ABSTRACT
Abstract Objective: To determine whether dual-energy computed tomography (DECT) of the chest can be performed at a reduced radiation dose, with an emphasis on images generated with post-processing techniques. Materials and Methods: In 21 patients undergoing DECT of the chest in a dual-source scanner, an additional image series was acquired at a reduced radiation dose. Four thoracic radiologists assessed both image series for image quality, normal thoracic structures, as well as pulmonary and mediastinal abnormalities, on virtual monochromatic images at 40 keV and 60 keV. Data were analyzed with Student's t-test, kappa statistics, analysis of variance, and the Wilcoxon signed-rank test. Results: The overall image quality of 60 keV virtual monochromatic images at a reduced radiation dose was considered optimal in all patients, and no abnormalities were missed. Contrast enhancement and lesion detection performance were comparable between reduced-dose images at 40 keV and standard-of-care images at 60 keV. The intraobserver and interobserver agreement were both good. The mean volumetric CT dose index (CTDIvol), size-specific dose estimate (SSDE), dose-length product (DLP), and effective dose (ED) for reduced-dose DECT were 3.0 ± 0.6 mGy, 4.0 ± 0.6 mGy, 107 ± 30 mGy.cm, and 1.5 ± 0.4 mSv, respectively. Conclusion: DECT of the chest can be performed at a reduced radiation dose (CTDIvol < 3 mGy) without loss of diagnostic information.
Resumo Objetivo: Verificar se a tomografia computadorizada de dupla energia (TCDE) do tórax pode ser realizada com baixas doses de radiação, com ênfase em imagens pós-processadas. Materiais e Métodos: Em 21 pacientes submetidos a DECT do tórax foi adicionada uma série de imagens adquiridas com baixas doses de radiação. Quatro radiologistas com especialidade em tórax avaliaram a qualidade, visualização de estruturas torácicas normais e também anormalidades pulmonares e mediastinais das imagens monocromáticas de baixa energia (40 e 60 keV). Os dados foram analisados utilizando t-test, estatística kappa, análise de variância e teste Wilcoxon. Resultados: A qualidade das imagens monocromáticas de baixa energia (60 keV) com doses reduzidas foi considerada ótima para todos os pacientes e nenhuma anormalidade no tórax foi perdida. O realce pelo contraste e a performance de detecção de lesões foram similares nas imagens com radiação reduzida e com radiação padrão. Boa concordância intra-avaliadores e interavaliadores foi observada. A média dos parâmetros CTDIvol, SSDE, DLP e ED para TCDE de baixa dose foram 3,0 ± 0,6 mGy, 4,0 ± 0,6 mGy, 107 ± 30 mGy.cm e 1,5 ± 0,4 mSv, respectivamente. Conclusão: TCDE do tórax pode ser realizada com baixas doses de radiação (CTDIvol < 3 mGy), sem perder informações diagnósticas.
ABSTRACT
Background: Gestational trophoblastic neoplasia [GTN] is a curable disease that involves the development of malignant tumor in the woman after a normal or molar pregnancy. The position of surgery in GTN is not properly specified and is changing due to new chemotherapy protocols. However, the role of surgery is highlighted in chemotherapy-resistant GTN. Other indications of surgery in trophoblastic diseases are drug toxicity and uterine perforation. Based on the fact that most women in certain age tend to preserve fertility, this study reported 4 cases of successful treatment after fertility sparing surgery
Case: A hospital-based case-report study was carried out to investigate the role of surgery in 4 patients with GTN. In this study, acute complications, such as intraabdominal bleeding and liver dysfunction due to chemotherapy occurred in some patients. Surgery was performed and all cases underwent localized tumor removal while preserving the uterus. No hysterectomy surgery was performed
Conclusion: Surgery is supposed in specific cases of GTN, who desire preserving fertility