RESUMO
BACKGROUND: Contrast-enhanced breast magnetic resonance imaging (MRI) is the most sensitive method for detection of breast cancer. The further spread of breast MRI is limited by the complicated examination procedure and the need for intravenously administered contrast media. OBJECTIVES: Can diffusion-weighted imaging (DWI) replace contrast-enhanced sequences to achieve an unenhanced breast MRI examination? MATERIALS AND METHODS: Narrative review and meta-analytic assessment of previously published studies. RESULTS: DWI can visualize breast lesions and distinguish benign from malignant findings. It is thus a valid alternative to contrast-enhanced sequences. As an additional technique, the use of DWI can reduce the numbers of unnecessary breast biopsies. The lack of robustness leading to variable sensitivity that is currently lower than that of contrast-enhanced breast MRI is a disadvantage of DWI. CONCLUSIONS: Presently, DWI can be recommended as an integral part of clinical breast MRI protocols. The application as a stand-alone technique within unenhanced protocols is still under evaluation.
Assuntos
Neoplasias da Mama , Imagem de Difusão por Ressonância Magnética , Neoplasias da Mama/diagnóstico por imagem , Meios de Contraste , Feminino , Humanos , Imageamento por Ressonância Magnética , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Fractures of the lateral humeral condyle with displacement (>2â¯mm; <2â¯mm articular gap) require open reduction and stabilization. Non-displaced fractures should be treated conservatively; however, there are difficulties in the differentiation of complete (potentially unstable) an incomplete (stable) articular fractures. The aim of this study was to analyze the frequency of conservative and operative treatment approaches as well as the accuracy of treatment decisions based on fracture stability displayed on repetitive Xrays. MATERIAL AND METHODS: A retrospective data analysis of all lateral humeral condyles in children <16 years old treated between 2005 and 2014 was carried out. The patients were classified according to the fracture stability at the time of the incident (primarily stable or unstable) and after 4 days (secondarily stable or unstable) using conventional Xray images. RESULTS: A total of 89 fractures of the lateral humeral condyle were treated (mean age 6.4 years, range 0.9-14 years). Of the fractures 52 (58%) were initially not displaced and 37 (42%) were initially displaced. The latter underwent open reduction and stabilization by osteosynthesis (primarily stable). Of the 52 initially not displaced fractures 35 remained stable and conservative treatment in a plaster cast was performed (primarily and secondarily stable). In 8 out of 52 cases a secondary displacement (>2â¯mm articular gap) occurred after an average of 6 days (range 3-10 days) and operative treatment was initiated (primarily stable and secondarily unstable). No follow-up xray could be performed in 2 of the 52 fractures and at the end of treatment the fractures healed with displacement (primarily stable and secondarily unstable). In 7 of the 52 fractures operative treatment was performed although no displacement (primarily stable) was initially documented (overtreatment). The outcome of the whole study cohort was comparable with that described in the literature. CONCLUSION: Treatment decisions in pediatric lateral humeral condyle fractures are based on the primary and secondary fracture stability as observed in staged follow-up radiographs. Stable fractures, whether complete or incomplete, healed with good results after conservative treatment and overtreatment could be avoided. Unstable fractures, whether primary or secondary during the course, need to be recognized as such and operative treatment with a stable osteosynthesis must be initiated.
Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Fraturas Intra-Articulares , Adolescente , Criança , Pré-Escolar , Fixação Interna de Fraturas , Humanos , Fraturas do Úmero/terapia , Úmero , Lactente , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the efficacy of an intravitreal dexamethasone implant (Ozurdex®) in patients with cystoid macular oedema (CME) suffering from non-infectious uveitis. METHODS: Monocentric, retrospective, single-arm analysis in 49 patients (59 implanted eyes) with inactive uveitis, in whom CME had been unresponsive to corticosteroids and/or immunosuppressants and systemic acetazolamide, and who received a dexamethasone implant. Patients were followed up at 6, 12 and 24 weeks after unilateral (n = 39)/bilateral (n = 10) implantation. The primary outcome measure was central foveal thickness (CFT), as measured by Spectralis optical coherence tomography (OCT); secondary outcome measures were improvement in best-corrected visual acuity (BCVA), laser flare photometry and safety measures, including intraocular pressure (IOP) and cataract progression. RESULTS: At 6, 12 and 24 weeks, mean CFT was reduced (≥ 20â%) in 68, 44 and 45â% and BCVA improved (≥ 2 lines) in 47, 40 and 26â%, respectively, as compared to baseline. At 6, 12 and 24 weeks, significant flare reduction was observed in 70, 41, and 42â%, respectively. Cumulative cataract progression was observed in 12, 18 and 31â% at 6, 12 and 24 weeks, respectively. IOP ≥ 22 mmHg was noted in 5â% at baseline and in 21, 3, and 0â% at 6, 12 and 24 weeks, respectively. CONCLUSIONS: In uveitis patients with CME refractory to systemic anti-inflammatory drugs, the dexamethasone implant improves CME transiently. However, IOP increase and cataract progression are common side effects.
Assuntos
Dexametasona/administração & dosagem , Implantes de Medicamento/administração & dosagem , Edema Macular/tratamento farmacológico , Uveíte/tratamento farmacológico , Transtornos da Visão/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Doença Crônica , Feminino , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Uveíte/complicações , Uveíte/diagnóstico , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Acuidade Visual/efeitos dos fármacos , Adulto JovemRESUMO
OBJECTIVES: To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications. MATERIALS AND METHODS: According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined. RESULTS: Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %). CONCLUSION: The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses. KEY POINTS: ⢠DCE-MRI of the breast has a high accuracy in finding breast cancer. ⢠The set of indications for DCE-MRI of the breast is still very limited. ⢠DCE-MRI can achieve a high accuracy in a 'screening-like' setting. ⢠Accuracy of breast DCE-MRI is strongly dependent on technique and reader experience. ⢠A negative DCE-MRI effectively excludes cancer.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Adulto , Biópsia , Mama/patologia , Meios de Contraste , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The introduction and approval of Ocriplasmin as an intravitreally applicable drug in the pharmocological treatment of vitreomacular traction represents a new therapeutic approach possibly avoiding vitreoretinal surgery. With our article we report our first experience wih Ocriplasmin in clinical practice. METHODS: The indication for intravitreal therapy with Ocriplasmin was provided for symptomatic VMT or macular hole with VMT in 20 patients since March 2013. Surgery was planned in cases with remaining symptoms. Before IVI we performed SD-OCT. Best visual acuity (BCVA) was evaluated preoperatively, 7 and 28 days after treatment and finally every month in 14 treated eyes. SD-OCT images were analysed before treatment and later on with every follow-up examination. In addition to functional and morphological changes we analysed all side effects. RESULTS: The mean BCVA at the beginning of treatment was 0.3 and 0.4 before injection. The indications for treatment were as follows: symptomatic VMT in 10 patients and 4 patients suffering from full thickness macular hole stage 2. In 3 patients spontaneous regression of VMT could be observed with increasing of vision from 0.3 to 0.5. In one patient his macular hole was closed and BCVA increased from 0.2 to 0.6 within 7 days. Two patients showed significant enlargement of their macular holes after 7 days and finally underwent surgery. A massive cystoid macular oedema occurred in one patient. No change in the SD-OCT image could be observed 28 days after treatment. The mean visual acuity improved to 0.6 during a follow-up period of 90 days. Photopsia and disturbing vitreous opacities up to 28 days post injection could be regarded as minor side effects. CONCLUSION: Our first clinical experience with intravitreous injection of Ocriplasmin were performed to confirm the presumed therapeutic effect in patients suffering from VMT. Small macular holes could frequently be closed. The possibility of special side effects must be taken in consideration just as the possibility of spanteous improvement before performing IVI with Ocriplasmin. Further prospective studies must be recommended to be right about Ocriplasmin injections.
Assuntos
Fibrinolisina/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Perfurações Retinianas/tratamento farmacológico , Perfurações Retinianas/patologia , Descolamento do Vítreo/tratamento farmacológico , Descolamento do Vítreo/patologia , Fibrinolíticos/administração & dosagem , Humanos , Injeções Intravítreas , Projetos Piloto , Perfurações Retinianas/complicações , Aderências Teciduais/complicações , Aderências Teciduais/tratamento farmacológico , Aderências Teciduais/patologia , Resultado do Tratamento , Descolamento do Vítreo/complicaçõesRESUMO
BACKGROUND: Endophthalmitis, regarded as a severe complication, can occur after intraocular injection of drugs (IVI). At present only few reports exist on the development of this disease, although recently the number of intraocular injections to treat especially age-related macular degenerations is increasing considerably. METHODS: In this paper we present our results of a retrospective study of 27 patients suffering from endophthalmitis after IVI. Treatment had been performed between January 2008 and March 2012. The indications for IVI were as follows: age-related macular degeneration 19, venous branch occlusion 1, diabethic retinopathies 6, uveitis 1. The following drugs were injected: bevacizumab in 8, Rranibizumab in 19 patients. The following data were assessed: incubation time, best corrected visual acuity that had been determined before treatment and later 3, 6 and 9 months after therapeutic vitrectomy. Additionally we describe the ophthalmoscopic changes and the results of bacteriological studies. RESULTS: Endophthalmitis was diagnosed 5.8 days after IVI on average. The vision of all patients had only been hand movements during the first examination. During the observation time the postoperative visual acuity could be improved only to 1/35 on average. During vitrectomy in 24 out of 27 patients a whitish retinal infiltration could be observed. 18 of 27 patients showed a hypopyon during slit lamp examination. 11 patients developed a retinal detachment and one eye had to be enucleated. CONCLUSIONS: Endophthalmitis must be regarded as a severe complication causing a high risk of retinal detachment with permanent loss of visual acuity. Retinal infiltrations and haemorrhages occur already in the early stages and cause finally a very poor prognosis. The incubation time as a rule amounts to 6 days. The increasing number of IVI and the high risk of damaged retinal structures due to intraocular infections should make postoperative retinal follow-up examinations mandatory, especially during the first 6 days.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Endoftalmite/induzido quimicamente , Endoftalmite/diagnóstico , Injeções Intravítreas/efeitos adversos , Degeneração Macular/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Bevacizumab , Endoftalmite/prevenção & controle , Feminino , Humanos , Degeneração Macular/complicações , Degeneração Macular/diagnóstico , Masculino , Ranibizumab , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Diffusion-weighted imaging (DWI) techniques have shown potential to differentiate between benign and malignant neoplasms. However, the diagnostic significance of using DWI under routine conditions remains unclear. This study investigated the use of echo planar imaging (EPI) and half-Fourier acquired single-shot turbo spin echo (HASTE)-DWI with respect to the three parameters: lesion visibility, apparent diffusion coefficient (ADC) measurements, and size estimation. Following MRM (1.5 T), EPI- and HASTE-DWI were applied in 65 patients. Lesion visibility on DWI was compared with lesion visibility on subtracted contrast-enhanced T1w images (CE-T1w). Statistical tests were applied to diameter, visibility, and ADC value measurements. Seventy-four lesions were identified. ADC value measurements did not differ significantly between the two DWI sequences. The sensitivity and specificity of routine diagnostics (97.4% and 85.7%) were superior to EPI-DWI (87.2% and 82.9%) and HASTE-DWI (76.9% and 88.6%). Selecting only nonmass lesions, DWI did not prove to be of diagnostic value. Lesion demarcation by DWI was significantly lower compared with that by CE-T1w, with EPI-DWI showing the better performance (p < 0.001). No significant differences were found for size measurements between CE-T1w and DWI. Although clearly inferior compared with CE-T1w imaging, both DWI techniques are applicable for lesion assessment and size measurements.
Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Imagem Ecoplanar/métodos , Feminino , Análise de Fourier , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Marcadores de SpinRESUMO
BACKGROUND: Even during consistent anti-vascular endothelial growth factor (VEGF) therapy a reactivation of exudative age-related macular degeneration (AMD) lesions can be observed in many patients. The present case series examined whether a switch from ranibizumab to aflibercept is safe and whether differences in potency can be observed. PATIENTS AND METHODS: In 56 consecutive patients with recurrent activity of AMD according to the morphological criteria of the spectral domain optical coherence tomography (SD-OCT) examination, a change to aflibercept was made after 6-41 (mean 18.9, SD 6.3) injections with ranibizumab. In all controls and before each injection logMAR visual acuity was measured and a SD-OCT (volume scan) was performed in addition to the clinical examination. RESULTS: The mean visual acuity was stable under both therapies. The analysis of the morphological parameters showed a greater reduction of the retinal thickness after the change in therapy (mean retinal thickness within 1000 µm and central foveal thickness) compared to the initial treatment. The changes in the subretinal fluid as well as the height of an associated pigment epithelial detachment (PED) did not show any significant differences. The analysis of the morphological parameters at the level of the photoreceptors showed a decrease in discontinuity in the ellipsoid layer and also in the external limiting membrane (ELM). CONCLUSION: In patients with recurrent or high SD-OCT-based activity of exudative AMD lesions, a switch of the treatment strategy from ranibizumab to aflibercept can achieve a new functional stability in spite of multiple pretreatment. We found morphological indications of a regression of intraretinal edema and improvement in the photoreceptor area. In the context of a well-defined treatment strategy, a switch from anti-VEGF therapy to a similar active substance is safe. Before a definitive evaluation can be made, prospective controlled conditions are required to verify the clinical benefits of the switch.
Assuntos
Ranibizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Transtornos da Visão/prevenção & controle , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Inibidores da Angiogênese/administração & dosagem , Doença Crônica , Esquema de Medicação , Feminino , Humanos , Masculino , Recidiva , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Acuidade Visual , Degeneração Macular Exsudativa/complicaçõesRESUMO
Thirty-six male patients with a diagnosis of chronic alcoholism were detoxified and color vision tests were performed on day 4, 11, and 32 of their abstinence on an inpatient basis (Ishihara color plates, Nagel anomaloscope, three color-matching tests according to Farnsworth). Of the 36 patients, 47.2% manifested color vision deficiencies. The frequency of congenital red/green defects (11.1%) and a ratio of 3:1 deutan/protan defects showed no significant difference from the incidence in the normal population. In 36.1%, manifest acquired color vision deficiencies were diagnosed. Within the course of withdrawal, a marked improvement of these disturbances could be proved. The degree of the disturbance seems to correlate with the severity of withdrawal symptoms, but seems to be unrelated to acute toxic effects of alcohol, nicotine, or medication.
Assuntos
Alcoolismo/reabilitação , Defeitos da Visão Cromática/etiologia , Etanol/efeitos adversos , Síndrome de Abstinência a Substâncias/etiologia , Adulto , Alcoolismo/genética , Testes de Percepção de Cores , Defeitos da Visão Cromática/genética , Marcadores Genéticos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Síndrome de Abstinência a Substâncias/genéticaRESUMO
We investigated a wild-type (wt) p53 rhabdomyosarcoma (A-204) and a mutated (mt p53) undifferentiated sarcoma cell line (US8-93) for their response to X-rays. The observation period was 0 to 96 h after irradiation. Both cell lines showed a strikingly delayed G2/M arrest and an induction of apoptosis after irradiation. Compared with the cell line A-204 (wt p53), the cell line US8-93 (mt p53) revealed a stronger G2/M arrest. In agreement with this, in terms of viability as well as the rate of apoptosis, A-204 (wt p53) showed a stronger response to irradiation than US8-93 (mt p53). We suggest that the different p53 gene status might be the cause for a different response to irradiation.
RESUMO
The influence of partial sleep deprivation during the second half of the night on the secretion of thyroid stimulating hormone (TSH), thyroxin (T4), free T4 (fT4), triiodothyronine (T3), prolactin (PRL), growth hormone (GH), luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (E2) was investigated in 10 healthy young women. Blood samples were drawn at hourly intervals over a 64-hour period (i.e., 3 consecutive days and nights). During night 2, all subjects were awakened at 1:30 a.m. During partial sleep deprivation, TSH concentrations increased significantly and remained elevated throughout the following day. Levels of T4, fT4, and T3 were enhanced during the partial sleep deprivation hours only, and changes in these hormones seemed to be independent of TSH. PRL levels decreased, LH and E2 concentrations increased, and GH and FSH secretion remained unchanged during partial sleep deprivation. This pattern of change of different endocrine axes during partial sleep deprivation resembles those seen after total sleep deprivation, suggesting that similar neurochemical changes are induced by both forms of antidepressant therapy. The late evening GH peak occurred almost exclusively before the onset of sleep. Partial sleep deprivation did not influence the chronobiological profiles of any of the hormones investigated. The chemical changes underlying these alterations are speculated to involve enhancement of central norepinephrine and dopamine activity with a concomitant increase in the activity of the sympathetic nervous system.
Assuntos
Hormônios/sangue , Privação do Sono/fisiologia , Adulto , Ritmo Circadiano/fisiologia , Dopamina/fisiologia , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Hormônio do Crescimento/sangue , Humanos , Hormônio Luteinizante/sangue , Norepinefrina/fisiologia , Prolactina/sangue , Valores de Referência , Hormônios Tireóideos/sangue , Tireotropina/sangueRESUMO
The study was carried out to show how bright light affects intellectual mnestic performance alertness, mood and psychophysiological variables in order to understand the mechanism of bright light which is still unclear. 15 healthy normal volunteers (8 males, 7 females) aged 22-34 years (mean 27) participated in the study. Exposure to bright light (2500 lux) or dim light (500 lux) was intermittent for 4 h between 9 a.m. and 5 p.m. Psychometric investigations for assessment of noopsychic variables, such as attention and concentration on the one hand, and thymopsychic variables, such as drive, on the other hand, as well as flexibility and psychophysiological measurements were carried out before, as well as 1, 2, 4, 6 and 8 h after baseline. As compared to the dim-light condition, subjects who were exposed to biologically-active light showed an improvement of noopsyche in the 6th and 8th hour. Also, the subjective thymopsyche revealed an improvement lasting for the whole investigation period. Psychophysiological measurements reflected an improvement of central and autonomous activation, which was parallel to the improvement of cognition and of well-being. However, biologically-active light did not affect flexibility.
Assuntos
Nível de Alerta/fisiologia , Luz , Adulto , Afeto/fisiologia , Atenção/fisiologia , Feminino , Fusão Flicker/fisiologia , Humanos , Masculino , Memória/fisiologia , Motivação , Atividade Motora/fisiologia , Psicometria , Desempenho Psicomotor/fisiologia , Pupila/fisiologia , Tempo de Reação/fisiologiaRESUMO
Fifty patients were examined immediately after renal transplantation by colour-coded duplex sonography. This procedure is a further development of conventional duplex sonography and permits demonstration of soft tissues in real time, as well as simultaneous imaging of blood flow over the whole imaging area. Perfusion of the transplant could be demonstrated in all patients by this method. Colour-coded duplex sonography can replace scintigraphy and angiography for the demonstration of perfusion of renal transplants. It is, however, not possible to distinguish with certainty between acute tubular necrosis and acute rejection by performing spectrum analysis of blood flow in the renal arteries.
Assuntos
Transplante de Rim , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Criança , Cor , Feminino , Seguimentos , Rejeição de Enxerto , Humanos , Rim/irrigação sanguínea , Rim/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos , Circulação RenalRESUMO
The disease concept of alcoholism was first introduced into the medical literature by Magnus Huss in 1984. Since that time many authors have attempted to define therapy-related sub-groups of chronic alcoholics but have been unsuccessful until now because alcoholism represents a complex development and becomes apparent in various clinical pictures. As the method of cross-sectional investigations does not seem to be able to produce reliable results, we performed a prospective long-term study of 444 alcoholics. The methodological claims in literature were taken into consideration like selection criteria, programmes and goals of therapy, follow-up rate and time, etc. Careful observation of the pertinent parts of the pathogenetic pathway leading to chronic alcoholism enabled the authors to establish 4 sub-groups of alcoholics relevant for treatment.
Assuntos
Alcoolismo/classificação , Consumo de Bebidas Alcoólicas , Alcoolismo/fisiopatologia , Alcoolismo/terapia , Humanos , Prognóstico , Estudos ProspectivosRESUMO
Due to their different physical origin, X-ray mammography and Magnetic Resonance Imaging (MRI) provide complementary diagnostic information. However, the correlation of their images is challenging due to differences in dimensionality, patient positioning and compression state of the breast. Our automated registration takes over part of the correlation task. The registration method is based on a biomechanical finite element model, which is used to simulate mammographic compression. The deformed MRI volume can be compared directly with the corresponding mammogram. The registration accuracy is determined by a number of patient-specific parameters. We optimize these parameters--e.g. breast rotation--using image similarity measures. The method was evaluated on 79 datasets from clinical routine. The mean target registration error was 13.2mm in a fully automated setting. On basis of our results, we conclude that a completely automated registration of volume images with 2D mammograms is feasible. The registration accuracy is within the clinically relevant range and thus beneficial for multimodal diagnosis.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/fisiopatologia , Imageamento Tridimensional/métodos , Mamografia/métodos , Modelos Biológicos , Reconhecimento Automatizado de Padrão/métodos , Técnica de Subtração , Algoritmos , Simulação por Computador , Feminino , Análise de Elementos Finitos , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Perifocal edema, defined as high T2w signal intensity around an enhancing lesion has been described as a specific feature of malignancy. In clinical MR-mammography (MRM), both fatsat and non-fatsat T2w sequences are available. However, there is no consensus on which technique should be used for edema assessment. Consequently, this investigation was performed to compare two commonly used pulse sequences for edema assessment in MRM. MATERIALS AND METHODS: 321 consecutive patients from a 22 month period were included in this investigation. Further selection criteria were histopathological verification of enhancing lesions and absence of presurgical chemotherapy or biopsy, resulting in 108 malignant and 107 benign lesions. All underwent MRM according to international guidelines including a non-fatsat T2w-TSE sequence (TR/TE: 8900/207 ms) and a short tau inversion recovery fatsat sequence (STIR, TR/TE: 8420/70 ms). All images were acquired in the same orientation (axial) and slice thickness. Two experienced radiologists in consensus rated presence of perifocal edema according to an ordinal scale: 0 = not present, 1 = little, 2 = intermediate, and 3 = distinct. Data analysis was performed using crosstabs and Visual Grading Characteristics (VGC) analysis. RESULTS: Overall sensitivity/specificity was calculated with 53.7%/94.4% (T2w-TSE) and 52.8%/95.3% (STIR). VGC revealed an area under the VGC curve of 0.502 (standard error 0.026), P = 0.814. CONCLUSION: Perifocal edema is a specific feature of malignancy with moderate sensitivity. VGC analysis did not reveal significant differences between both pulse sequences analysed. Consequently, both T2w-TSE and STIR images are suitable for assessment of perifocal edema.
Assuntos
Neoplasias da Mama/diagnóstico , Edema/diagnóstico , Imageamento por Ressonância Magnética/métodos , Mamografia , Área Sob a Curva , Neoplasias da Mama/patologia , Meios de Contraste , Feminino , Gadolínio DTPA , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: Accurate staging of primary breast cancer is essential for the therapeutic approach. Modern whole-body MR scanners would allow local and distant staging during a single examination. Accordingly, we designed a dedicated protocol for this purpose and prospectively evaluated the diagnostic accuracy. MATERIALS AND METHODS: 65 consecutive breast cancer patients underwent pre-therapeutic MRI (1.5 T). A bilateral breast protocol (axial: T1w/GRE dynamic contrast-enhanced, T2w/TSE; TA: 10 min) was extended to screen for distant metastasis at one stop without repositioning (coronal: T2w/HASTE, T1w/VIBE; FOV: thorax, abdomen and spine; TA: 90 sec; multichannel surface coils). The standard of reference was S3 guideline-compliant staging examinations. Global assessment regarding the presence of distant metastasis was performed independently by two experienced and blinded radiologists (five-level confidence score). Inter-rater agreement (weighted kappa) and observer scoring were analyzed (contingency tables). RESULTS: The prevalence of synchronous metastases was 7.7 % (n = 5). The protocol enabled global assessment regarding the presence of distant metastasis with high accuracy (sensitivity: 100 %; specificity: 98.3 %) and inter-rater agreement (kappa: 0.92). CONCLUSION: Applying the extended MRI protocol, accurate screening for distant metastasis was possible in combination with a dedicated breast examination.
Assuntos
Neoplasias da Mama/patologia , Carcinoma/patologia , Carcinoma/secundário , Imageamento por Ressonância Magnética/métodos , Programas de Rastreamento/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To evaluate the diagnostic accuracy of qualitative descriptors alone and in combination for the classification of focal liver lesions (FLLs) suspicious for metastasis in gadolinium-EOB-DTPA-enhanced liver MR imaging. MATERIALS AND METHODS: Consecutive patients with clinically suspected liver metastases were eligible for this retrospective investigation. 50 patients met the inclusion criteria. All underwent Gd-EOB-DTPA-enhanced liver MRI (T2w, chemical shift T1w, dynamic T1w). Primary liver malignancies or treated lesions were excluded. All investigations were read by two blinded observers (O1, O2). Both independently identified the presence of lesions and evaluated predefined qualitative lesion descriptors (signal intensities, enhancement pattern and morphology). A reference standard was determined under consideration of all clinical and follow-up information. Statistical analysis besides contingency tables (chi square, kappa statistics) included descriptor combinations using classification trees (CHAID methodology) as well as ROC analysis. RESULTS: In 38 patients, 120 FLLs (52 benign, 68 malignant) were present. 115 (48 benign, 67 malignant) were identified by the observers. The enhancement pattern, relative SI upon T2w and late enhanced T1w images contributed significantly to the differentiation of FLLs. The overall classification accuracy was 91.3 % (O1) and 88.7 % (O2), kappa = 0.902. CONCLUSION: The combination of qualitative lesion descriptors proposed in this work revealed high diagnostic accuracy and interobserver agreement in the differentiation of focal liver lesions suspicious for metastases using Gd-EOB-DTPA-enhanced liver MRI.
Assuntos
Algoritmos , Gadolínio DTPA , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética/métodos , Reconhecimento Automatizado de Padrão/métodos , Adulto , Idoso , Meios de Contraste , Técnicas de Apoio para a Decisão , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Vascularized pigment epithelial detachment (PED) in retinal angiomatous proliferation (RAP) represents a special morphological form of exudative age-related macular degeneration (ARMD) in the natural course and in the frequency of complications, such as tears in the pigment epithelium. In this study the results of inhibition of vascular endothelial growth factor (VEGF) for exudative ARMD with associated PED and RAP were examined. MATERIALS AND METHODS: Functional and morphological data were retrospectively collected for 61 consecutive eyes with RAP in stages 2 and 3 over an average observation period of 108 weeks. Patients were treated with bevacizumab (n=15), ranibizumab (n=29) and pegabtanib (n=17) according to the recommendations of the German Society of Ophthalmology (DOG) and the German Retina Society (RG). After an initial treatment cycle of 3 injections every 4 weeks (6 weeks for pegabtanib), best corrected visual acuity (BCVA), fluorescence angiography (FAG), indocyanine green angiography (ICG-A) and optical coherence tomography (OCT) were evaluated every 12 weeks. RESULTS: The mean visual acuity was 0.8 logMAR before therapy and 0.77 logMAR after therapy so that the average difference to the original acuity was -0.03 logMAR after 12 weeks and 0.00 logMAR after 48 weeks. The central retinal thickness measured by OCT decreased on average by 81.2 µm after the first cycle of injections and by -68.4 µm after 1 year. The maximum depth of PED could be reduced on average by 1 unit and after 1 year by 1.55 units. Better functional and morphological results were obtained by therapy with ranibizumab and avastin compared to pegabtanib (p=0.03). An RIP occurred in 9.8% of the patients (n=6) on average after 16 weeks. CONCLUSIONS: The morphological functional results can be improved in the early months using the therapy strategy presently recommended in Germany. However, in later stages there was a significant worsening of the functional results. Modification of the treatment strategy with respect to close surveillance and possibly early stage repeat treatment would seem advisable.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Aptâmeros de Nucleotídeos/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Descolamento Retiniano/tratamento farmacológico , Neovascularização Retiniana/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Aptâmeros de Nucleotídeos/efeitos adversos , Bevacizumab , Neovascularização de Coroide/diagnóstico , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Verde de Indocianina , Injeções Intravítreas , Degeneração Macular/diagnóstico , Masculino , Oftalmoscópios , Ranibizumab , Retina/efeitos dos fármacos , Retina/patologia , Descolamento Retiniano/diagnóstico , Neovascularização Retiniana/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/efeitos dos fármacosRESUMO
PURPOSE: Hormonal stimulation can induce background enhancement (BE) in MR mammography (MRM). This fact has been assumed to decrease the accuracy of MRM. Consequently, this report investigates: 1. The prevalence of BE in postmenopausal vs. premenopausal women in correlation to hormonal cycle phase (CP). 2. The impact of hormonal status (HS) and BE on diagnostic accuracy. MATERIALS AND METHODS: Consecutive patients over 22 months with complete HS information (week of CP or postmenopausal) were included in this prospective investigation. Exclusion criteria were any hormonal therapy, hysterectomy as well as cancer proven by biopsy. The standard of reference was histopathology. All MRM scans were acquired using the same protocol (1.5 T, dynamic T 1w GRE after 0.1 mmol/kg bw Gd-DTPA i. v.). Two radiologists rated all examinations in consensus according to BI-RADS. BE was defined as: 0 = missing, 1 = moderate, 2 = distinct. RESULTS: 224 patients (150 postmenopausal, 74 premenopausal, 45 in the second week of CP) were included in this study (83 benign and 141 malignant findings). BE was more frequent in premenopausal women (p = 0.006), but did not differ between CP (p = 0.460). Neither HS nor BE had a significant impact on the diagnostic parameters of MRM (p ≥ 0.375). However, regarding BE, the relative number of false positive (FP) findings was highest (5 / 10; 50 %) in the distinct BE group. Regarding HS, 17 % more FP findings were observed in premenopausal women examined outside the second week of CP. CONCLUSION: In premenopausal women, HS leads to increased BE of breast tissue, independent of CP. Distinct BE and less pronounced, non-optimal CP may lead to an increased number of false positive findings.