Role of low dose 256-slice CT perfusion imaging in predicting mediastinal lymph node metastasis of lung cancer

SUMMARY OBJECTIVE: CT perfusion (CTP) is an imaging technique that can be used to evaluate the changes in the microcirculation of tumor tissues. Our study aimed to investigate the role of CTP in predicting mediastinal lymph node metastasis. METHODS: Clinical data of 58 patients who received surgical resection of lung cancer and lymph node dissection in our hospital from June 2012 to December 2014 were collected. Patients were divided into a positive lymph node metastasis group and a negative lymph node metastasis group. Parameters of CTP, including peak enhancement intensity (PEI), perfusion value (PV), as well as blood volume (BV), were compared between the two groups. The receiver-operating characteristic (ROC) curve was used to predict mediastinal lymph node metastasis. RESULTS: The PV of the positive lymph node metastasis group was significantly higher than that of the negative group (p < 0.001). The ROC curve analysis showed that PV can be used as an index to predict mediastinal lymph node metastasis of lung cancer. The sensitivity and specificity of a PV greater than 7.5ml·min-1·ml-1 in predicting lymph node metastasis of lung cancer were 78.3 % and 91.4 %, respectively. CONCLUSION: The PV of low dose CT perfusion can be used as an index for predicting mediastinal lymph node metastasis of lung cancer.

RESUMO OBJETIVOS: A perfusão por TC objetiva (CTP) é uma técnica de imagem que pode ser usada para avaliar as alterações na microcirculação de tecidos tumorais. Nosso estudo teve como objetivo investigar o papel da CTP na predição de metástases em linfonodos mediastinais. MÉTODOS: Dados clínicos de 58 pacientes que receberam ressecção cirúrgica de câncer de pulmão e dissecção de linfonodos em nosso hospital de junho de 2012 a dezembro de 2014 foram coletados. Os pacientes foram divididos em grupo positivo para metástase linfonodal e grupo negativo para metástase linfonodal. Parâmetros de CTP incluindo pico de intensidade de realce (PEI) e valor de perfusão (PV), bem como volume de sangue (BV), foram comparados entre os dois grupos. A curva característica de operação do receptor (ROC) foi usada para predizer metástase linfonodal mediastinal. RESULTADOS: PV do grupo de linfonodos metastáticos positivos foi significativamente maior do que o grupo negativo de linfonodos metastáticos (p<0,001). A análise da curva ROC mostrou que a PV pode ser usada como um índice para predizer a metástase linfonodal mediastinal do câncer de pulmão. A sensibilidade e a especificidade da VP maior que 7,5ml · min-1 · ml-1 na predição de metástase linfonodal de câncer de pulmão foram de 78,3% e 91,4%, respectivamente. CONCLUSÃO: A VP de perfusão por TC de baixa dose pode ser usada como um índice para a predição de metástase linfonodal mediastinal de câncer de pulmão.

Absorption mechanism of three curcumin constituents through in situ intestinal perfusion method

This study aimed to investigate the absorption mechanism of three curcumin constituents in rat small intestines. Self-emulsification was used to solubilize the three curcumin constituents, and the rat in situ intestinal perfusion method was used to study factors on drug absorption, including drug mass concentration, absorption site, and the different types and concentrations of absorption inhibitors. Within the scope of experimental concentrations, three curcumin constituents were absorbed in rat small intestines through the active transport mechanism.

A novel effective method for the assessment of microvascular function in male patients with coronary artery disease: a pilot study using laser speckle contrast imaging

Evaluation of microvascular endothelial function is essential for investigating the pathophysiology and treatment of cardiovascular and metabolic diseases. Although laser speckle contrast imaging technology is well accepted as a noninvasive methodology for assessing microvascular endothelial function, it has never been used to compare male patients with coronary artery disease with male age-matched healthy controls. Thus, the aim of this study was to determine whether laser speckle contrast imaging could be used to detect differences in the systemic microvascular functions of patients with established cardiovascular disease (n=61) and healthy age-matched subjects (n=24). Cutaneous blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with the transdermal iontophoretic delivery of acetylcholine and post-occlusive reactive hyperemia. The maximum increase in skin blood flow induced by acetylcholine was significantly reduced in the cardiovascular disease patients compared with the control subjects (74 vs 116%; P<0.01). With regard to post-occlusive reactive hyperemia-induced vasodilation, the patients also presented reduced responses compared to the controls (0.42±0.15 vs 0.50±0.13 APU/mmHg; P=0.04). In conclusion, laser speckle contrast imaging can identify endothelial and microvascular dysfunctions in male individuals with cardiovascular disease. Thus, this technology appears to be an efficient non-invasive technique for evaluating systemic microvascular and endothelial functions, which could be valuable as a peripheral marker of atherothrombotic diseases in men.

Is previous experience in laparoscopic necessary to perform robotic radical prostatectomy? A comparative study with robotic and the classic open procedure in patients with prostate cancer

PURPOSE: To assess comparative results of robot-assisted radical laparoscopic prostatectomy (RARP) performed by surgeons without any experience in laparoscopic prostatectomy and the open procedure performed by surgeons with large experience. METHODS: We analyzed 84 patients (50 subjected to robotic surgery) from June 2012 to September 2013. Data were prospectively collected in a customized database. Two surgeons carried out all the RARP cases. These two surgeons and six more performed the open cases. The perioperative outcomes between the two groups were analyzed with a minimum followup of 12 months. RESULTS: The corporal mass index (BMI) was higher in the open group (p=0.001). There was more operatve time, less hospitalization and blood loss, better trifecta and pentafecta and earlier continence (p=0.045) in the robotic group (p=0.001). There was no difference in positive surgical margins but with greater extraprostatic extension in the open group (p=0.002). CONCLUSIONS: Robot-assisted radical prostatectomy is a safe procedure even in the hands of surgeons with no previous experience. Besides this, better operative outcomes can be reached with this modern approach. .

CT Perfusion Imaging Can Predict Patients' Survival and Early Response to Transarterial Chemo-Lipiodol Infusion for Liver Metastases from Colorectal Cancers

OBJECTIVE: To prospectively evaluate the performance of computed tomography perfusion imaging (CTPI) in predicting the early response to transarterial chemo-lipiodol infusion (TACLI) and survival of patients with colorectal cancer liver metastases (CRLM). MATERIALS AND METHODS: Computed tomography perfusion imaging was performed before and 1 month after TACLI in 61 consecutive patients. Therapeutic response was evaluated on CT scans 1 month and 4 months after TACLI; the patients were classified as responders and non-responders based on 4-month CT scans after TACLI. The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI. The optimal parameter and cutoff value were determined. The patients were divided into 2 subgroups according to the cutoff value. The log-rank test was used to compare the survival rates of the 2 subgroups. RESULTS: Four-month images were obtained from 58 patients, of which 39.7% were responders and 60.3% were non-responders. The percentage change in hepatic arterial perfusion (HAP) 1 month after TACLI was the optimal predicting parameter (p = 0.003). The best cut-off value was -21.5% and patients who exhibited a > or = 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001). CONCLUSION: Computed tomography perfusion imaging can predict the early response to TACLI and survival of patients with CRLM. The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.

Perfusão por tomografia computadorizada do abdome: aplicações clínicas, princípios e técnica do exame / Abdominal perfusion computed tomography: clinical applications, principles and technique

Novas técnicas de exames têm sido desenvolvidas com o objetivo de se obter não apenas uma avaliação estrutural, mas também uma análise funcional e metabólica de diversos órgãos e tipos de lesões. Entre estas ferramentas, a perfusão por tomografia computadorizada (PTC) tem despertado o interesse de muitos pesquisadores em estudar a sua aplicabilidade em órgãos e doenças abdominais. Entre estas aplicações podemos citar a avaliação do comportamento biológico de tecidos sadios e doentes, a diferenciação de processos inflamatórios de tumorais e o diagnóstico da recidiva tumoral após terapêuticas minimamente invasivas. A principal característica da PTC reside na sua capacidade de caracterizar comportamentos perfusionais distintos e que traduzem alterações biológicas de determinadas lesões e tecidos doentes. Dessa forma, o nosso objetivo foi realizar uma ampla revisão da literatura, mostrando as principais técnicas e protocolos utilizados nos exames de PTC, as principais indicações, vantagens e desvantagens do método, além de propor um protocolo de exame que possa ser introduzido na rede privada e pública de saúde, com reprodutibilidade e simplicidade de implementação.

New imaging techniques have been developed with the objective of obtaining not only a structural assessment, but also a metabolic and functional analysis of different organs and types of lesions. Among such tools perfusion computed tomography (PCT) has recently aroused the interest of many researchers in studying the applicability of such imaging modality in the evaluation of abdominal organs and diseases. Analysis of the biological behavior of healthy and diseased tissues, differentiation of inflammatory processes from tumors, and diagnosis of tumor recurrence after minimally invasive therapies can be mentioned as applications of such an imaging modality. The main features of PCT are related to its ability to characterize different perfusional behaviors reflecting biological changes of certain lesions and diseased tissues. Thus, the present study was aimed at carrying out a comprehensive literature review, describing the key techniques and protocols utilized in PCT imaging, main clinical applications, advantages and disadvantages of the method, besides proposing an imaging protocol that can be adopted by both private and public health services, with good reproducibility and easy implementation.

rear case of congenital anterior diaphragmatic hernia

We report a case of a newborn with the rare anterior diaphragmatic hernia with herniation of the liver into the pericardial sac that posed a diagnostic dilemma in our Neonatal Intensive Care Unit [NICU]. An anterior diaphragmatic hernia should be suspected in any newborn with an anterior mediastinal mass or a pericardial effusion. A MRI of the chest helped to confirm the diagnosis. The relevant literature is reviewed

Detection of silent myocardial ischemia by exercise perfusion imaging in asymptomatic diabetic and non-diabetic patients

Silent myocardial ischemia [SMI], the most common manifestation of coronary artery disease [CAD], may account for the poor prognosis and its actual prevalence in diabetic patients has not been ascertained. The aim of the study was to determine prevalence of SMI in asymptomatic diabetic patients compared to asymptomatic non-diabetics using exercise ECG and myocardial perfusion imaging [MPI]. The prevalence of silent myocardial ischemia was 25.9% in diabetic patients and 17.9% in non-diabetics. The diagnostic value of exercise ECG test in comparison to MPI was relatively low in diabetic patients particularly the sensitivity [21.5%] and the positive predictive value [33%]. This study demonstrated that the prevalence of silent myocardial ischemia is relatively higher in diabetic patients in comparable to non-diabetics. The exercise ECG test had relatively low value for detecting CAD in asymptomatic diabetic patients comparing with myocardial perfusion imaging