RESUMO
BACKGROUND: A 25-year-old woman presented with a history of abdominal pain. Endoscopy of the upper gastrointestinal tract revealed a tumor that protruded into the prepyloric antrum. After resection, a 'high-risk' gastrointestinal stromal tumor was histologically confirmed. INVESTIGATIONS: Endoscopy, endoscopic ultrasound, hemigastrectomy, [(18)F]-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT scan, histological examination, immunohistochemistry, cardiac MRI, high-resolution CT with electrocardiogram gating, CT angiography, and cardiac surgery. DIAGNOSIS: Gastrointestinal stromal tumor, epicardial paraganglioma, and Carney's syndrome. MANAGEMENT: Abdominal ultrasound and endoscopy combined with endoscopic ultrasound, annual FDG-PET/CT scan.
Assuntos
Tumores do Estroma Gastrointestinal/patologia , Neoplasias Cardíacas/patologia , Neoplasias Primárias Múltiplas/patologia , Paraganglioma Extrassuprarrenal/patologia , Pericárdio/patologia , Tomografia por Emissão de Pósitrons , Neoplasias Gástricas/patologia , Adulto , Biomarcadores Tumorais , Administração de Caso , Angiografia Coronária , Diagnóstico Diferencial , Feminino , Gastrectomia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/secundário , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Humanos , Imageamento por Ressonância Magnética , Neoplasias Primárias Múltiplas/classificação , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Paraganglioma Extrassuprarrenal/diagnóstico por imagem , Paraganglioma Extrassuprarrenal/cirurgia , Pericárdio/diagnóstico por imagem , Pericárdio/cirurgia , Antro Pilórico/diagnóstico por imagem , Antro Pilórico/patologia , Antro Pilórico/cirurgia , Indução de Remissão , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Síndrome , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
PURPOSE: To prospectively evaluate accuracy of gadolinium-enhanced three-dimensional (3D) magnetic resonance (MR) angiography with gadodiamide and gadopentetate dimeglumine (0.1 mmol/kg), with intraarterial DSA as reference standard, for imaging abdominal and iliac arterial stenoses. MATERIALS AND METHODS: The study was approved by all institutional review boards; informed consent was obtained from each subject before procedures. Two hundred forty-seven subjects were included; 240 received either contrast agent and were available for safety analysis; 222 were available for accuracy analysis. Enhanced 3D MR angiography and DSA were performed; image data were evaluated in a double-blinded randomized study. Stenoses were classified as not relevant (<50% stenosis) or relevant (> or =50%). For detection of main stenosis, accuracy with enhanced 3D MR angiography compared with that with DSA was determined. RESULTS: The difference in accuracy for imaging with gadodiamide and gadopentetate was 3.6%. Noninferiority was inferred because the lower bound of the exact two-sided 95% confidence interval was -10.1 and was above the noninferiority margin (-15%). Accuracy for detection of the main stenosis was low, 56.4% for gadodiamide and 52.8% for gadopentetate group. Subgroup analysis with exclusion of inferior mesenteric artery and internal iliac arteries and the most false-positive stenosis classifications yielded better results: 76.6% and 71.6%, respectively. Sensitivity, specificity, and negative and positive predictive values did not differ substantially between study groups. In the main analysis, values were 44%, 96%, 35%, and 97% for gadodiamide and 44%, 83%, 30%, and 90% for gadopentetate, respectively. In the subgroup analysis, values were 66%, 95%, 61%, and 96% for gadodiamide and 63%, 86%, 58%, and 88% for gadopentetate, respectively. CONCLUSION: Noninferiority of gadodiamide versus gadopentetate was verified based on the primary end point, which was accuracy for detection of the main stenosis with enhanced 3D MR angiography compared with DSA.