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Consistent spatial lesion-symptom patterns: A comprehensive analysis using triangulation in lesion-symptom mapping in a cohort of stroke patients. Magn Reson Imaging 2024; 109:286-293. [PMID: 38531463 DOI: 10.1016/j.mri.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The relationship between brain lesions and stroke outcomes is crucial for advancing patient prognosis and developing effective therapies. Stroke is a leading cause of disability worldwide, and it is important to understand the neurological basis of its varied symptomatology. Lesion-symptom mapping (LSM) methods provide a means to identify brain areas that are strongly associated with specific symptoms. However, inner variations in LSM methods can yield different results. To address this, our study aimed to characterize the lesion-symptom mapping variability using three different LSM methods. Specifically, we sought to determine a lesion symptom core across LSM approaches enhancing the robustness of the analysis and removing potential spatial bias. MATERIAL & METHODS A cohort consisting of 35 patients with either right- or left-sided middle cerebral artery strokes were enrolled and evaluated using the NIHSS at 24 h post-stroke. Anatomical T1w MRI scans were also obtained 24 h post-stroke. Lesion masks were segmented manually and three distinctive LSM methods were implemented: ROI correlation-based, univariate, and multivariate approaches. RESULTS The results of the LSM analyses showed substantial spatial differences in the extension of each of the three lesion maps. However, upon overlaying all three lesion-symptom maps, a consistent lesion core emerged, corresponding to the territory associated with elevated NIHSS scores. This finding not only enhances the spatial accuracy of the lesion map but also underscores its clinical relevance. CONCLUSION This study underscores the significance of exploring complementary LSM approaches to investigate the association between brain lesions and stroke outcomes. By utilizing multiple methods, we can increase the robustness of our results, effectively addressing and neutralizing potential spatial bias introduced by each individual method. Such an approach holds promise for enhancing our understanding of stroke pathophysiology and optimizing patient care strategies.
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Cost-effective Solution for Maxillofacial Reconstruction Surgery with Virtual Surgical Planning and 3D Printed Cutting Guides Reduces Operative Time. Plast Surg (Oakv) 2024; 32:70-77. [PMID: 38433805 PMCID: PMC10902495 DOI: 10.1177/22925503221078692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background: This study aimed to explore a low-cost solution for virtual surgical planning/3D printed surgical guides in a training hospital, assessing the impact on intraoperative time and bleeding. Material and Methods: We included a total of 13 patients. 8 who underwent maxillofacial reconstruction surgery with fibula-free flap utilizing virtual surgical planning/3D printed guides (VP/SG), and 5 using conventional surgery (CS) from 2017 to 2020. The surgical time, bleeding, length of hospital stay, and comorbidities were collected and compared in two groups. We recorded the average cost for the complete surgical planning and 3D printed guides. We applied a qualitative survey to the surgeons involved in the surgical procedures. Results The mean surgical time in the VP/SG group was 8.16 ± 2.7, compared to the CS group 12.5 ± 3.8, showing a 4.34 hours difference with statistical significance (p = 0.033). Patients from the CS group had a higher bleeding volume of 921 ± 467.6 mL VS 760 ± 633.8 mL in the VP/SG group. The average cost for the complete surgical planning and 3D printed guides was 914.44 ± 46.39 USD. All the surgeons who answered the survey preferred to perform the procedure utilizing the virtual planning/3D printed guides. Conclusions Virtual planning and 3D printed surgical guides have the potential to reduce operation time in maxillofacial reconstruction.
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Initial evaluation and external validation of 68Ga-PSMA-11 PET/CT in tubarial gland characterization. Radiother Oncol 2024; 190:109975. [PMID: 37913955 DOI: 10.1016/j.radonc.2023.109975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/10/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Radiotracer 68Ga-PSMA-11 used in PET/CT scans allows for identification and localization of gland tissue. It allows for their consideration in clinical scenarios and to design further and stronger research to answer pertinent questions regarding their function and implications. We aimed to externally validate first reported findings of location, size, and ligand uptake of the tubarial glands using 68Ga-PSMA-11 PET/CT. MATERIALS AND METHODS A cross-sectional study was performed with 68Ga-PSMA-11 PET/CT studies of patients with prostate cancer confirmed diagnosis from the database of the Radiology Department from 2018 to 2022. The maximum cephalocaudal length (CCL) in the tubarial glands and the Maximum Standardized Uptake Value (SUVmax) of major glands were recorded. RESULTS A total of 202 patients were included (mean age 67.43 ± 8.5). The mean CCL of the tubarial glands was 37.38 ± 9.84 and a SUVmax of 6.56 ± 2.14. The rest of the glands were as follows: parotid 15.12 ± 4.43, submandibular 16.82 ± 5.43 and sublingual 5.84 ± 3.24. No differences were found between laterality. A weak correlation between age and SUVmax of tubarial glands was identified. Tubarial glands had a similar 68Ga-PSMA-11 uptake to that of sublingual glands. CONCLUSION This study corroborates the existence of a conglomerate of glands in the nasopharynx roof, near the posterolateral pharyngeal recess. It serves as validation in a different population with similar results in previous research. Without 68GA-PSMA-11 PET/CT the abundance, configuration and potential clinical relevance of these glands would probably not have been identified. Radiotracer uptake was similar amongst the major salivary glands, with a more similar uptake to that shown by the sublingual gland.
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Forging Connections in Latin America to Advance AI in Radiology. Radiol Artif Intell 2022; 4:e220125. [PMID: 36204535 PMCID: PMC9530756 DOI: 10.1148/ryai.220125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
The 1° Encontro Latino-Americano de IA em Saúde (1st Latin American Meeting on AI in Health) was held during the 2022 Jornada Paulista de Radiologia, the annual radiology meeting in the state of São Paulo. The event was created to foster discussion among Latin American countries about the complexity, challenges, and opportunities in developing and using artificial intelligence (AI) in those countries. Technological improvements in AI have created high expectations in health care. AI is recognized increasingly as a game changer in clinical radiology. To counter the fear that AI would "take over" radiology, the program included activities to educate radiologists. The development of AI in Latin America is in its early days, and although there are some pioneer cases, many regions still lack world-class technological infrastructure and resources. Legislation, regulation, and public policies in data privacy and protection, digital health, and AI are recent advances in many countries. The meeting program was developed with a broad scope, with expertise from different countries, backgrounds, and specialties, with the objective of encompassing all levels of complexity (from basic concepts to advanced techniques), perspectives (clinical, technical, ethical, and business), and specialties (both informatics and data science experts and the usual radiology clinical groups). It was an opportunity to connect with peers from other countries and share lessons learned about AI in health care in different countries and contexts. Keywords: Informatics, Use of AI in Education, Impact of AI on Education, Social Implications © RSNA, 2022.
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Endovascular management of arterioenteric fistula: a case report. CIR CIR 2022; 90:406-409. [DOI: 10.24875/ciru.20000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Trendelenburg (Head-Down Tilt) and Head Rotation: Ultrasonographic effects on the internal jugular vein for catheterization safety. Clin Anat 2022; 35:883-890. [PMID: 35411564 DOI: 10.1002/ca.23884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022]
Abstract
Most guidelines fail to specify patient positioning during central venous catheterization. The objective was to determine the effects of head-down tilt (Trendelenburg position) and head rotation on the internal jugular vein (IJV). A prospective, observational, longitudinal, and descriptive study using healthy adult volunteers, of both sexes, was performed. The change in position and cross-sectional areas (CSA) of the right IJV and common carotid artery (CA) were measured by ultrasonography during Trendelenburg position (TP) (0°, 5°, 10°, and 15°) and contralateral head-rotation (HR) (0°, 45°, and 90°) for a total of 12 positions. The neutral supine position was first, randomizing the other 11 positions, with 5-minute rest intervals in between. Vital signs and symptoms were recorded. A total of 54 volunteers were recruited between the ages of 21 and 32, of which 30 were men. Any degree of TP or HR significantly increased the CSA. The largest area obtained was 1.78cm2 with a TP15HR90 which did not have a statistical difference with TP10HR45 1.59cm2 . A HR90 tended to displace the IJV medially, overlaying the CA. Any degree of TP or HR will significantly increase CSA or the right IJV. A 5° to 10° TP is recommended when the patient's condition allows it, with a 45° HR, without significantly displacing the IJV anterior to the CCA. This article is protected by copyright. All rights reserved.
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Morphometric variants of the paranasal sinuses in a Mexican population: expected changes according to age and gender. Folia Morphol (Warsz) 2022; 82:339-345. [PMID: 35380013 DOI: 10.5603/fm.a2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are developmental variations in the paranasal sinuses. Our objective is to determine their dimensions and volume stratified by age and sex and define the expected growth pattern. MATERIALS AND METHODS A retrospective, observational study was performed including computed tomography (CT) of patients between 1 and 20 years of age. The volumes of the frontal, sphenoid, and maxillary sinuses were obtained. RESULTS A total of 210 CT were included with a mean age of 10±6.1 years, 106(50.5%) were female. Groups were categorized in ranges of 5 years. Spearman correlation coefficients between the right and left sides were 0.843, 0.711, 0.916 for the frontal, sphenoid and maxillary sinuses. Post-hoc for the categorical age groups demonstrated statistically significant differences with values of p < 0.01, except between age groups 11-15 against ≥ 16 years of age (p = 0.8). Gender-related differences were evident with a higher air volume in girls in the 5-10-year-old group, while boys predominated in the rest of the groups. CONCLUSIONS CT is ideal for pre-surgical sinus assessment. The maximum volume of paranasal sinuses is reached at age 15. There is a clear volumetric difference between age and gender groups. There is a direct relationship between a volume and its contralateral counterpart.
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Carotid Intima-Media Thickness in Patients with Subclinical Hypothyroidism: A Prospective Controlled Study. CLIN INVEST MED 2021; 44:E39-45. [PMID: 34978774 DOI: 10.25011/cim.v44i4.37139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The association between subclinical hypothyroidism (SCH) and cardiovascular risk, particularly with a TSH <10 µIU/ml, remains controversial. The objective of our study was to assess the association between SCH and cardiovascular risk through carotid intima-media thickness, and alternatively, to evaluate its change after treatment with levothyroxine. METHODS A total of 54 individuals were included in the study: 18 with SCH; 18 with overt hypothyroidism (OH); and 18 healthy controls (HC). The carotid intima-media thickness was measured in each group. In SCH, follow-up was performed at three and six months after the start of levothyroxine treatment. RESULTS The mean age of the total population at baseline was 35.8 years. The median TSH in SCH was 6.15 µIU/ml. The carotid intima-media thickness (mean and standard deviation) was greater in SCH in comparison to the HC group: right common carotid artery (RCCA), 0.486 ± 0.106 mm and 0.413 ± 0.075 mm in SCH and HC, respectively, p=0.01 and left common carotid artery (LCCA), 0.511 ± 0.144 mm and 0.427 mm ± 0.090 in SCH and HC, respectively, p=0.03). In patients with SCH, there was a decrease in the carotid intima-media thickness after treatment with levothyroxine (RCCA and LCCA, p <0.05 at three and six months). CONCLUSIONS There was an association between increased carotid intima-media thickness in patients with SCH in comparison with HC, even with a TSH <10 µIU/ml. The increase was reversed with levothyroxine therapy. The association of this increased thickness with important cardiovascular outcomes remains uncertain and should be evaluated in future studies.
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Correlating imaging findings with clinical presentation: the boomerang effect for radiologists. RADIOLOGIA 2021; 63:467-468. [PMID: 34801178 DOI: 10.1016/j.rxeng.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/28/2022]
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Value of a breast imaging unit in the detection of breast cancer in Mexico. Ecancermedicalscience 2021; 15:1272. [PMID: 34567257 PMCID: PMC8426018 DOI: 10.3332/ecancer.2021.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Indexed: 11/06/2022] Open
Abstract
The screening breast cancer detection rate in Mexico is low. The main objective of this study was to determine the breast cancer detection rate in a Mexican population that attended a breast imaging unit, in which the same radiologist comprehensively evaluated and interpreted breast imaging studies. A total of 5,429 mammograms performed between 2015 and 2016 were evaluated. Rates for biopsy indication, biopsies performed and positive biopsies for cancer were determined. The malignancy detection rate, after a comprehensive imaging evaluation in a breast imaging unit, was 24.3 per 1,000 mammograms. In symptomatic women was 52.9 per 1,000 mammograms, and in screening women was 11.1 per 1,000 mammograms. Breast imaging units in which a comprehensive imaging approach is performed represent an opportunity for low- and middle-income countries without population-based screening programs to achieve a more efficient detection of breast cancer, without generating a higher cost.
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Basal cell nevus syndrome: an update on clinical findings. Int J Dermatol 2021; 61:1047-1055. [PMID: 34494262 DOI: 10.1111/ijd.15884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
Basal cell nevus syndrome, also known as Gorlin-Goltz syndrome, is a rare autosomal dominant disorder caused by mutations in the hedgehog signaling pathway, mainly in PTCH1. This pathway is involved in embryogenesis and tumorigenesis, and the loss of function of PTCH1 protein produces an aberrant increase in the hedgehog signaling pathway activity. Basal cell nevus syndrome is characterized by tumor predisposition, particularly with the development of multiple basal cell carcinomas at an early age, along with odontogenic keratocysts, palmoplantar pits, skeletal abnormalities, and an increased risk of medulloblastoma. Diagnosis is clinical, with gene mutation analysis confirming the suspicion. The striking phenotypic variability of the syndrome may lead to a delayed diagnosis, making it an uncommon but important entity to recognize. A high index of suspicion and an early diagnosis is crucial for prevention, surveillance, and the prompt establishment of multidisciplinary medical care.
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Anatomical and positional variants of the brachiocephalic trunk in a Mexican population. BMC Med Imaging 2021; 21:126. [PMID: 34388973 PMCID: PMC8364066 DOI: 10.1186/s12880-021-00645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Brachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal. The objective of this study was to classify height positions of the BCT and report their prevalence in a Mexican population.
Methods Patients: A retrospective, descriptive, observational, and cross-sectional was performed using computed tomography angiography (CTA) of adult (> 18 years of age) patients, without gender distinction, of Mexican origin. Measuring techniques were standardized using the suprasternal notch to analyze linear and maximum heights, linear and curved lengths, and the vertebral origin and bifurcation levels of the BCT. Results A total of 270 CTA were obtained (66.7% men and 33.3% women). A high position of BCT was present in 64.81% (n 175/270). The mean linear medial height was 0.58 ± 1.91 cm, the maximum height of the free edge was 3.85 ± 2.04 cm, side length of the midline at the maximum height of the free edge was 1.46 ± 2.59, linear length 3.72 ± 0.70, and a curve length 3.99 ± 0.79. The BCT origin was most predominant at the T3 (57.9%) and T4 (27.0%) vertebral levels, with the bifurcation at T2 (57.9%) and T1 (36.2%). Conclusions There is a high prevalence of high position BCT in our population. Patients should be assessed before any procedures in the area, due to the potential risk of complications.
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Correlating imaging findings with clinical presentation: the boomerang effect for radiologists. RADIOLOGIA 2021; 63:S0033-8338(21)00085-0. [PMID: 33958206 DOI: 10.1016/j.rx.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 12/01/2022]
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Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes. Orthop J Sports Med 2021; 9:2325967120977892. [PMID: 33614808 PMCID: PMC7874354 DOI: 10.1177/2325967120977892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences (P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.
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3D-printed anatomical models of the cystic duct and its variants, a low-cost solution for an in-house built simulator for laparoscopic surgery training. Surg Radiol Anat 2021; 43:537-544. [PMID: 33386458 DOI: 10.1007/s00276-020-02631-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore a method to create affordable anatomical models of the biliary tree that are adequate for training laparoscopic cholecystectomy with an in-house built simulator. METHODS We used a fused deposition modeling 3D printer to create molds of Acrylonitrile Butadiene Styrene (ABS) from Digital Imaging and Communication on Medicine (DICOM) images, and the molds were filled with silicone rubber. Thirteen surgeons with 4-5-year experience in the procedure evaluated the molds using a low-cost in-house built simulator utilizing a 5-point Likert-type scale. RESULTS Molds produced through this method had a consistent anatomical appearance and overall realism that evaluators agreed or definitely agreed (4.5/5). Evaluators agreed on recommending the mold for resident surgical training. CONCLUSIONS 3D-printed molds created through this method can be applied to create affordable high-quality educational anatomical models of the biliary tree for training laparoscopic cholecystectomy.
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[Diffusion tensor imaging of the corticospinal pathway and its association with the prognosis of acute cerebral infarction: experience with a cohort in Mexico]. Rev Neurol 2021; 72:16-22. [PMID: 33378075 DOI: 10.33588/rn.7201.2020232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Magnetic resonance diffusion tensor imaging through the fraction of anisotropy allows evaluation of the integrity of the motor pathways after cerebral infarction. AIMS To correlate the fraction of anisotropy with the clinical scales and the prognosis of cerebral infarction. SUBJECTS AND METHODS Prospective study of patients with cerebral infarction to compare the fraction of anisotropy in different regions of interest with functional evaluations and with controls free of infarction. A subgroup of subjects with rehabilitation underwent an initial MRI scan and another at three months, with clinical follow-up for six months. RESULTS Thirty-eight consecutive patients with middle cerebral artery infarction were included. The fraction of anisotropy values were lower in the ipsilateral corticospinal pathway than the fraction of anisotropy of the corticospinal pathway of the controls. The values of the fraction of anisotropy in the ipsilateral corticospinal pathway were associated with the value of the functional scale on admission. Changes in the fraction of anisotropy values between the initial MRI and the scan performed at three months correlated with the score on the functional scale and the modified Rankin scale at three and six months. CONCLUSIONS The value of the fraction of anisotropy in the ipsilateral internal capsule is associated with the presence of a lesion and with its presenting symptoms. Changes in the fraction of anisotropy at three months suggest long-term clinical recovery.
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Does axillary lymph node size predict better metastatic involvement than apparent diffusion coefficient (ADC) value in women with newly diagnosed breast cancer? Acta Radiol 2020; 61:1494-1504. [PMID: 32064890 DOI: 10.1177/0284185120903449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND It has been demonstrated that the number of metastatic axillary lymph nodes (mALNs) influence disease-free and overall survival in patients with breast cancer. PURPOSE To determine if the ALN size is more accurate than the ALN apparent diffusion coefficient (ADC) value to predict metastatic involvement in newly diagnosed breast cancer. MATERIAL AND METHODS A total of 44 patients with breast cancer were included. Magnetic resonance imaging (MRI) examinations were performed on a 1.5-T system with sagittal T1-weighted fast spin-echo non-fat saturated, sagittal T2-weighted fast spin-echo non-fat saturated, axial diffusion-weighted imaging echo-planar (b values of 0 and 700 s/mm2), and non-contrast axial VIBRANT sequences. The size and the ADC value were obtained for ALN ipsilateral and contralateral to breast cancer. The reference standard was the histopathologic lymph node status. RESULTS mALN had a greater cortical thickness compared to contralateral non-mALN (10.3 ± 5.32 mm vs. 4 ± 1.17 mm, P ≤ 0.001). The threshold of ≥6.7 mm for predicting axillary metastatic involvement had a sensitivity and a specificity of 80.0% and 97.7%, respectively. The ADC value of mALN was significantly higher than the contralateral non-mALN (0.90 ± 0.12 × 10-3mm2/s vs. 0.78 ± 0.12 × 10-3mm2/s; P = 0.001). The threshold of ≥0.86 × 10-3mm2/s had a sensitivity and a specificity of 66.7% and 76.7%, respectively. CONCLUSION Our results indicate that the cortical thickness has a better diagnostic performance in the differentiation of metastatic and non-metastatic lymph nodes than the lymph node ADC.
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Peritoneal cavity circumference on computed tomography predicts outcomes in acute pancreatitis. Eur J Radiol 2020; 132:109327. [PMID: 33049650 DOI: 10.1016/j.ejrad.2020.109327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We investigated the role of novel intra-abdominal parameters measured by computed tomography (CT) in the prediction of clinical outcomes in acute pancreatitis (AP). METHODS Patients with AP underwent an abdominal CT scan on admission to define different intra-abdominal parameters (abdominal circumference, peritoneal cavity circumference, intraabdominal visceral fat area, and subcutaneous fat area) at the L2-L3 level using the open-source image analysis software Osirix Lite v.11.0.4 to predict clinical outcomes. RESULTS Eighty patients with AP were analyzed. Peritoneal cavity circumference (PCC) was the only variable independently associated with outcomes. PCC showed an area under ROC for prediction of severity in AP of 0.830. A PCC ≥ 85 cm increased the risk of severity of AP (RR 15.7), persistent systemic inflammatory response syndrome (RR 9.3), acute peripancreatic fluid collection (RR 6.4), necrotizing pancreatitis (RR 21.50), and mortality (RR 2.4). We found a 4.7-fold increase in the risk of developing severe AP for each 10 cm increase in PCC. CONCLUSIONS PCC measurement at the L2-L3 level using a non-enhanced abdominal CT scan on admission in patients with AP is useful in the early prediction of severity, persistent systemic inflammatory response syndrome, local complications, and mortality.
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Avoiding iatrogenic injuries to the vertebral artery: A morphometric study of the vertebral artery-free dissection area. Clin Neurol Neurosurg 2020; 196:106001. [PMID: 32534385 DOI: 10.1016/j.clineuro.2020.106001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the area of a safety window that excludes the vertebral artery for the safe access of the occipital condyle screws during occipitocervical fixation. METHODS This study included 138 cervical computed tomography angiograms. Six measurements per side were made in each imaging study. These measurements are from the vertebral artery to (A) the mastoid process, (B) the mastoid incisura, (C) the posterior condylar fossa, (D) the occipital condyle in its midline, and (E) the medial border of the condyle. We also measured from the tip of the mastoid process to the lower border of the occipital condyle on its lateral side (F). RESULTS A total of 276 areas from 138 individuals were included, of which 51.4 % were men. The mean age was 54.2 ± 18.63 years. The mean variable measurements (mm) for all the population were 21 ± 4, 16 ± 3, 6 ± 2, 3 ± 2, 2 ± 1 and 35 ± 4 for variables A-F, respectively. We found significant differences between sex when we compared measurements A (p = 0.003), C (p = 0.001), D (p = 0.000) and F (p = 0.000). The incidence rate of dominance for the vertebral artery was 18.8 % and 30.4 % for right and left respectively. CONCLUSION Women had significantly smaller measures than men. This could indicate a higher risk of iatrogenic injury secondary to a smaller vertebral artery-free area. Results may guide surgeons in the pre-surgical planning aiming to reduce the risk of iatrogenic injuries to the vertebral artery.
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Origin variations of the superior thyroid, lingual, and facial arteries: a computed tomography angiography study. Surg Radiol Anat 2020; 42:1085-1093. [PMID: 32488410 DOI: 10.1007/s00276-020-02507-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/25/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine the anatomical variations and morphology of the external carotid artery (ECA) and its anterior branches. METHODS Using computed tomography angiography (CTA), the origin, internal diameter, and surface laterality emergence of the superior thyroid (STA), lingual (LA), and facial (FA) arteries were evaluated retrospectively evaluated and classified. The bifurcation level of the common carotid artery (CCA) in relation to the cervical vertebrae and disc was also determined. RESULTS A total of 76 CTA were included in the study. STA originated from the carotid bifurcation (CB) (type I), CCA (type II) and ECA (type III) in 20.4 (31/152), 17.1 (26/152) and 50.7% (77/152) cases, respectively. Also 10.5% (16/152) arose from a shared trunk with LA as a thyrolingual trunk (TLT) (type IVa), and absent in 1.3% (2/152). LA originated in the CB in only one case. A linguofacial trunk (LFT) was present in 14.5% (22/152). Mean diameters of STA, LA and FA were 1.70, 1.95 and 2.45 mm, respectively. Meanwhile, surface laterality were predominately from anteromedial, medial, and anterior, respectively. CB was mainly on C3 or C3-C4 (55.9% of cases). CONCLUSIONS STA origin below the ECA is a common finding. Our population presented the highest percentage of TLT (10.5%) and high CB (9.8%) in literature. Considering these variations are important to prevent complications in neck surgical procedures.
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Maximizing Radiology’s Global Value-Add. J Am Coll Radiol 2020; 17:824-826. [DOI: 10.1016/j.jacr.2019.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 10/25/2022]
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Anatomical variations of the acromial and coracoid process: clinical relevance. Surg Radiol Anat 2020; 42:877-885. [PMID: 32418123 DOI: 10.1007/s00276-020-02497-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The acromial and coracoid process morphology is of clinical relevance due to associations with functional limitations and shoulder pathology. Our objective was to describe the anatomical characteristics of the acromial and coracoid process using computed tomography (CT). METHODS Descriptive, observational, transversal and retrospective study. A total of 155 CT of patients without shoulder pathology, of both genders, and indistinct age were evaluated and grouped by age: Group 1 < 25 years; group 2 25-40 years; group 3 > 40 years. The following parameters were evaluated: Acromial type (AcT), vertical coracoid distance (VCD), acromial tilt (AT), acromial projection (AP), critical shoulder angle (CSA), type of the subcoracoid outlet (TSO), and the area of the subcoracoid outlet (ASO). RESULTS Statistically significant differences were found between men and women for VCD (14.44 ± 4.79 vs. 11.76 ± 4.00 mm; p < 0.001) and AP (3.66 ± 4.71 vs. 1.62 ± 4.99 mm; p < 0.05) as well as between age groups 1 and 3 for AT (35.08 ± 11.53 vs. 28.41 ± 6.60; p < 0.05) and ASO (398.99 ± 153.91 vs. 255.56 ± 124.58 mm2; p < 0.001). An unexpected high ASO variation was identified with 11% of S-shaped acromion and 1.3% clock-shaped TSO. CONCLUSION The age group between 25-40 years had the most uniform distribution of data. There is a high morphological variability present in an asymptomatic population, which should be considered in the clinical assessment such as shoulder impingement syndrome.
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Prevalence of facial canal dehiscence and other bone defects by computed tomography. Eur Arch Otorhinolaryngol 2020; 277:2681-2686. [PMID: 32383094 DOI: 10.1007/s00405-020-06013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/25/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The facial nerve is the most vulnerable structure during otological surgeries. Facial canal dehiscence (FCD) is the main risk factor for iatrogenic injuries. Its prevalence in clinical studies ranges between 6 and 33.3%, while anatomical studies report 25-57%. The objective was to determine the prevalence of FCD stratified by age and gender in a healthy population. MATERIALS AND METHODS Temporal bones from high-resolution computed tomography (CT) were analyzed. Patients with a history of trauma or tumors of the temporal bone, cholesteatomas, chronic middle ear disease, and any pathology that could modify the bone's anatomy, were excluded. RESULTS A total of 184 temporal bones were included. FCD was observed in 94 (51.2%) of the analyzed bones. The tympanic portion was the most frequently affected site with 91 (49.5%), followed by the mastoid segment with 3 (1.6%). No dehiscence was found in the labyrinth portion. We observed 30 (31.9%) of the FCD involved the oval window. Other bone defects identified with the FCD included: 11 (11.7%) with a lateral semicircular canal fistula and 7 (7.4%) with tegmen tympani erosions. CONCLUSION FCD has a high prevalence among healthy patients. A pre-surgical otological evaluation using high-resolution CT should be indicated to properly assess the patient and reduce the risk of injury.
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3:36 PM Abstract No. 277 First-in-human evaluation of an absorbable vena cava filter for the prevention of pulmonary embolism. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Searching for an objective evaluation of patients with cerebral palsy after stem cells treatment. Is functional magnetic resonance imaging a solution? Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Intracavernous application of autologous bone marrow stem cells for erectile dysfunction unresponsive to medical treatment: a clinical case. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Carotid ultrasound findings in rheumatoid arthritis and control subjects: A case-control study. Int J Rheum Dis 2018; 22:25-31. [DOI: 10.1111/1756-185x.13377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 12/31/2022]
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Apparent Diffusion Coefficient Value to Evaluate Tumor Response After Neoadjuvant Chemotherapy in Patients with Breast Cancer. Acad Radiol 2018; 25:179-187. [PMID: 29033147 DOI: 10.1016/j.acra.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES This study explored tumor behavior in patients with breast cancer during neoadjuvant chemotherapy (NAC) by sequential measurements of tumor apparent diffusion coefficient (ADC) after each chemotherapy cycle. The aim was to determine if the tumor ADC is useful to differentiate complete pathological response (cPR) from partial pathological response (pPR) during NAC. MATERIALS AND METHODS A total of 16 cases (in 14 patients) with diagnosis of breast cancer eligible to receive NAC were included. There were 70 magnetic resonance imaging examinations performed, 5 for each patient, during NAC cycles. Diffusion-weighted imaging was performed on a 1.5T system (b values of 0 and 700s/mm2). Four ADC ratios between the five MRI examinations were obtained to assess ADC changes during NAC. Absence of invasive breast cancer at surgical specimens (Miller-Payne 5) was considered as cPR and was used as reference for ADC cutoff ratios. RESULTS In this study, we were able to differentiate between cPR and pPR, after two cycles of NAC until the end of NAC before surgery (ADC ratios 2-4). The thresholds to differentiate between cPR and pPR of ADC ratios 2, 3, and 4, were 1.14 × 10-3mm2/s, 1.08 × 10-3mm2/s, and 1.25 × 10-3mm2/s, respectively, and have a cross-validated sensitivity and specificity of 79.2%, 79.7% (ADC ratio 2); 100%, 66.7% (ADC ratio 3); and 100%, 83.8% (ADC ratio 4), respectively. CONCLUSIONS The ADC ratios were useful to differentiate cPR from pPR in breast cancer tumors after NAC. Thus, it may be useful in tailoring treatment in these patients.
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Anatomical Variants of Anterior Cerebral Arterial Circle: A Study by Multidetector Computerized 3D Tomographic Angiography. INT J MORPHOL 2017. [DOI: 10.4067/s0717-95022017000300049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Comparison of Gadoterate Meglumine and Gadobutrol in the MRI Diagnosis of Primary Brain Tumors: A Double-Blind Randomized Controlled Intraindividual Crossover Study (the REMIND Study). AJNR Am J Neuroradiol 2017; 38:1681-1688. [PMID: 28663267 DOI: 10.3174/ajnr.a5316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Effective management of patients with brain tumors depends on accurate detection and characterization of lesions. This study aimed to demonstrate the noninferiority of gadoterate meglumine versus gadobutrol for overall visualization and characterization of primary brain tumors. MATERIALS AND METHODS This multicenter, double-blind, randomized, controlled intraindividual, crossover, noninferiority study included 279 patients. Both contrast agents (dose = 0.1 mmol/kg of body weight) were assessed with 2 identical MRIs at a time interval of 2-14 days. The primary end point was overall lesion visualization and characterization, scored independently by 3 off-site readers on a 4-point scale, ranging from "poor" to "excellent." Secondary end points were qualitative assessments (lesion border delineation, internal morphology, degree of contrast enhancement, diagnostic confidence), quantitative measurements (signal intensity), and safety (adverse events). All qualitative assessments were also performed on-site. RESULTS For all 3 readers, images of most patients (>90%) were scored good or excellent for overall lesion visualization and characterization with either contrast agent; and the noninferiority of gadoterate meglumine versus gadobutrol was statistically demonstrated. No significant differences were observed between the 2 contrast agents regarding qualitative end points despite quantitative mean lesion percentage enhancement being higher with gadobutrol (P < .001). Diagnostic confidence was high/excellent for all readers in >81% of the patients with both contrast agents. Similar percentages of patients with adverse events related to the contrast agents were observed with gadoterate meglumine (7.8%) and gadobutrol (7.3%), mainly injection site pain. CONCLUSIONS The noninferiority of gadoterate meglumine versus gadobutrol for overall visualization and characterization of primary brain tumors was demonstrated.
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Thermal Resistance Anastomosis Device for the Percutaneous Creation of Arteriovenous Fistulae for Hemodialysis. J Vasc Interv Radiol 2017; 28:380-387. [DOI: 10.1016/j.jvir.2016.10.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/28/2016] [Accepted: 10/29/2016] [Indexed: 10/20/2022] Open
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Pelvimetry by Reformatted Computed Tomography in 290 Female Pelvis: Morphometric Variations Regarding Age. INT J MORPHOL 2016. [DOI: 10.4067/s0717-95022016000100043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fatal Outcome from Brain Vascular Lesions in a Neonate with Blue Rubber Bleb Nevus Syndrome. Pediatr Dermatol 2016; 33:e29-31. [PMID: 26608350 DOI: 10.1111/pde.12718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The most common cause of death in blue rubber bleb nevus syndrome is gastrointestinal bleeding. Here we present a case of central nervous system bleeding that resulted in death.
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Apparent diffusion coefficient (ADC) value to evaluate BI-RADS 4 breast lesions: correlation with pathological findings. Clin Imaging 2014; 39:51-5. [PMID: 25457520 DOI: 10.1016/j.clinimag.2014.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 08/11/2014] [Accepted: 09/09/2014] [Indexed: 01/08/2023]
Abstract
Diffusion-weighted imaging and apparent diffusion coefficient (ADC) of 36 breast lesions previously categorized as 4 according to the Breast Imaging Reporting and Data System (BI-RADS) were prospectively studied. The pathological results were 21 benign lesions and 15 malignant. The ADC of malignant lesions was significantly lower than that of the benign ones (0.87 ± 0.12 × 10(-3) mm(2)/s vs. 1.41 ± 0.22 × 10(-3) mm(2)/s, respectively) (P<.001). Using a threshold ADC value of 1.08 × 10(-3) mm(2)/s, a sensitivity of 95% and specificity of 100% were obtained.
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Safety and tolerability of intrathecal delivery of autologous bone marrow nucleated cells in children with cerebral palsy: an open-label phase I trial. Cytotherapy 2014; 16:810-20. [PMID: 24642016 DOI: 10.1016/j.jcyt.2014.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AIMS Cerebral palsy (CP) is related to severe perinatal hypoxia with permanent brain damage in nearly 50% of surviving preterm infants. Cell therapy is a potential therapeutic option for CP by several mechanisms, including immunomodulation through cytokine and growth factor secretion. METHODS In this phase I open-label clinical trial, 18 pediatric patients with CP were included to assess the safety of autologous bone marrow-derived total nucleated cell (TNC) intrathecal and intravenous injection after stimulation with granulocyte colony-stimulating factor. Motor, cognitive, communication, personal-social and adaptive areas were evaluated at baseline and 1 and 6 months after the procedure through the use of the Battelle Developmental Inventory. Magnetic resonance imaging was performed at baseline and 6 months after therapy. This study was registered in ClinicaTrials.gov (NCT01019733). RESULTS A median of 13.12 × 10(8) TNCs (range, 4.83-53.87) including 10.02 × 10(6) CD34+ cells (range, 1.02-29.9) in a volume of 7 mL (range, 4-10.5) was infused intrathecally. The remaining cells from the bone marrow aspirate were administered intravenously; 6.01 × 10(8) TNCs (range, 1.36-17.85), with 3.39 × 10(6) cells being CD34+. Early adverse effects included headache, vomiting, fever and stiff neck occurred in three patients. No serious complications were documented. An overall 4.7-month increase in developmental age according to the Battelle Developmental Inventory, including all areas of evaluation, was observed (±SD 2.63). No MRI changes at 6 months of follow-up were found. CONCLUSIONS Subarachnoid placement of autologous bone marrow-derived TNC in children with CP is a safe procedure. The results suggest a possible increase in neurological function.
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Age- and gender-related variations in morphometric characteristics of thoracic spine pedicle. Clin Anat 2013; 27:441-50. [DOI: 10.1002/ca.22359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/11/2013] [Accepted: 11/15/2013] [Indexed: 11/12/2022]
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Abstract
A thyroid nodule (TN) is a discrete lesion in the thyroid gland radiologically distinct from the adjacent parenchyma, with a prevalence variable depending on the diagnostic method used and the study population. Thyroid disorders have been identified in more than 50% of patients with systemic lupus erythematosus (SLE); however, the prevalence of TN has not been frequently studied. We identified a prevalence of 27% TN in 55 SLE patients > 16 years of age. One-third of TN were >1 cm with radiological features of malignancy. The mean age of patients with TN was 39 ± 11 years, 93% women, and SLE duration 10 ± 6 years. Among patients, we reported family history of cancer in three cases (20%), thyroid disease in one (7%), and autoimmune disease in six (40%). Regarding treatment, 50% of patients with TN were treated with azathioprine vs. 23% of patients without TN (p = 0.02), with an OR of 3.94 (95% CI 1.12-13.84, p = 0.03). As a conclusion a high prevalence of TN in SLE patients was found. Prevalence of TN correlated only with history of azathioprine use. We don't know the long-term implications of our findings; however, a functional and morphological evaluation of the thyroid gland is warranted in all patients with SLE.
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Effect of physician training on the X-ray dose delivered during coronary angioplasty. THE JOURNAL OF INVASIVE CARDIOLOGY 2013; 25:109-113. [PMID: 23468437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess whether physician training helps decrease the amount of radiation delivered to patients undergoing coronary angioplasty with stent placement. BACKGROUND Coronary angioplasty exposes patients to high doses of ionizing radiation, possibly related to equipment misuse or inappropriate training. METHODS Reference point air kerma (K(a,r)) and kerma area product (P(KA)) were prospectively registered during a period of 6 months in patients undergoing coronary angiography and angioplasty with stent ad hoc. All interventionalists were then invited to an informative conference on appropriate use of radiation and changes in x-ray delivery settings. Data were recorded during the following 6 months and then compared for the whole group and for those who did or did not attend the conference. RESULTS K(a,r) decreased from 5.44 ± 0.3 Gy (n = 106) to 3.39 ± 0.22 Gy (n = 112); P<.0001 and P(KA) decreased from 365.4 ± 21.1 Gy·cm(-2); to 233.7 ± 13.1 Gy·cm(-2); P<.0001. During the first 6 months, there were no differences in radiation emitted among physicians; however, during the second half of the study, there was a 34% difference in K(a,r) between those that attended the conference and those who did not (2.78 ± 0.23 Gy vs 4.18 ± 0.37 Gy; P=.002), regardless of the fact that both groups lowered radiation emission settings. CONCLUSION Changes in x-ray parameters profoundly reduce the amount of radiation delivered to patients, a situation that was more evident in those who attended an informative conference. It is important to educate cardiologists in the appropriate use of modern x-ray equipment.
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[Vertebral fixation with a transpedicular approach. Relevance of anatomical and imaging studies]. ACTA ORTOPEDICA MEXICANA 2012; 26:402-411. [PMID: 24712211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The number of patients with spine conditions has grown exponentially in recent years leading to an increase in the number of cases requiring surgical treatment. Currently vertebral fusion surgery with a transpedicular approach represents the most commonly used technique to treat any type of vertebral disorder. The morphometric characteristics of vertebrae, particularly the pedicle, determine the size of pedicular implants, including width and length, as well as the shape and direction of the screw and its ideal angulation at the time of introduction. Knowing these characteristics is important to prevent injuring important adjacent structures and to decrease the postoperative complication rate. In recent decades numerous studies on the morphometric characteristics of the vertebral pedicle have been conducted in different populations to determine its real dimensions by means of direct measurement and imaging methods. These studies have concluded that there are significant differences in these measurements among the different ethnic groups, races, genders, ages and the vertebral regions studied. This paper analyzes the different morphometric studies of the pedicle and all the other vertebral elements studied in Mexico and the rest of the world and explain the importance of their knowledge and surgical application for the correct development of vertebral fusion surgery with a transpedicular approach.
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[Thyroid incidentaloma frequency in a university hospital]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2011; 49:197-200. [PMID: 21703148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The prevalence of thyroid incidentaloma is variable and always created the dilemma of how to manage them. The objective was to determine the frequency of thyroid incidentalomas in a University Hospital. METHODS A descriptive, transversal, prospective study was done; a non-probabilistic sample was used with patients who met the following criteria: >18 years, indiscriminate sex, and an image that included neck: ultrasound, computed tomography and/or magnetic resonance. Patients with known or suspected thyroid nodule or any other thyroid disease and pregnant women were excluded. Descriptive statistics were used. RESULTS 153 patients who had the criterion; 11 patients had an incidentaloma (7.18%). Females were more frequent with seven cases (63.6%), the mean age was 56.9 years. Morphologically only a single thyroid nodule was detected. The nodules were smaller than 1.5 cm. CONCLUSIONS The prevalence documented in our study is smaller than other reports, it is proposed monitoring patients with thyroid incidentalomas according to current consensus guidelines.
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An arteriovenous fistula increases exercise capacity in patients with COPD. Chest 2010; 138:52-8. [PMID: 20382714 DOI: 10.1378/chest.09-2381] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Supplemental oxygen usually increases exercise capacity in hypoxemic COPD, but some patients are refractory because of venous admixture. An arteriovenous fistula (AVF) with left-to-right shunt increases mixed venous oxygen content and cardiac output; therefore, this might improve arterial oxygen delivery. We hypothesized that creation of an AVF would therefore increase exercise capacity in severe COPD. METHODS We created an AVF in 12 patients with severe hypoxemic COPD: mean (SD) age, 66 (6) years; Pao(2), 57.5 (3.0) mm Hg, and FEV(1), 19% (8%) predicted. We measured 6-min walk distance (6MWD) while the subjects were breathing room air and again while they were breathing portable supplemental oxygen at baseline, 6 weeks, and 12 weeks after creation of an AVF in the iliofemoral region. RESULTS After surgery, the mean (SEM) 6MWD increased from 217 (63) m at baseline to 272 (18) m and 276 (25) m, 6 weeks and 12 weeks after surgery, respectively. Patients who walked > 54 m further while breathing supplemental oxygen at baseline (n = 5) increased 6MWD while breathing room air by 129 (34) m after 6 weeks (P = .02) and by 124 (29) m after 12 weeks (P = .004). Walking distance did not change in patients who did not have a clinically meaningful response to oxygen at baseline. CONCLUSIONS An iliofemoral AVF increased 6MWD patients with severe COPD, matching the improvement seen with supplemental oxygen. An initial response to supplemental oxygen predicted a therapeutic response to the AVF.
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[Posttransplant relapse in non viral hepatopathies]. GAC MED MEX 2008; 144:403-408. [PMID: 19043959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE We describe the recurrence of non-viral liver disease after orthotopic liver transplantation (OLT). METHODS AND RESULTS We studied 39 patients who received an OLT for non-viral chronic liver disease. Six (15.3%) of these patients presented disease recurrence after OLT, one following alcohol abuse, 3 presented autoimmune liver disease [2 received an OLT for primary biliary cirrhosis and recurred as autoimmune hepatitis (AIH) one patient had cryptogenic cirrhosis before OLT and recurred as AIH]. One patient showed recurrence of a non-alcoholic steatohepatitis (NASH). One patient received an OLT for cirrhosis secondary to the use of metothrexate and post OLT developed secondary biliary cirrhosis due to a choledocal stenosis in the anastomotic site. CONCLUSIONS All patients described here displayed long term recurrence (after 11 months post OLT). The recurrence of alcoholism was 8.3% among patients transplanted for this condition. AIH was observed in 30% of cases and NASH in 20%. All three patients with autoimmune liver disease recurred with a different autoimmune disease post OLT.
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[Recent advances in the diagnosis and management of acute ischemic cerebrovascular disease]. GAC MED MEX 1997; 133:431-53. [PMID: 9504071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Proton spin-lattice relaxation times (T1) of pectoralis major muscles from normal (Line 412) and homozygous dystrophic (Line 413) chicks was measured by FONAR QED 80 at 1.69 MHz. The T1 values of dystrophic muscles (216.8 +/- 17.3 ms) was two-fold higher than those of normal muscles (110.2 +/- 8.1 msec). When these values were compared with the T1 values obtained at high frequencies (20 MHz and 32 MHz), the T1 differentiation between normal and dystrophic muscles was considerably enhanced at 1.69 MHz. Based on these results, we suggest that the high resolution of T1 obtained at low frequency (1.69 MHz) could be effectively used to detect the degenerative processes in muscles by the NMR techniques.
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