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Kramer SJ, Amanavicius N, Staanum PF, Villadsen GE, Arveschoug AK. Incidental Finding of Pulmonary Embolism at Workup Before SIRT. Clin Nucl Med 2022; 47:e201-e202. [PMID: 34507328 DOI: 10.1097/rlu.0000000000003883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Selective internal radiation therapy (SIRT) is a catheter-guided treatment offered to selected patients with primary and secondary liver malignancies. SIRT is preceded by a workup procedure, where 99mTc-MAA (macroaggregated albumin) is injected in the tumor supplying artery/arteries followed by MAA scintigraphy. SIRT is frequently offered to patients with hepatocellular carcinoma (HCC), but large HCCs are known to be associated with a high risk of liver-to-lung shunting. We present a HCC patient case where a large lung-shunt enabled diagnosis of pulmonary embolism.
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Sivesgaard K, Larsen LP, Sørensen M, Kramer S, Schlander S, Amanavicius N, Mortensen FV, Pedersen EM. Whole-body MRI added to gadoxetic acid-enhanced liver MRI for detection of extrahepatic disease in patients considered eligible for hepatic resection and/or local ablation of colorectal cancer liver metastases. Acta Radiol 2020; 61:156-167. [PMID: 31189329 DOI: 10.1177/0284185119855184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can detect extrahepatic disease before local treatment of colorectal liver metastases. Purpose To investigate if whole-body magnetic resonance imaging (MRI) added to gadoxetic acid liver MRI could replace FDG-PET/CT for detection of extrahepatic disease in patients with colorectal liver metastases eligible for hepatic local treatment. Material and Methods This health-research-ethics-committee-approved prospective consecutive diagnostic accuracy study with written informed consent analyzed 79 cases included between 29 June 2015 and 7 February 2017. Whole-body MRI covering the thorax, abdomen, and pelvis and FDG-PET/CT including contrast-enhanced CT was performed 0–3 days before local treatment of liver metastases. Whole-body MR images were read independently by two readers. FDG-PET/CT images were read independently by two pairs of readers. Histopathology and follow-up imaging were used as reference standard. Sensitivities and specificities were calculated and compared including noninferiority analysis. Results Seventy-five malignant lesions and 419 benign lesions were confirmed. Sensitivities of both PET/CT reader pairs 1 and 2 (56.7 and 67.9%) and MRI reader 2 (63.0%) were significantly higher than that of MRI reader 1 (42.7) (P<0.04). Specificities of both PET/CT reader pairs 1 and 2 (92.5 and 92.4%) and MRI reader 1 (91.1%) were significantly higher than that of MRI reader 2 (86.3%) ( P < 0.02). Sensitivity of MRI reader 2 was non-inferior compared to PET/CT reader pair 1. Specificities of both MRI readers were non-inferior to both PET/CT reader pairs. Conclusion For detection of extrahepatic disease in patients with colorectal liver metastases, whole-body MRI was non-inferior to FDG-PET/CT for some reader combinations. However, reader-independent non-inferiority could not be demonstrated.
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Affiliation(s)
- Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sørensen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Sven Schlander
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frank V Mortensen
- Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreato-biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Erik M Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Kraglund F, Jepsen P, Amanavicius N, Aagaard NK. Long-term effects and complications of the transjugular intrahepatic portosystemic shunt: a single-centre experience. Scand J Gastroenterol 2019; 54:899-904. [PMID: 31203699 DOI: 10.1080/00365521.2019.1630675] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Accurate estimates of the long-term risks of adverse outcomes after transjugular intrahepatic portosystemic shunt (TIPS) treatment are needed. The aim of this cohort study was to estimate the risks of stent dysfunction, variceal bleeding, refractory ascites, hepatic encephalopathy (HE), and death after TIPS treatment. Methods: We extracted data from electronic medical records of 104 consecutive TIPS patients. Gore® Viatorr® TIPS endoprostheses were used in all patients. We conducted competing risks analysis of the risk of stent dysfunction and variceal bleeding, and Kaplan-Meier estimation of overall survival. Results: The overall 1-year survival after TIPS insertion was 82% (95% confidence interval [CI]: 73-88%), and the 1-year risk of stent dysfunction was 15% (95% CI: 9-22%). In patients who had a TIPS for variceal bleeding, the 1-year risk of rebleeding was 23% (95% CI: 13-35%). In patients who had a TIPS for refractory ascites, the risk of having an unsuccessful ascites outcome 1 year after TIPS for refractory ascites was 35% (95% CI: 21-52%). Overall, the 1-year risk of overt HE was 38% (95% CI: 32-43%). The risk of experiencing any of the defined complications during the first year was 56% (95% CI: 45-66%). Conclusion: TIPS is an effective treatment for variceal bleeding and refractory ascites in most cases, but more than half of the patients experience either death, stent dysfunction, recurrence of symptoms, or overt HE within the first year after the procedure.
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Affiliation(s)
- Frederik Kraglund
- Department of Hepatology and Gastroenterology, Aarhus University Hospital , Aarhus , Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital , Aarhus , Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital , Aarhus , Denmark
| | | | - Niels Kristian Aagaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital , Aarhus , Denmark
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Sivesgaard K, Larsen LP, Sørensen M, Kramer S, Schlander S, Amanavicius N, Bharadwaz A, Tønner Nielsen D, Viborg Mortensen F, Morre Pedersen E. Diagnostic accuracy of CE-CT, MRI and FDG PET/CT for detecting colorectal cancer liver metastases in patients considered eligible for hepatic resection and/or local ablation. Eur Radiol 2018; 28:4735-4747. [PMID: 29736846 DOI: 10.1007/s00330-018-5469-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the diagnostic performance of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI) and combined fluorodeoxyglucose/positron emission tomography/computed tomography (FDG-PET/CT) for detection of colorectal liver metastases (CRLM) in patients eligible for local treatment. MATERIALS AND METHODS This health-research ethics-committee-approved prospective consecutive diagnostic accuracy study, with written informed consent, included 80 cases (76 patients, four participating twice) between 29 June 2015 and 7 February 2017. Prior chemotherapy or local treatment did not exclude participation. Combined FDG-PET/CT including CE-CT and MRI was performed within 0-3 days shortly before local treatment. CE-CT and MRI images were read independently by two readers for each modality. The combined FDG-PET/CT images were read independently by two pairs of readers. A composite reference standard was used. Sensitivities, specificities and area under the receiver operating characteristic curves (AUCROC) were calculated and compared. RESULTS In total, 260 CRLMs were confirmed. The MRI readers had significantly higher per-lesion sensitivity (85.9% and 83.8%) than both CE-CT readers (69.1% and 62.3%) and both PET/CT reader pairs (72.0% and 72.1%) (p<0.001). There were no significant differences in per-lesion specificity. MRI readers had significantly higher AUCROC (0.92 and 0.88) than both CE-CT readers (0.80 and 0.82) (p≤0.001). AUCROC for MR reader 1 was higher than that of both PET/CT reader pairs (0.83 and 0.84) (p≤0.0001). CONCLUSION MRI performed significantly better than both CE-CT and combined FDG-PET/CT for detection of CRLM in consecutive patients eligible for local treatment irrespective of prior chemotherapy or local treatment. KEY POINTS • Patients eligible for local treatment of colorectal liver-metastases require optimal imaging. • In 80 consecutive patients, MRI had superior per lesion diagnostic performance. • Findings were independent of prior treatment and type of planned local treatment. • Equally, MRI had superior diagnostic performance on per segment basis.
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Affiliation(s)
- Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark.
| | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Michael Sørensen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Sven Schlander
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Nerijus Amanavicius
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Arindam Bharadwaz
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Dennis Tønner Nielsen
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Frank Viborg Mortensen
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Erik Morre Pedersen
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
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Kirkegård J, Avlund TH, Amanavicius N, Mortensen FV, Kissmeyer-Nielsen P. Non-operative management of blunt splenic injuries in a paediatric population: a 12-year experience. Dan Med J 2015; 62:A4998. [PMID: 25634501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Non-operative management (NOM) is now the primary treatment for blunt splenic injuries in children. Only one study has examined the use of NOM in a Scandinavian population. Thus, the purpose of this study is to report our experience in treating children with blunt splenic injuries with NOM at a Danish university hospital. METHODS We conducted a retrospective observational study of 34 consecutive children (aged 16 years or less) admitted to our level 1-trauma centre with blunt splenic injury in the 12-year period from 1 January 2001 to 31 December 2012. Data on patients and procedures were obtained by review of all medical records and re-evaluation of all initial computed tomographies (CT). RESULTS We included 34 children with a median age of 10.5 years (67.6% males) in this study. All patients were scheduled for NOM, and two (5.9%) patients underwent splenic artery embolisation (SAE). Two (5.9%) patients later needed surgical intervention. The NOM success rate was 88% (95% confidence interval (CI): 73-97%) without SAE and 94% (95% CI: 80-99%) with SAE. We found no difference in the American Association for the Surgery of Trauma grade when comparing the initial CT evaluation (mean 2.59 ± 1.1) with the CT re-evaluation (mean 2.71 ± 0.94); p = 0.226. CONCLUSION We demonstrated a high degree of success and safety of non-operative treatment in children with blunt splenic injury in a Scandinavian setting. Our results are comparable to international findings.
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Affiliation(s)
- Jakob Kirkegård
- Abdominalkirurgisk Afdeling, Abdominalcentret, Aarhus Universitetshospital, Bygning 1C, Nørrebrogade 44, 8000 Aarhus C, Denmark.
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Riahi S, Schmidt EB, Amanavicius N, Karmisholt J, Jensen HS, Christoffersen RP, Niebuhr U, Christensen JH, Toft E. The effect of atorvastatin on heart rate variability and lipoproteins in patients treated with coronary bypass surgery. Int J Cardiol 2005; 111:436-41. [PMID: 16290290 DOI: 10.1016/j.ijcard.2005.08.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 08/10/2005] [Accepted: 08/20/2005] [Indexed: 11/30/2022]
Abstract
Statins reduce mortality in patients with coronary heart disease (CHD). An antiarrhythmic effect of statins has been suggested and reported as a possible contributing mechanism. The aim of this study was to examine whether atorvastatin had any effect on heart rate variability (HRV), an important predictor of sudden cardiac death. Eighty patients previously treated with coronary artery bypass grafting (CABG) were studied. The study was designed as a randomized, placebo-controlled, double blinded crossover study. The patients were randomized in two groups, and were treated with 80 mg atorvastatin or placebo for 6 weeks before crossing over to the opposite treatment for another 6 weeks. There was no washout between treatments. Twenty-four-hour Holter recording and plasma lipids and lipoprotein measurements were performed at baseline and after each 6-week period. There was no change in HRV indices after treatment with 80 mg atorvastatin for 6 weeks. A significant reduction in total cholesterol (46%, p</=0.001), LDL cholesterol (61%, p</=0.001) and triglycerides (35%, p</=0.001) were observed during treatment with atorvastatin. Therapy with 80 mg atorvastatin daily for 6 weeks reduced total cholesterol, LDL cholesterol and triglycerides significantly, while there was no effect on 24-h HRV indices. The study therefore does not lend support for any effect of atorvastatin on HRV after 6 weeks of treatment in patients treated with CABG.
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Affiliation(s)
- Sam Riahi
- Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Arhus University Hospital, Denmark.
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