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1.
AJR Am J Roentgenol ; 211(2): 379-382, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29894218

RESUMO

OBJECTIVE: We describe our institutional experience using a simplified Prostate Imaging Reporting and Data System (PI-RADS) based on biparametric prostate MRI. We discuss two important controversies: the use of gadolinium-based contrast agents and the management of PI-RADS category 3 lesions. CONCLUSION: Our simplified PI-RADS identifies four categories and suggests management strategies for each. The simplified PI-RADS can be an effective system to facilitate multidisciplinary cooperation and to improve the management of suspected prostate cancer.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Sistemas de Informação em Radiologia , Adulto , Idoso , Meios de Contraste , Gadolínio , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia
2.
Radiology ; 278(3): 873-80, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26361222

RESUMO

PURPOSE: To assess the incremental value of split-bolus multidetector computed tomography (CT) combined with fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for follow-up of oncologic patients. MATERIALS AND METHODS: The institutional ethics committee approved the use of this protocol. Thirty-eight oncologic patients who underwent FDG PET/unenhanced multidetector CT and split-bolus multidetector CT for restaging were investigated retrospectively. The split-bolus CT protocol included imaging during the hepatic arterial and portal venous phases in one scan. Software was used for fusion of the independently acquired FDG PET and split-bolus CT data, and fused datasets were compared with FDG PET/unenhanced CT data. The standard of reference for diagnosis of lesions in all patients was a combination of histologic results (if available), clinical results (medical history, physical examination, and laboratory test results), and the results of follow-up imaging (conventional CT, magnetic resonance imaging, and/or ultrasonography) for at least 6 months. Descriptive statistics were used. RESULTS: Fifty-nine true-positive lesions were identified with fused FDG PET/split-bolus CT; 41 were concordant and detected with both split-bolus CT and PET/unenhanced CT, 16 with split-bolus CT only, and two with PET/unenhanced CT. Two different false-positive lesions were identified with PET/unenhanced CT and PET/split-bolus CT. Furthermore, in 20 of 38 (53%) patients, FDG PET/split-bolus CT allowed detection of important additional findings (n = 40) not detected at FDG PET/unenhanced CT. Both the tumor-related findings (n = 13, 32.5%) and the non-tumor-related findings (n = 27, 67.5%) were important to the clinical treatment of these patients. CONCLUSION: Fused FDG PET/split-bolus multidetector CT provides additional information compared with FDG PET/unenhanced multidetector CT in oncologic patients.


Assuntos
Tomografia Computadorizada Multidetectores , Imagem Multimodal , Neoplasias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Feminino , Fluordesoxiglucose F18 , Humanos , Iohexol/administração & dosagem , Iohexol/análogos & derivados , Iopamidol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos , Estudos Retrospectivos
4.
Abdom Imaging ; 40(7): 2127-42, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26063072

RESUMO

Body packing is the ingestion or insertion in the human body of packed illicit substances. Over the last 20 years, drug smuggling has increased global and new means of transport of narcotics have emerged. Among these, the most frequent one is the gastrointestinal tract: from mouth to anus, vagina, and ears. Cocaine is one of the most traded drugs, followed by heroin. Condoms, latex gloves, and balloons are typically used as drug packets for retention in the body. There are different radiologic modalities to detect illicit drugs in body packing: Plain radiography, computed tomography (CT), ultrasound, and magnetic resonance. Current protocols recommend the use of radiography to confirm packet retention and, in case of doubt, the use of abdominal CT scan with reduced mAs. In case of packet rupture, catastrophic effects can occur. Management of patients carrying packets of drugs is a recurrent medico-legal problem. To improve diagnostic accuracy and prevent hazardous complications, radiologists and emergency physicians should be familiar with radiologic features of body packing. The radiologist plays both a social and a medico-legal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location. In this review, we focus on diagnostic errors and medico-legal issues related to the radiological assessment of body packers.


Assuntos
Erros de Diagnóstico , Diagnóstico por Imagem , Embalagem de Medicamentos/métodos , Tráfico de Drogas/legislação & jurisprudência , Corpos Estranhos/diagnóstico , Drogas Ilícitas/legislação & jurisprudência , Abdome/diagnóstico por imagem , Cocaína , Embalagem de Medicamentos/legislação & jurisprudência , Heroína , Humanos , Imageamento por Ressonância Magnética , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Ultrassonografia
5.
Radiol Med ; 120(9): 856-65, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26032854

RESUMO

The main cause of severe civilian trauma is not the same all over the world; while in Europe the majority of cases are due to blunt traumatic injury, in the United States, penetrating gunshot wounds are the most common. Penetrating wounds can be classified into two different entities: gunshot wounds, or more technically ballistic traumas, and sharp penetrating traumas, also identifiable with non-ballistic traumas. Sharp penetrating injuries are mainly caused by sharp pointed objects such as spears, nails, daggers, knives, and arrows. The type of injuries caused by sharp pointed objects depends on the nature and shape of the weapon, the amount of energy in the weapon or implement when it strikes the body, whether it is inflicted upon a moving or a still body, and the nature of the tissue injured. In the assessment of hemodynamically stable patients with sharp penetrating wounds, the main imaging procedure is Multidetector Computed Tomography (MDCT), especially used in complicated cases of penetrating injuries with an important impact on the final therapeutic choice. The diagnostic approach has been changed by MDCT due to its technical improvements, in particular, faster data acquiring and upgraded image reconstructions.


Assuntos
Diagnóstico por Imagem , Ferimentos Penetrantes/diagnóstico , Humanos , Tomografia Computadorizada Multidetectores , Ferimentos Perfurantes/diagnóstico
6.
BMC Gastroenterol ; 14: 16, 2014 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-24447719

RESUMO

BACKGROUND: The aim is to assess the time-density curves (TDCs) and correlate the histologic results for small (≤ 2 cm) PDA and surrounding parenchyma at triphasic Multidetector-row CT (MDCT). METHODS: Triphasic MDCT scans of 38 consecutive patients who underwent surgery for a small PDA were retrospectively reviewed. The TDCs were analyzed and compared with histologic examination of the PDA and pancreas upstream/downstream in all cases. Three enhancement patterns were identified: 1) enhancement peak during pancreatic parenchymal phase (PPP) followed by a rapid decline on portal venous phase (PVP) and delayed phase (DP) at 5 minutes (type 1 pattern: normal pancreas); 2) maximum enhancement in PVP that gradually decreases in DP (type 2 pattern: mild chronic pancreatitis or PDA with mild fibrous stroma); 3) progressive enhancement with maximum peak in DP (type 3 pattern: severe chronic pancreatitis or PDA with severe fibrous stroma). A p value less than 0.05 was considered statistically significant. Sensitivity was calculated for PDA detection and an attenuation difference with the surrounding tissue of at least 10 HU was considered. RESULTS: PDA showed type 2 pattern in 5/38 cases (13.2%) and type 3 pattern in 33/38 cases (86,8%). Pancreas upstream to the tumor had type 2 pattern in 20/38 cases (52,6%) and type 3 pattern in 18/38 cases (47,4%). Pancreas downstream to the tumor had type 1 pattern in 19/25 cases (76%) and type 2 pattern in 6/25 cases (24%). Attenuation difference between tumor and parenchyma upstream was higher of 10 UH on PPP in 31/38 patients (sensitivity = 81.6%), on PVP in 29/38 (sensitivity = 76.3%) and on DP in 17/38 (sensitivity = 44.7%). Attenuation difference between tumor and parenchyma downstream was higher of 10 UH on PPP in 25/25 patients (sensitivity = 100%), on PVP in 22/25 (sensitivity = 88%) and on DP in 20/25 (sensitivity = 80%). Small PDAs were isodense to the pancreas upstream to the tumor, and therefore unrecognizable, in 8 cases (8/38; 21%) at qualitative analysis and in 4 cases (4/38; 10,5%) at quantitative analysis. CONCLUSIONS: The quantitative analysis increases the sensitivity for detection of small PDA at triphasic MDCT.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Intensificação de Imagem Radiográfica , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
Recenti Prog Med ; 104(7-8): 403-5, 2013.
Artigo em Italiano | MEDLINE | ID: mdl-24042416

RESUMO

Tumor stage is an important prognostic factor for patients suffering from lung cancer, because it affects the type of therapeutic treatment to be implemented. Computed tomography is the imaging method of choice for the staging of lung cancer, and for central neoplasm, it is essential to assess any possible involvement of bronchovascular structures that may affect operability. We report our experience based on the use of reconstruction algorithms for the study of the relationship between tumor, bronchi and adjacent vessels.


Assuntos
Angiografia/métodos , Broncografia/métodos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/secundário , Tomografia Computadorizada Multidetectores/métodos , Algoritmos , Vasos Sanguíneos/patologia , Brônquios/patologia , Humanos , Imageamento Tridimensional , Neoplasias Pulmonares/diagnóstico por imagem , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Tamanho do Órgão , Carga Tumoral
11.
Recenti Prog Med ; 104(7-8): 406-8, 2013.
Artigo em Italiano | MEDLINE | ID: mdl-24042417

RESUMO

In the study of urinary tract, traditional imaging modalities still play a vital role in the diagnosis of urothelial tumors of the upper urinary tract; however, the introduction of multidetector computed tomography has greatly changed the way of evaluation of urological patients. In fact, by means of a multiphasic study protocol is possible to recognize with high sensitivity small urothelial lesions and, moreover, to perform at the same time, an evaluation of local and metastatic extension also. The evaluation of the pattern of contrast enhancement in addition, allows a judgement of biological aggressiveness related to tumor grading.


Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Meios de Contraste , Iodatos , Tomografia Computadorizada Multidetectores/métodos , Urografia/métodos , Neoplasias Urológicas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/patologia , Protocolos Clínicos , Meios de Contraste/farmacocinética , Diurese/efeitos dos fármacos , Diuréticos/farmacologia , Feminino , Furosemida/farmacologia , Humanos , Iodatos/farmacocinética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Carga Tumoral , Neoplasias Urológicas/patologia
12.
Recenti Prog Med ; 104(7-8): 409-11, 2013.
Artigo em Italiano | MEDLINE | ID: mdl-24042418

RESUMO

In the study of inflammatory kidney diseases, the use of integrated imaging is considered the best diagnostic approach. However, given the high cost of radiological examinations, the radiologist is responsible for the choice of the best method to solve the question asked by the clinician. In this paper are presented the main imaging methods for the study of pyelonephritis and, based on our experience, it is emphasized the role of multidetector Computed Tomography urographic technique in the identification, characterization and subsequent follow-up of inflammatory kidney diseases.


Assuntos
Tomografia Computadorizada Multidetectores/métodos , Pielonefrite/diagnóstico por imagem , Urografia/métodos , Idoso , Meios de Contraste , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Urolitíase/diagnóstico por imagem
13.
Recenti Prog Med ; 104(7-8): 412-4, 2013.
Artigo em Italiano | MEDLINE | ID: mdl-24042419

RESUMO

Ultrasound examination of the testis is the imaging modality of choice for the evaluation of intratesticular focal lesions. In spite of its high sensibility, eco-Doppler-elastography is lacking of specificity in discrimination between benign and malign lesions, not always allowing us to make a definitive diagnosis of malignancy. When a diagnostic doubt persists, for such lesions that are indeterminate at clinical and radiological evaluation, it is possible to recur to ultrasound-guided testicular needle biopsy. This paper describes the main application scenarios of testicular fine-needle aspiration under ultrasound guidance and the experience in our institute.


Assuntos
Biópsia por Agulha Fina/métodos , Técnicas de Imagem por Elasticidade , Testículo/patologia , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Criança , Criptorquidismo/patologia , Cistadenoma Papilar/patologia , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Teratoma/patologia , Neoplasias Testiculares/patologia , Testículo/diagnóstico por imagem , Adulto Jovem
14.
Recenti Prog Med ; 104(11): 597-600, 2013 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-24336623

RESUMO

Acute appendicitis is the most common cause of acute abdomen requiring emergency surgery. In particular, it affects patients older than 20 years and diagnosis is challenging in this patient subset. The radiologic methods (ultrasound and computed tomography) play a key role in the identification, characterization and staging of the disease as well as optimal timing of surgery. The aim of our study is to assess the usefulness of ultrasound imaging in the diagnosis of acute appendicitis and in a retrospective analysis of 54 ultrasound and computed tomography exams performed in the emergency department.


Assuntos
Apendicectomia/métodos , Apendicite/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Ultrassonografia
15.
Anticancer Res ; 43(1): 297-303, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36585156

RESUMO

The application of biparametric magnetic resonance imaging (bpMRI) [T2-weighted (T2W) and diffusion weighted imaging (DWI)/apparent diffusion coefficient (ADC)] using dedicated structured methods, such as Simplified Prostate Imaging Reporting and Data System (S-PI-RADS) for the detection, categorization, and management of prostate cancer (PCa) is reported. Also, Prostate Imaging Reporting for Local Recurrence and Data System (PI-RRADS) for the detection and assessment of the probability of local recurrence after radiotherapy (RT) or radical prostatectomy (RP) in patients with biochemical recurrence (BCR) is proposed. Both S-PI-RADS and PI-RRADS assign to DWI/ADC a main role for the above purpose. S-PI-RADS identifies four categories and, on the basis of the qualitative and quantitative analysis of the restricted diffusion on ADC map and lesion volume, distinguishes two categories of lesions: category 3 (moderately homogeneous hypointense on ADC map) and category 4 (markedly homogeneous or inhomogeneous hypointense on ADC map). Ιn category 3, two subcategories (3a: volume <0.5 cm3 and 3b: volume ≥0.5 cm3) suggesting clinical management. PI-RRADS distinguishes four assessment categories and suggests the stratification of the probability (ranging from very low for category 1 to very high for category 4) of local disease recurrence. In clinical practice, S-PI-RADS and PI-RRADS, based on bpMRI represent a potential valid approach that may facilitates the detection and management of PCa and for detecting local recurrence after treatment improving communication with other professionals.


Assuntos
Imageamento por Ressonância Magnética , Neoplasias da Próstata , Masculino , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Meios de Contraste , Imagem de Difusão por Ressonância Magnética/métodos , Próstata/patologia , Estudos Retrospectivos , Proteínas ras
16.
Urol Res Pract ; 49(4): 233-240, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37877824

RESUMO

We investigated a novel dedicated Prostate Imaging for Local Recurrence Reporting and Data System (PI-RRADS) in biochemical recurrence after radiotherapy (RT) and rad- ical prostatectomy (RP) evaluating biparametric magnetic resonance imaging (bpMRI) exams, at 3T MRI of 55 patients. Associating bpMRI and biochemical recurrence data, we calculated bpMRI diagnostic accuracy. Four probability categories, from 1 (very low) to 4 (very high), were distinguished. In 20 patients with radiotherapy, 25% and 75% of lesions were reported as PI-RRADS 3, and 4, respectively. In 35 patients with radi- cal prostatectomy, 7.7% of lesions were included in PI-RRADS 1-2, whereas 40.4% and 51.9% in PI-RRADS 3 and 4 categories, respectively. Excellent agreement and significant correlation between bpMRI and biochemical recurrence were found. BpMRI showed sensitivity, specificity, positive predictive value, negative predictive value, false-posi- tive value, false-negative value, and total diagnostic accuracy of 96.15%, 86.7%, 97.4 %, 81.25%, 13.3%, 3.8% and 94.6%, respectively. BpMRI-based PI-RRADS allows the detection and localization local recurrence in biochemical recurrence after RT and RP contributing in clinical management and treatment.

18.
Turk J Urol ; 47(3): 175-182, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-35929870

RESUMO

Biparametric magnetic resonance imaging (bpMRI) of the prostate has emerged as an alternative to multiparametric MRI (mpMRI) for the detection of clinically significant prostate cancer (csPCa). However, while the Prostate Imaging Reporting and Data System (PI-RADS) is widely known for mpMRI, a proper PI-RADS for bpMRI has not yet been adopted. In this review, we report the current status and the future directions of bpMRI, and propose a simplified PI-RADS (S-PI-RADS) that could help radiologists and urologists in the detection and management of PCa.

19.
Turk J Urol ; 47(6): 448-451, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35118962

RESUMO

Prostate specific antigen (PSA) remains the most used test to assess the response after therapies including the radiation therapy (RT). Apparent diffusion coefficient (ADC) derived from the conventional diffusionweighted imaging (DWI), as a part of noncontrast or biparametric MRI (bpMRI) (T2-weighted and DWI), offers diagnostic accuracy and cancer detection rate equivalent to that of multiparametric MRI. Cellular changes induced by RT can be quali-qualitatively demonstrated as early as 3months after RT as an increase in the signal intensity of the tumor on the ADC map. ADC, in association with PSA, represents a potential biomarker imaging for evaluating treatment efficacy in PCa both during and shortly after RT.

20.
Abdom Radiol (NY) ; 45(12): 3974-3981, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32303773

RESUMO

Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 update, in the attempt to improve clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) of the prostate, has clear limitations. The role of dynamic contrast-enhanced sequences is not defined, precise guidance on the clinical management (biopsy or clinical surveillance) for score 3 lesions [equivocal for clinical significant prostate cancer (sPCa)] is not offered and criteria for lesions interpretation remain difficult and subjective. We report criteria and arguments in supporting the use of abbreviated or biparametric prostate MRI protocol in clinical practice for detection and management of PCa.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos
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