ABSTRACT
PURPOSE: The aim of this study was to assess the prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta (AA-CTA) and lower limbs (LL-CTA). MATERIALS AND METHODS: The images of 536 AA-CTA and LL-CTA examinations performed for suspected aortic and peripheral vascular disease in 500 patients were retrospectively reviewed. Two radiologists evaluated the 5-mm axial images independently using appropriate window settings for the area under investigation. Collateral findings were divided according to their clinical significance into significant, nonsignificant and meriting further investigation. RESULTS: No collateral findings were identified in 97/500 patients (19.4%). In the remaining patients, 821 collateral findings were detected, of which 43 (5.24%) were classified as significant, 135 (16.44%) as meriting further investigation and 643 (78.32%) as nonsignificant. The findings indicative of the presence of a malignant lesion totalled 36 (4.5%). CONCLUSIONS: AA-CTA and LL-CTA demonstrate a nonnegligible prevalence of collateral findings, many of them major. It therefore appears that the evaluation should focus not only on the image reconstructions to identify vascular disease, but also on the native axial images to detect incidental findings.
Subject(s)
Angiography , Aorta, Abdominal/diagnostic imaging , Incidental Findings , Lower Extremity/blood supply , Lower Extremity/diagnostic imaging , Tomography, X-Ray Computed , Aortic Diseases/diagnostic imaging , Aortography , Humans , Peripheral Vascular Diseases/diagnostic imaging , Prevalence , Radiographic Image Interpretation, Computer-Assisted , Retrospective StudiesABSTRACT
PURPOSE: This study was undertaken to evaluate the potential of 64-row multislice computed tomography (CT) versus digital subtraction angiography (DSA) in detecting significant lesions of lower-extremity inflow and runoff arteries. MATERIALS AND METHODS: Fifty-three patients underwent 64-row multislice CT and DSA over a mean of 36 days. The vascular tree was divided into 33 segments. Three readers independently reviewed the axial CT scans and multiplanar oblique and two- and three-dimensional reconstructions (maximum intensity projection and volume rendering) images to assess degree of stenosis according to four categories: 1 (0%-49% stenosis); 2 (50%-99% stenosis); 3 (occluded); 4 (not evaluable). In all cases, DSA was performed by arterial catheterisation. RESULTS: In 53 patients, 1,440 segments were evaluated (infrarenal aorta and 16 arterial segments for each leg; 42 bilateral studies, 11 unilateral studies). Compared with DSA, CT angiography yielded 97.2% sensitivity, 97% specificity, 92.5% positive predictive value, 98.9% negative predictive value, 97.1% diagnostic accuracy and 95.4% concordance on the degree of stenosis. CONCLUSIONS: Sixty-four-row multislice CT proved to be helpful in detecting haemodynamically significant lesions in peripheral arterial occlusive disease and improved the results obtained with 4- and 16-slice multidetector CT. In addition, owing to the high spatial resolution and rigorous technique, no variations in the data obtained below the knee were detected, overcoming a limitation of earlier generations of CT scanners.
Subject(s)
Angiography, Digital Subtraction/methods , Angiography/methods , Lower Extremity/diagnostic imaging , Peripheral Vascular Diseases/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Female , Humans , Image Processing, Computer-Assisted , Knee/diagnostic imaging , Leg/diagnostic imaging , Lower Extremity/blood supply , Male , Middle Aged , Predictive Value of Tests , Radiographic Image Interpretation, Computer-Assisted , Retrospective Studies , Sensitivity and Specificity , Thigh/diagnostic imagingABSTRACT
The aim of this paper is to describe the intratumoural tissue components of solid lung tumours evidenced by macroscopic and/or microscopic examination of the autopsy or surgical specimen and visible on computed tomography (CT) without and with contrast material administration. Seven intratumoural tissue components can be identified both at CT and at pathology: (1) solid component, (2) haemorrhagic component, (3) coagulation necrosis, (4) liquefaction necrosis, (5) parenchymal consolidation, (6) diffuse peripheral component and (7) fibrotic component. Necrotic and haemorrhagic components are typically observed in malignant lesions, whereas solid and fibrotic components may be seen both in solid lung malignancies and in benign lesions.
Subject(s)
Carcinoma, Bronchogenic/diagnostic imaging , Carcinoma, Bronchogenic/pathology , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Tomography, X-Ray Computed , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/pathology , Cadaver , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Fibrosis/diagnostic imaging , Hemorrhage/diagnostic imaging , Humans , Necrosis/diagnostic imaging , Radiographic Image Enhancement , Radiographic Image Interpretation, Computer-Assisted , Small Cell Lung Carcinoma/diagnostic imaging , Small Cell Lung Carcinoma/pathologyABSTRACT
BACKGROUND: Accurate staging is necessary to determine the appropriate therapy in patients with lung cancer. Few studies have compared integrated fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and contrast-enhanced CT in the characterization and staging of pulmonary tumors considered eligible for surgical resection. PURPOSE: To compare 18F-FDG PET/CT with standard contrast-enhanced CT for the diagnosis and staging of lung neoplasms eligible for surgical resection. MATERIAL AND METHODS: Seventy-six consecutive patients (56 male, 20 female; mean age+/-SD, 63.4+/-20 years) with 84 pulmonary tumors suspected for malignancy and considered eligible for surgical resection were prospectively enrolled. Seventy-three malignant (65 non-small-cell lung carcinomas, one small-cell lung cancer, two carcinoids, and five metastases) and 11 benign lung tumors (three hamartomas, two sarcoidosis, one amyloidosis, one Wegener granulomatosis, one tuberculosis, and three areas of scarring) were finally diagnosed by histology. Tumor staging was based on the revised American Joint Committee on Cancer. RESULTS: In lesion characterization, the sensitivity and specificity of 18F-FDG PET/CT versus contrast-enhanced CT were 90% vs. 83% and 18% vs. 63% (P<0.05, McNemar test), respectively. In nodal staging, the sensitivity and specificity of 18F-FDG PET/CT versus contrast-enhanced CT were 78% vs. 46% and 80% vs. 93% (P<0.05), respectively. CONCLUSION: In patients with lung neoplasms considered eligible for surgical resection, (18)F-FDG PET/CT versus contrast-enhanced CT revealed higher sensitivity in nodal staging, but lower specificity both in lesion characterization and nodal staging.
Subject(s)
Fluorodeoxyglucose F18 , Lung Neoplasms/diagnosis , Positron-Emission Tomography , Tomography, X-Ray Computed , Contrast Media , Female , Humans , Image Enhancement , Lung Diseases/diagnosis , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging/methods , Prospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: Superselective embolization of the torn artery is currently considered the treatment of choice for patients with high-flow priapism. After embolization, however, the arterial-sinusoidal fistula is still patent in a significant percentage of patients, despite arteriographic evidence of occlusion. PURPOSE: To investigate the prevalence and flow characteristics of penile cavernosal-spongiosal communications (CSCs) in patients with high-flow priapism, and to establish whether the recognition of these vessels before and after angiographic embolization has a role in predicting the outcome of therapy. MATERIAL AND METHODS: Twelve consecutive patients with high-flow priapism underwent penile color Doppler ultrasound before and after angiographic embolization of the arterial-sinusoidal fistula. The prevalence of CSCs feeding the fistula was evaluated before and after embolization. RESULTS: Before angiographic embolization, color Doppler ultrasound identified five CSCs in 3/12 patients. One CSC was proximal to the fistula, and 4/5 were distal. After angiographic embolization, the fistula was not completely closed in these patients, fed by the distal CSCs. However, spontaneous closure occurred within 1 month. The fistula was also fed by CSCs in another two patients in whom these vessels were not evident before embolization. In one case, the fistula closed spontaneously within 1 week, while in the other case the fistula remained patent, fed by other collateral vessels. CONCLUSION: The type of vessels that are involved in refilling the fistula after embolization is of concern for the outcome of the patients. In our series, the fistulas supplied only by CSCs closed spontaneously within 1 month. Watchful waiting should be preferred to repeated embolization to avoid the risk of unnecessary procedures.
Subject(s)
Penis/diagnostic imaging , Priapism/diagnostic imaging , Priapism/therapy , Ultrasonography, Doppler, Color/methods , Vascular Fistula/diagnosis , Adolescent , Adult , Angiography , Blood Flow Velocity , Embolization, Therapeutic/methods , Humans , Male , Penis/blood supply , Penis/injuries , Polyvinyl Alcohol/administration & dosage , Predictive Value of Tests , Treatment Outcome , Vascular Fistula/etiologyABSTRACT
The objective of this study was to obtain post-marketing information about the use of infliximab in an ambulatory setting. We studied--retrospectively and prospectively--the case records of patients with rheumatoid arthritis (n=37), psoriatic arthritis (n=5), mixed connective tissue disease (n=1), and ankylosing spondylitis (n=2) who received infliximab (3 mg/kg) from August 2000 to January 2003. Descriptive values were given as percentage, mean or median, and standard deviation or interquartile range. Wilcoxon test was used for paired analysis of pre/post doses of corticosteroids, non-steroidal anti-inflammatory drugs, and methotrexate therapy. A p value < or = 0.05 was considered significant. Forty-five patients were included. A total of 207 infusions were administered. In 4 patients the treatment was permanently discontinued due to severe back pain during the infusion (2 cases) and serious anaphylactic reactions (2 cases). Other adverse reactions occurring during infusions were mild and successfully managed with standard treatment. A case of staphylococcal septic arthritis resolved with standard antibiotic treatment. No patient had evidence of active tuberculosis. One patient with rheumatoid arthritis and chronic renal insufficiency, received treatment with infliximab 1.9 mg/kg, every 30 days, with no changes in renal function. Due to improvement of symptoms, 14/39 (35.9%) patients could decrease the doses of corticosteroids, 15/43 (34.8%) decreased the doses of antiinflammatory drugs and 12/34 (35.3%) decreased methotrexate dosage. Although some questions remain to be elucidated, this case series shows the drug safety profile, the possibility to reduce concomitant drug doses, as well as individual approaches for situations where there are not yet guidelines available, so that rheumatologists have to make decisions based on clinical needs.
El objetivo de este estudio fue obtener informacion postmarketing sobre el uso de infliximab en un centro reumatologico de atencion ambulatoria. Se realizo un analisis retrospectivo y prospectivo de las historias clinicas de pacientes con diagnostico de artritis reumatoidea (n=37), artritis psoriasica (n=5),enfermedad mixta del tejido conectivo (n=1) y espondilitis anquilosante (n=2) que recibieron infliximab (3 mg/kg) desde agosto de 2000 a junio de 2003. El analisis descriptivo se realizo con porcentajes, media o medianay desviacion estandar o intervalo intercuartilo. La prueba de Wilcoxon se utilizo para el analisis apareado dedosis de antiinflamatorios no esteroideos y metotrexato, anterior y posterior a la administracion de infliximab. Se consideraron significativos valores de p < o = 0.05. Se incluyeron 45 pacientes a los que se les administraron un total de 207 infusiones. En 2 pacientes el infliximab se discontinuó debido a lumbalgia severa durante la infusion y en otros 2 por anafilaxia intrainfusional. Otras reacciones adversas ocurridas durante las infusiones fueron moderadas y respondieron adecuadamente al tratamiento estandar. Se presento un caso de artritis septica de rodilla por estafilococos. Un caso de artritis reumatoidea con insuficiencia renal compensada recibio infliximab en dosis de 1.9 mg/kg cada 30 dias, sin cambios en la funcion renal. Al momento, ningun paciente ha desarrollado tuberculosis activa. Debido a la mejoria clinica, se redujo la dosis de corticoides en 14/39 (35.9%) pacientes, de antiinflamatorios no esteroideos en 15/43 (34.8%) y de metotrexato en 12/34 (35.3%). En estaserie de casos se muestra el perfil de seguridad de infliximab, la posibilidad de reducir la dosis de drogas concomitantes,asi como algunos enfoques individuales sobre situaciones para las cuales no disponemos de guias basadas en la evidencia medica, y en las que los reumatologos debemos tomar decisiones segun las necesidades clinicas.
Subject(s)
Humans , Male , Female , Middle Aged , Antirheumatic Agents , Antibodies, Monoclonal/therapeutic use , Joint Diseases/drug therapy , Mixed Connective Tissue Disease/drug therapy , Ambulatory Care , Antirheumatic Agents , Antibodies, Monoclonal/adverse effects , Prospective Studies , C-Reactive Protein/analysis , Retrospective StudiesABSTRACT
The objective of this study was to obtain post-marketing information about the use of infliximab in an ambulatory setting. We studied--retrospectively and prospectively--the case records of patients with rheumatoid arthritis (n=37), psoriatic arthritis (n=5), mixed connective tissue disease (n=1), and ankylosing spondylitis (n=2) who received infliximab (3 mg/kg) from August 2000 to January 2003. Descriptive values were given as percentage, mean or median, and standard deviation or interquartile range. Wilcoxon test was used for paired analysis of pre/post doses of corticosteroids, non-steroidal anti-inflammatory drugs, and methotrexate therapy. A p value < or = 0.05 was considered significant. Forty-five patients were included. A total of 207 infusions were administered. In 4 patients the treatment was permanently discontinued due to severe back pain during the infusion (2 cases) and serious anaphylactic reactions (2 cases). Other adverse reactions occurring during infusions were mild and successfully managed with standard treatment. A case of staphylococcal septic arthritis resolved with standard antibiotic treatment. No patient had evidence of active tuberculosis. One patient with rheumatoid arthritis and chronic renal insufficiency, received treatment with infliximab 1.9 mg/kg, every 30 days, with no changes in renal function. Due to improvement of symptoms, 14/39 (35.9%) patients could decrease the doses of corticosteroids, 15/43 (34.8%) decreased the doses of antiinflammatory drugs and 12/34 (35.3%) decreased methotrexate dosage. Although some questions remain to be elucidated, this case series shows the drug safety profile, the possibility to reduce concomitant drug doses, as well as individual approaches for situations where there are not yet guidelines available, so that rheumatologists have to make decisions based on clinical needs.(AU)
El objetivo de este estudio fue obtener informacion postmarketing sobre el uso de infliximab en un centro reumatologico de atencion ambulatoria. Se realizo un analisis retrospectivo y prospectivo de las historias clinicas de pacientes con diagnostico de artritis reumatoidea (n=37), artritis psoriasica (n=5),enfermedad mixta del tejido conectivo (n=1) y espondilitis anquilosante (n=2) que recibieron infliximab (3 mg/kg) desde agosto de 2000 a junio de 2003. El analisis descriptivo se realizo con porcentajes, media o medianay desviacion estandar o intervalo intercuartilo. La prueba de Wilcoxon se utilizo para el analisis apareado dedosis de antiinflamatorios no esteroideos y metotrexato, anterior y posterior a la administracion de infliximab. Se consideraron significativos valores de p < o = 0.05. Se incluyeron 45 pacientes a los que se les administraron un total de 207 infusiones. En 2 pacientes el infliximab se discontinuó debido a lumbalgia severa durante la infusion y en otros 2 por anafilaxia intrainfusional. Otras reacciones adversas ocurridas durante las infusiones fueron moderadas y respondieron adecuadamente al tratamiento estandar. Se presento un caso de artritis septica de rodilla por estafilococos. Un caso de artritis reumatoidea con insuficiencia renal compensada recibio infliximab en dosis de 1.9 mg/kg cada 30 dias, sin cambios en la funcion renal. Al momento, ningun paciente ha desarrollado tuberculosis activa. Debido a la mejoria clinica, se redujo la dosis de corticoides en 14/39 (35.9%) pacientes, de antiinflamatorios no esteroideos en 15/43 (34.8%) y de metotrexato en 12/34 (35.3%). En estaserie de casos se muestra el perfil de seguridad de infliximab, la posibilidad de reducir la dosis de drogas concomitantes,asi como algunos enfoques individuales sobre situaciones para las cuales no disponemos de guias basadas en la evidencia medica, y en las que los reumatologos debemos tomar decisiones segun las necesidades clinicas.(AU)
