RESUMO
T-cell Acute Lymphoblastic Leukemia (T-cell ALL) is a rare haematological neoplasia, that affects children and less commonly adults. Female genital tract and particularly uterus involvement in acute ALL is rare. This report presents the CT features of a 64-year-old woman with uterine relapse of T-cell ALL, occurring 11 months after the diagnosis, as a second, unique relapse of disease. The patient was asymptomatic when a CT examination showed a homogenous thickness of the uterine wall in comparison with the previous CT examination. Histology from biopsy specimens, obtained through hysteroscopy, confirmed T-cell ALL localisation (TdT+, CD10+, CD3c+ and CD2+). The uterus could be a site of relapse in patients suffering from ALL. Even though an MRI examination could better demonstrate the disease in cases of suspected female genital tract involvement by ALL, the comparison of differences between a present and a previous CT examination is sufficient to suspect the diagnosis.
Assuntos
Infiltração Leucêmica/diagnóstico por imagem , Leucemia-Linfoma Linfoblástico de Células T Precursoras/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Útero/diagnóstico por imagem , Antígenos de Diferenciação de Linfócitos T/análise , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Neoplasias da Mama/tratamento farmacológico , DNA Nucleotidilexotransferase/análise , Feminino , Humanos , Histeroscopia , Imunofenotipagem , Pessoa de Meia-Idade , Segunda Neoplasia Primária , Leucemia-Linfoma Linfoblástico de Células T Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células T Precursoras/patologia , Linfócitos T/química , Linfócitos T/patologiaRESUMO
Multidetector row computed tomography (MDCT) represents the technique of choice for the majority of pathologies today and is responsible for the majority of diagnoses. However, despite the low number of studies dedicated to errors in MDCT, CT reporting seems especially prone to generating errors and errors are an inevitable part of MDCT practice. Most of these arise during image interpretation but, differently from other radiological techniques, the awareness of radiologists regarding technical CT aspects and pathologies substantially contribute in generating errors, in particular because CT technology expands rapidly and radiologists do not routinely receive specific and appropriate training for its use and because CT examinations are not the same for each patient and each pathology and the choice of the most appropriate CT examination (including the dose exposure to the patient) presumes a very large awareness from radiologists. This review is aimed at increasing awareness regarding the type of errors in MDCT and in particular to also highlight technical and procedural errors.
Assuntos
Erros de Diagnóstico , Tomografia Computadorizada Multidetectores , Humanos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por ComputadorAssuntos
Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/diagnóstico , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/etiologia , Sarcoidose/complicações , Sarcoidose/diagnóstico , Adolescente , Encéfalo/diagnóstico por imagem , Seio Cavernoso , Doenças do Sistema Nervoso Central/tratamento farmacológico , Doenças dos Nervos Cranianos/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Doenças do Nervo Óptico/tratamento farmacológico , Sarcoidose/tratamento farmacológico , SíndromeRESUMO
PURPOSE: This study evaluated the feasibility of magnetic resonance (MR) volumetry using a diffusion-weighted data set (V(DWI)) and compared it with conventional T2-weighted volumetry (V(C)) in patients affected by rectal cancer treated with chemoradiation therapy (CHRT). MATERIALS AND METHODS: Fourteen patients with a biopsy diagnosis of rectal cancer underwent MR examination before and after CHRT. T2-weighted images were used to extrapolate V(C). A diffusion-weighted (DW) sequence was acquired [spin-echo diffusion-weighted echo-planar imaging (SE-DW-EPI)] with a b-value of 800 s/mm(2) and volume (V(DWI)) was calculated by semiautomatic segmentation of tumour hyperintensity. Two radiologists independently assessed volumes and analysed data in order to establish interobserver agreement and compare and correlate volumes to tumour regression grade (TRG), as evaluable at pathological examination of the surgical specimen. RESULTS: Interobserver agreement was 0.977 [(95% confidence interval (CI) 0.954-0.989) and 0.956 (95% CI 0.905-0.980) for V(C) and V(DWI) and 0.964 (95% CI 0.896-0.988) and 0.271 (95% CI-0.267 to 0.686) between V(C) and V(DWI) before and after CHRT. The correlation between TRG and V(C) and V(DWI) was, respectively, rho = 0.597 (p<0.05) and r(2)=0.156 (p=0.162) and rho=0.847 (p<0.001). CONCLUSIONS: V(DWI) seems to be a promising tool for assessing response to CHRT in rectal cancer. Further studies on large series of patients are needed to refine the technique and evaluate its potential predictive value.
Assuntos
Quimiorradioterapia/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Retais/terapia , Idoso , Antineoplásicos/uso terapêutico , Biópsia , Imagem de Difusão por Ressonância Magnética , Estudos de Viabilidade , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Organoplatínicos/uso terapêutico , Oxaliplatina , Dosagem Radioterapêutica , Neoplasias Retais/patologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: Ground-glass pulmonary opacities (GGOs) are increasingly encountered in routine clinical practice and an accurate differentiation between benign and malignant lesions is crucial. The aim of this study is to evaluate the relationship between radiological features and the actual biological behavior of these nodules. The secondary endpoint is to identify any radiological predictors able to choose the type of surgical resection and the extent of lymphadenectomy. MATERIALS AND METHODS: This single-center retrospective study included all patients, who underwent high resolution computed tomography (HRCT) and surgical resection for GGOs between 2010 and 2020. Histopathological sampling focused on lesion size, histology, growth pattern, amount of lepidic component, percentage of ground-glass (GG), grade of tumor and proliferation index (Ki67). RESULTS: In 56 patients enrolled, 65 lesions (15 pure GG and 50 part-solid) were resected (44 lobectomies, 9 anatomical segmentectomies, 12 wedge resections). A direct significant correlation was found between: the GG at HRCT and the amount of lepidic component (p < 0.0001; R = 0.305), the tumor grading and the lepidic component at HRCT (p = 0.003), the percentage of GG and the expression of Ki67 (p = 0.016), the lepidic percentage and the expression of Ki67 (p = 0.004; R = 0.223). A total of 609 lymph-nodes were removed (stations N1 and N2) and histopathological analysis was negative for nodal involvement in all cases. CONCLUSION: Pure and part-solid GGOs could benefit from less invasive and lung sparing surgery with just nodal sampling. These would reduce surgical complications and guarantee a better quality of life for the patient. The major limitations are the number of patients and the lack of a longer follow-up.
Assuntos
Neoplasias Pulmonares , Humanos , Antígeno Ki-67 , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Qualidade de Vida , Estudos RetrospectivosRESUMO
Sarcoidosis is a multisystem disease of unknown origin. Granulomatous bone involvement has an overall incidence of 1-13%. This incidence is probably underestimated in certain patient series because bone involvement is often asymptomatic. The small bones of hands and feet are the most common localizations, while skull, knee, rib, pelvic and sternal localizations are rarely reported. Here we describe some interesting cases of chronic sarcoidosis with unusual bone localizations observed at our regional referral centre for sarcoidosis. We also review the literature to underline the complexity of the disease, the problem of differential diagnosis with respect to malignancies and the need for appropriate and effective therapy of this rare localization.
Assuntos
Doenças Ósseas/patologia , Doenças Raras , Sarcoidose/patologia , Alendronato/uso terapêutico , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/tratamento farmacológico , Neoplasias Ósseas/diagnóstico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metotrexato/uso terapêutico , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Osteólise/diagnóstico por imagem , Osteólise/patologia , Radiografia , Costelas/diagnóstico por imagem , Costelas/patologia , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Crânio/diagnóstico por imagem , Crânio/patologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Resultado do TratamentoRESUMO
PURPOSE: To identify the predictors of malignancy on CT for the evaluation of gastrointestinal stromal tumors (GIST) by correlating CT findings with the mitotic index in order to propose a "CT-based predictive model of Miettinen index." METHODS: One radiologist and one resident in radiology with 14- and 4-year experience in oncological field reviewed the CT findings of 42 patients by consensus, with respect to lesion site, size, contour, tumor growth pattern, enhancing pattern, degree of enhancement of tumor, percentage of tumor necrosis, mesenteric fat infiltration, ulceration, calcification, regional lymphadenopathy, direct invasion to adjacent organs, and distant metastasis. All parameters were correlated with the mitotic index evaluated at histopathological analysis following surgery. Normality of variables was evaluated using Shapiro-Wilk test. Pearson's correlation test was used to assess the interaction between variables. The diagnostic accuracy percentage of tumor necrosis was measured by receiver operating characteristic (ROC) analysis for detecting whether the number of mitosis per 50 high-power fields was > 5. RESULTS: A significant statistical correlation was found between percentage of tumor necrosis and the mitotic index (p < 0.005), dimension, and location of the tumor. CONCLUSION: CT could be an accurate technique in the prediction of malignancy of GIST in a CT risk assessment system, based on the location of the tumor, its size, and the percentage of tumor necrosis.
Assuntos
Tumores do Estroma Gastrointestinal , Medição de Risco , Tomografia Computadorizada por Raios X , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: The aim of this study was to determine by triplephase helical computed tomography (CT) the appearance of atypical small (< or = 2 cm) hepatic haemangiomas (HHs) in the non-cirrhotic patient. MATERIALS AND METHODS: We retrospectively reviewed the hepatic arterial-dominant phase (HAP), portal venous phase (PVP) and delayed-phase (DP) helical CT images of 47 patients with 52 atypical small (< or = 2 cm) HHs associated with 34 typical small HHs. Images were assessed to identify the patterns of enhancement of atypical HHs and correlate their appearance with that of typical small HHs in the delayed phase. Interobserver variability and kappa value were calculated. Statistical significance was calculated by the Fisher exact test. RESULTS: The 52 atypical small HHs were categorised as follows: type 1a (hyperattenuating in the HAP, n=17), type 1b [hyperattenuating with transient hepatic attenuation difference (THAD) around the lesion in the HAP, n=12], type 2a (homogeneously hypoattenuating in the HAP or PVP, n=9), type 2b (hypoattenuating with "bright-dot" sign in the HAP or PVP, n=13) and type 3 (hypoattenuating with central enhancing area, n=1). Interobserver agreement was perfect for HHs of types 1a, 1b, 2a and 3. On DP images, the appearance of atypical small HHs was identical to that of typical small HHs in all cases (p<0.0001), with lesions showing homogeneous isoattenuation to the aorta or liver parenchyma without peripheral capsule. CONCLUSIONS: Triple-phase helical CT scans can distinguish several types of atypical small HHs. The demonstration of patterns similar to those of typical forms on DP CT is fundamental for the diagnosis.
Assuntos
Hemangioma/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Feminino , Hemangioma/patologia , Humanos , Aumento da Imagem/métodos , Iohexol/análogos & derivados , Fígado/irrigação sanguínea , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ácidos Tri-IodobenzoicosRESUMO
PURPOSE: The authors retrospectively reviewed six cases of histologically proven Erdheim-Chester disease (ECD) to evaluate organ involvement and clinical and radiological findings. MATERIALS AND METHODS: Through a search of the pathology databases of four Italian hospitals, we identified six men (mean age, 56 years) with a histological diagnosis of ECD. Histology was performed on retroperitoneal or pulmonary biopsy, depending on disease involvement on imaging. Patients underwent plain radiography of the lower limbs and chest, total-body computed tomography (CT) and bone scintigraphy. Magnetic resonance (MR) imaging was performed in two patients to evaluate the lower limbs and in one patient to study the brain, the chest and the abdomen. RESULTS: Clinical manifestations included dyspnoea (n=2), hydronephrosis (n=2) and bone pain (n=1). Bilateral symmetrical osteosclerosis of the metaphyseal and diaphyseal portions of the lower-limb long bones was present in five patients. Imaging studies revealed extraskeletal manifestations in all patients, including involvement of the retroperitoneal space (n=4), the lung (n=4) and the heart (n=2). CONCLUSIONS: ECD is a multiorgan disease that displays constant involvement of the bones and retroperitoneum; in particular, of the perirenal fat. Although the diagnosis of ECD is histological, imaging can raise suspicion and help to establish a presumptive diagnosis.
Assuntos
Doença de Erdheim-Chester/diagnóstico , Adulto , Idoso , Biópsia , Dispneia/etiologia , Doença de Erdheim-Chester/diagnóstico por imagem , Humanos , Hidronefrose/etiologia , Itália , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the usefulness of magnetic resonance imaging (MRI) in Tietze's syndrome which, to our knowledge, has not previously been reported in the literature. METHODS: Twelve consecutive outpatients with clinical features of Tietze's syndrome underwent evaluation, including the anamnesis, clinical general examination, clinical evaluation of costosternal and sternoclavicular joints (SCJ) and biochemical and instrumental investigations. Twenty normal subjects age- and sex-matched to the patients' group were examined in a similar manner. MRI of costosternal and SCJ was performed using a 1.5 Tesla unit (Gyroscan NT 1.5 Philips, The Netherlands and GE Signa Excite HD, GE Healthcare, Milwaukee, Wis., USA). RESULTS: The MRI pattern of primary Tietze's syndrome was characterized as follows: enlargement and thickening of cartilage at the site of complaint (12/12 patients); focal or widespread increased signal intensities of affected cartilage on both TSE T2-weighted and STIR or FAT SAT images (10/12 patients); bone marrow oedema in the subcondral bone (5/12 patients); vivid gadolinium uptake in the areas of thickened cartilage, in the subcondral bone marrow and/or in capsule and ligaments (10/12, 4/12 and 7/12 patients respectively). CONCLUSION: Magnetic resonance is an excellent technique to evidence both the cartilage and bone abnormalities, therefore it represents the elective method in the investigation of primary Tietze's syndrome, due to its high sensitivity, diagnostic reliability and biological advantages thanks to the lack of ionizing radiation.
Assuntos
Imageamento por Ressonância Magnética , Articulações Esternocostais/patologia , Síndrome de Tietze/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Articulação Esternoclavicular/patologiaRESUMO
Primary hepatic epithelioid hemangioendothelioma (HEH) is a rare, low-grade malignant neoplasm of endothelial origin, with an unpredictable clinical course and prognosis. No standard therapeutic strategies are still available for HEH, due to the infrequency of the disease and to its variable natural history that limit the identification of the most effective treatment. In the absence of metastatic disease, surgical resection or liver transplantation represent the treatment of choice for HEH, while several antineoplastic agents have been proposed in the presence of metastatic nonresectable disesase. Herein, we describe the biological characterization and the clinical course of a primary HEH progressively responsive to treatment with intermediate doses of interferon-alpha (IFN)-alpha2a. Furthermore, based on the newly-identified expression of endoglin (CD105) on HEH, we discuss the clinical potential of novel anti-angiogenetic approaches to the disease.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Hemangioendotelioma Epitelioide/tratamento farmacológico , Interferon-alfa/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neovascularização Patológica/prevenção & controle , Antígenos CD/análise , Antígenos CD34/análise , Endoglina , Feminino , Hemangioendotelioma Epitelioide/irrigação sanguínea , Hemangioendotelioma Epitelioide/imunologia , Hemangioendotelioma Epitelioide/patologia , Humanos , Imuno-Histoquímica , Interferon alfa-2 , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/patologia , Pessoa de Meia-Idade , Neovascularização Patológica/imunologia , Neovascularização Patológica/patologia , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Receptores de Superfície Celular/análise , Proteínas Recombinantes , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: Many studies aimed at validating the application of Dual Energy Computed Tomography (DECT) in clinical practice where conventional CT is not exhaustive. An example is given by bone marrow oedema detection, in which DECT based on water/calcium (W/Ca) decomposition was applied. In this paper a new DECT approach, based on water/cortical bone (W/CB) decomposition, was investigated. MATERIALS AND METHODS: Eight patients suffering from marrow oedema were scanned with MRI and DECT. Two-materials density decomposition was performed in ROIs corresponding to normal bone marrow and oedema. These regions were drawn on DECT images using MRI informations. Both W/Ca and W/CB were considered as material basis. Scatter plots of W/Ca and W/CB concentrations were made for each ROI in order to evaluate if oedema could be distinguished from normal bone marrow. Thresholds were defined on the scatter plots in order to produce DECT images where oedema regions were highlighted through color maps. The agreement between these images and MR was scored by two expert radiologists. RESULTS: For all the patients, the best scores were obtained using W/CB density decomposition. CONCLUSIONS: In all cases, DECT color map images based on W/CB decomposition showed better agreement with MR in bone marrow oedema identification with respect to W/Ca decomposition. This result encourages further studies in order to evaluate if DECT based on W/CB decomposition could be an alternative technique to MR, which would be important when short scanning duration is relevant, as in the case of aged or traumatic patients.
Assuntos
Medula Óssea/diagnóstico por imagem , Osso Cortical/diagnóstico por imagem , Osso Cortical/metabolismo , Edema/diagnóstico por imagem , Edema/metabolismo , Tomografia Computadorizada por Raios X , Água/metabolismo , Adulto , Idoso , Medula Óssea/metabolismo , Estudos de Viabilidade , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-IdadeRESUMO
A case of single pulmonary leiomyoma with giant cyst formation is presented. Metastasizing uterine fibroleiomyoma and fibroleiomyomatous hamartoma both give rise to multiple pulmonary nodules on chest films. Leiomyoma of the lung presenting as a single pedunculated lesion with cyst formation is exceptional. This report documents the existence of other rare cystic lesions that may mimic the more common cystic air space and bullous disease.
Assuntos
Cistos/diagnóstico , Leiomioma/diagnóstico , Pneumopatias/diagnóstico , Neoplasias Pulmonares/diagnóstico , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/cirurgia , Pneumopatias/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Toracotomia , Neoplasias Uterinas/patologiaRESUMO
Eleven cases of pancreatic cystadenocarcinoma were studied with respect to the differential diagnosis from that of pancreatic pseudocysts, using diagnostic ultrasound as the initial investigative technique. Most of the cases presented an ultrasonic picture that correlated well with the gross pathology, but this correlation was not reliable enough to be considered characteristic in differentiating such masses from pseudocysts. The authors divide the cystadenocarcinomas of the pancreas into four echographic classes. In all but one of the classes, diagnostic ultrasound was insufficient by itself to render an accurate diagnosis. In such cases other techniques, i.e. CT, tissue biopsy, and especially angiography, were required for a reliable diagnosis.
Assuntos
Cistadenocarcinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Ultrassonografia , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pseudocisto Pancreático/diagnósticoRESUMO
This article presents an experimental model of pulmonary injury resembling subclinical human adult respiratory distress syndrome (ARDS) mediated by leukocytes. The activation of complement was prolonged by an intraperitoneal injection of a suspension of zymosan in paraffin. The first step in the development of the disease was an accumulation of polymorphonuclear leukocytes in the lungs. No significant changes were observed on chest radiographs or computed tomograms and the pathophysiologic changes were only minimal in spite of the characteristic structural changes. The criteria currently used for the diagnosis of ARDS are not sensitive enough to detect the subclinical phase of the disease.
Assuntos
Ativação do Complemento , Neutrófilos/fisiologia , Síndrome do Desconforto Respiratório/diagnóstico , Animais , Dióxido de Carbono/sangue , Agregação Celular , Modelos Animais de Doenças , Masculino , Oxigênio/sangue , Pressão Parcial , Coelhos , Síndrome do Desconforto Respiratório/sangue , Síndrome do Desconforto Respiratório/imunologia , Zimosan/administração & dosagemRESUMO
Gastrointestinal stromal tumors (GISTs) represent a distinct subset of mesenchymal tumours of the gastrointestinal tract. They are more common in the stomach and small intestine, and are characterized by the proliferation of spindle or epithelioid cells and by the expression of CD117. Extra-gastrointestinal stromal tumors are rare and only 13 cases of pancreatic GISTs have been reported in the literature, only 1 of which presented as a cystic lesion. Mutational analysis of KIT and Platelet derived growth factor receptor-α genes was performed only in two out of the 13 cases. We report 3 cases of cystic GISTs of the pancreas, radiologically mimicking a cystoadenocarcinoma. Routine histopathology and molecular characterization of the tumours have been performed. In two of them, molecular analysis showed unusual genetic alterations (the internal repeat of codon 502 and 503 in exon 9 of the KIT gene and the KIT exon 9 single nucleotide substitution c.1427G⟩T). Pancreatic GIST should be included in the differential diagnosis of both cystic and solid masses of the pancreas. The diagnosis should be accomplished by a combination of radiology, histology, immunohistochemistry and molecular biology. The evaluation of CD117 expression and the sequence analysis of KIT and Platelet derived growth factor receptor-α gene is mandatory for therapy.
Assuntos
Cistadenocarcinoma/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adulto , Idoso , Análise Mutacional de DNA , Diagnóstico Diferencial , Feminino , Tumores do Estroma Gastrointestinal/genética , Deleção de Genes , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/genética , Polimorfismo de Nucleotídeo Único , Proteínas Proto-Oncogênicas c-kit/genéticaRESUMO
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare disease that occurs almost exclusively in smokers, generally young adults between 20 and 40 years old. Prognostic biomarkers of the disease are lacking. This study describes the clinical-radiological features of a group of PLCH patients and applies a semi-quantitative CT score of the chest to verify the prognostic value of radiological findings in this disease. Clinical-radiological and immunological data from 12 Caucasian patients (6M, 7 smokers and 5 ex-smokers, mean age 36±8 years) were recorded at onset and after a follow-up period of 4 years. Application of the semi-quantitative CT score revealed a prevalently cystic pattern at onset and follow-up in the majority of the patients. Patients with a prevalently nodular pattern developed cystic lesions during follow-up. Interestingly, significant correlations were found between the extent of cystic lesions and DLCO values at onset (time 0: p<0.05) and at the end of follow-up (time 1, p<0.05) and with FEV1 values at time 0 (p<0.05) and time 1 (p<0.05). Patients with progressive functional decline were those with CT evidence of severe cystic alterations. The results suggest that high resolution CT scan of the chest is mandatory for characterizing PLCH patients at diagnosis and during follow-up. The proposed CT score of the chest showed potential prognostic value.
Assuntos
Histiocitose de Células de Langerhans/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemAssuntos
Transtorno Autístico/genética , Doenças Ósseas Metabólicas/genética , Deficiências do Desenvolvimento/genética , Cabelo/anormalidades , Doenças Renais Císticas/genética , Nefrocalcinose/genética , Anormalidades Dentárias/genética , Xantinas/urina , Criança , Humanos , Masculino , Erros Inatos do Metabolismo da Purina-Pirimidina/diagnóstico , Erros Inatos do Metabolismo da Purina-Pirimidina/genética , Erros Inatos do Metabolismo da Purina-Pirimidina/urinaRESUMO
PURPOSE: Magnetic resonance diffusion-weighted imaging (MR-DWI) is useful to assess proton motion by the computation of an apparent diffusion coefficient (ADC). This property could be used to assess renal damage, with special regard to unilateral dysfunction. The aim of this study was to estimate the correlation between ADC and the stage of chronic renal failure (CRF) using a spin-echo echo-planar imaging (SE-EPI) sequence with the sensitivity encoding (SENSE) technique. MATERIALS AND METHODS: Fourteen patients (nine men and five women, mean age 49 years, range 22-66 years) underwent an MR examination on a 1.5-T system. Seven patients had a history of hypertension or CRF, one had Takayasu disease and one had nephrovascular hypertension. Five subjects without known kidney disease were used as controls. The glomerular filtration rate (GFR) assessed by Cockcroft-Gault's equation was used as a functional marker. The imaging protocol consisted of T1- and T2-weighted sequences followed by a SE-EPI acquisition with a diffusion gradient of 600 s/mm(2) and SENSE factor 2 and pixel-by-pixel ADC map reconstruction. In five patients, the SE-EPI-DWI sequence was repeated after i.v. administration of 1 mg of furosemide. RESULTS: ADC was of 2.44+/-0.24 x 10(-3) mm(2)/s in patients with normal GFR and of 2.05+/-0.33 x 10(-3) mm(2)/s (p<0.05) in subjects with altered GFR; a significant difference was found between stage III and IV (p<0.01), whereas no differences were found between stage I and II (p=0.27) and between stage II and III (p=0.39). A good correlation was found between GFR and ADC (r=0.79; p<0.01), with no significant change after furosemide administration (p=0.7). CONCLUSIONS: DWI is a feasible MR technique for assessing renal damage. Further studies with scintigraphic correlation are needed to confirm these results and to establish reference values for this imaging technique.