each data set by sequencing multiple blood pulse cycles into one cycle. The sequencing method uses the original frame rate and the estimated pulse wave rate obtained from AAA distension curves. Second, the temporal registration was applied to multi-perspective acquisitions of the same AAA. Third, the field of view was increased through spatial registration and fusion using an image feature-based phase-only correlation method and a wavelet transform, respectively. Temporal sequencing was fully correct in aortic phantoms and was successful in 51 of 62 AAA patients, yielding a factor 5 frame rate increase. Spatial registration of proximal and distal ultrasound acquisitions was successful in 32 of 37 different AAA patients, based on the comparison between the fused ultrasound and computed tomography segmentation (95th percentile Haussdorf distances and similarity indices of 4.2 ± 1.7 mm and 0.92 ± 0.02 mm, respectively). Furthermore, the field of view was enlarged by 9%-49%.


Assuntos
Aneurisma da Aorta Abdominal , Humanos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ultrassonografia , Imagens de Fantasmas , Tomografia Computadorizada por Raios X , Análise de Ondaletas
14.
Urol Oncol ; 41(1): 49.e7-49.e12, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441069

RESUMO

BACKGROUND: Initial tumour staging in bladder cancer mainly relies on the histo-pathological outcome of the transurethral bladder tumour resection (TURBT) and imaging by means of a CT-scan (CT-intravenous urography; CT-IVU). The reported risk of understaging varies from 24-50%. To further improve the the evaluation of depth of invasion of the bladder tumour the application of magnetic resonance imaging (MRI) may be useful. To substantiate the additional value of this imaging modality the present observational study was designed. STUDY DESIGN: This is a prospective observational study to analyse bladder tumour staging with multiparametric magnetic resonance imaging (mpMRI) in patients with a known bladder tumour, who are planned for radical cystectomy. STUDY POPULATION: Patients with an invasive bladder cancer who are planned for radical cystectomy. INTERVENTION: Patients were accrued during their visit to the outpatient department of urology. They underwent routine cystoscopy, laboratory tests (including serum Creatinin) and CT-IVU investigations and subsequently a mpMRI. MAIN STUDY PARAMETERS/ENDPOINTS: To demonstrate the value of mpMRI in the initial staging of bladder tumours using radiological bladder tumour stage (T-stage) based on mpMRI and pathological bladder tumour stage based on 'whole-mount' histo-pathology after radical cystectomy. RESULTS: Thirty-seven participants with known bladder tumours underwent mpMRI and subsequent cystectomy. After mpMRI 10 participants were diagnosed with non-muscle-invasive bladder cancer (NMIBC) and 27 participants with muscle-invasive bladder cancer (MIBC). In the 'whole-mount' pathology results 12 participants had NMIBC and 25 participants had MIBC. We found a sensitivity and specificity of 0.88 en 0.58 respectively, for the evaluation of MIBC. The positive and negative predictive value were 81% and 70% respectively. The diagnostic accuracy of mpMRI to differentiate between NMIBC and MIBC was 78%. CONCLUSIONS: We found a sensitivity of 88% and a specificity of 58% for mpMRI to discriminate NMIBC from MIBC.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Cistectomia , Bexiga Urinária , Cistoscopia
15.
Urol Oncol ; 41(1): 48.e11-48.e18, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441068

RESUMO

INTRODUCTION: Ductal adenocarcinoma (DA) and intraductal carcinoma (IDC) of the prostate are associated with higher stage disease at radical prostatectomy (RP). We evaluated diagnostic accuracy of biopsy, MRI-visibility, and outcomes for patients undergoing RP with DA/IDC histology compared to pure acinar adenocarcinoma (AA) of the prostate. MATERIALS AND METHODS: A retrospective cohort study of men receiving RP between 2014 and 2021 revealing AA, DA, or IDC on final pathology was conducted. Multivariable logistic regression and Cox proportional hazards regression models were employed. RESULTS: A total of 609 patients were included with 103 found to have DA/IDC. Patients with DA/IDC were older and had higher PSA, biopsy grade group (GG), RP GG, and other pathologic findings (extraprostatic extension, lymphovascular invasion, perineural invasion, pN stage) compared to AA patients (all P < 0.05). On multivariable analysis, higher age, RP GG, and pT3a were associated with DA/IDC on RP (all P < 0.05). Sensitivity and specificity of biopsy compared to RP for diagnosis of DA/IDC was 29.1% (16.7% DA, 27.8% IDC) and 96.6% (99.3% DA, 96.6% IDC), respectively. In a subset of 281 men receiving MRI, PI-RADS distribution was similar for patients with DA/IDC vs. AA (90.7% vs. 80.7% with PI-RADS 4-5 lesions, P = 0.23) with slightly higher biopsy sensitivity (41.9%). DA/IDC was associated with worse BCR (HR = 1.77, P = 0.02) but not biopsy DA/IDC (P = 0.90). CONCLUSIONS: Sensitivity of prostate biopsy was low for detection of DA/IDC histology at RP. Patients with DA/IDC histology had unfavorable pathologic features at RP and worse BCR. Of patients with DA/IDC at RP, 90.7% were categorized as PI-RADS 4 to 5 on preoperative MRI.


Assuntos
Carcinoma Intraductal não Infiltrante , Neoplasias da Próstata , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/cirurgia , Imageamento por Ressonância Magnética , Incidência , Estudos Retrospectivos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia
16.
Anal Chim Acta ; 1237: 340586, 2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36442948

RESUMO

Since oxalate plays an important role in the metabolic assessment of urolithiasis, there is need for convenient and efficient methods for oxalate detection. Herein, we report a three-signal fluorescence strategy for oxalate analysis based on the ability of oxalate to reduce Cu2+ to Cu+, and the ability of pyrophosphate-cerium coordination polymeric networks (PPi-Ce CPNs), cadmium telluride quantum dots (CdTe QDs), and N-Methyl Mesoporphyrin (NMM) to selectively detect Cu2+ and Cu+. The detection range was 100 nM to 1 mM, the turnaround time was 6 min, while the limits of detections for PPi-Ce CPNs, QDs and NMM as reporters were 25 nM, 10 nM and 40 nM, respectively. Visual detection of oxalate relied on color change in the solution, which could be observed using the naked eye. The fluorescent system was used for oxalate analysis in 44 urine samples (32 calcium oxalate stone patients, 12 controls without urolithiasis), and the results were consistent with clinical diagnosis and imaging data. Moreover, the visual system was used to analyze 8 urine samples (4 patients and 4 controls), and showed good consistency with clinical diagnosis and computed tomography imaging results. These findings suggest that the method has potential application for the metabolic assessment of urolithiasis.


Assuntos
Compostos de Cádmio , Pontos Quânticos , Urolitíase , Humanos , Fluorescência , Telúrio , Custos e Análise de Custo , Urolitíase/diagnóstico por imagem , Oxalatos
17.
PET Clin ; 18(1): 21-29, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36442963

RESUMO

Osteoarthritis is a common cause of pain and morbidity resulting in heavy economic burden and large societal costs. Although cross-sectional imaging and in particular MR imaging have largely contributed to a better understanding of the complexity of this complex disease, especially in large joints such as the hip and knee joints, metabolic information of the subchondral bone and periarticular synovial environment has been consistently suggested to provide valuable supplemental information to morphologic and compositional MR imaging. The aim of this narrative review is to provide an overview of the role of the hybrid PET imaging in osteoarthritis with particular focus on PET/MR imaging.


Assuntos
Osteoartrite , Tomografia por Emissão de Pósitrons , Humanos , Osteoartrite/diagnóstico por imagem , Imagem Multimodal , Dor
18.
PET Clin ; 18(1): 39-47, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36442965

RESUMO

Back pain is a common health complaint that contributes globally to medical burden and costs, particularly in elderly populations. Nuclear medicine techniques using PET tracers offer diagnostic information about various spine disorders, including malignant, degenerative, inflammatory, and infectious diseases. Herein, the authors briefly review applications of PET in the evaluation of spine disorders in elderly patients.


Assuntos
Doenças da Coluna Vertebral , Coluna Vertebral , Idoso , Humanos , Doenças da Coluna Vertebral/diagnóstico por imagem , Envelhecimento , Tomografia por Emissão de Pósitrons
19.
PET Clin ; 18(1): 1-20, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36442958

RESUMO

Osteoporosis is a metabolic bone disorder that leads to a decline in bone microarchitecture, predisposing individuals to catastrophic fractures. The current standard of care relies on detecting bone structural change; however, these methods largely miss the complex biologic forces that drive these structural changes and response to treatment. This review introduces sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) as a powerful tool to quantify bone metabolism. Here, we discuss the methods of 18F-NaF PET/CT, with a special focus on dynamic scans to quantify parameters relevant to bone health, and how these markers are relevant to osteoporosis.


Assuntos
Fraturas Ósseas , Osteoporose , Humanos , Fluoreto de Sódio , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia Computadorizada por Raios X , Osteoporose/diagnóstico por imagem
20.
PET Clin ; 18(1): 123-133, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36442960

RESUMO

Brain PET adds value in diagnosing neurodegenerative disorders, especially frontotemporal dementia (FTD) due to its syndromic presentation that overlaps with a variety of other neurodegenerative and psychiatric disorders. 18F-FDG-PET has improved sensitivity and specificity compared with structural MR imaging, with optimal diagnostic results achieved when both techniques are utilized. PET demonstrates superior sensitivity compared with SPECT for FTD diagnosis that is primarily a supplement to other imaging and clinical evaluations. Tau-PET and amyloid-PET primary use in FTD diagnosis is differentiation from Alzheimer disease, although these methods are limited mainly to research settings.


Assuntos
Doença de Alzheimer , Demência Frontotemporal , Humanos , Demência Frontotemporal/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Doença de Alzheimer/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia por Emissão de Pósitrons
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