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1.
Radiat Oncol ; 19(1): 90, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010133

RESUMO

BACKGROUND: The planification of radiation therapy (RT) for pancreatic cancer (PC) requires a dosimetric computed tomography (CT) scan to define the gross tumor volume (GTV). The main objective of this study was to compare the inter-observer variability in RT planning between the arterial and the venous phases following intravenous contrast. METHODS: PANCRINJ was a prospective monocentric study that included twenty patients with non-metastatic PC. Patients underwent a pre-therapeutic CT scan at the arterial and venous phases. The delineation of the GTV was performed by one radiologist (gold standard) and two senior radiation oncologists (operators). The primary objective was to compare the Jaccard conformity index (JCI) for the GTVs computed between the GS (gold standard) and the operators between the arterial and the venous phases with a Wilcoxon signed rank test for paired samples. The secondary endpoints were the geographical miss index (GMI), the kappa index, the intra-operator variability, and the dose-volume histograms between the arterial and venous phases. RESULTS: The median JCI for the arterial and venous phases were 0.50 (range, 0.17-0.64) and 0.41 (range, 0.23-0.61) (p = 0.10) respectively. The median GS-GTV was statistically significantly smaller compared to the operators at the arterial (p < 0.0001) and venous phases (p < 0.001), respectively. The GMI were low with few tumors missed for all patients with a median GMI of 0.07 (range, 0-0.79) and 0.05 (range, 0-0.39) at the arterial and venous phases, respectively (p = 0.15). There was a moderate agreement between the radiation oncologists with a median kappa index of 0.52 (range 0.38-0.57) on the arterial phase, and 0.52 (range 0.36-0.57) on the venous phase (p = 0.08). The intra-observer variability for GTV delineation was lower at the venous phase than at the arterial phase for the two operators. There was no significant difference between the arterial and the venous phases regarding the dose-volume histogram for the operators. CONCLUSIONS: Our results showed inter- and intra-observer variability in delineating GTV for PC without significant differences between the arterial and the venous phases. The use of both phases should be encouraged. Our findings suggest the need to provide training for radiation oncologists in pancreatic imaging and to collaborate within a multidisciplinary team.


Assuntos
Neoplasias Pancreáticas , Planejamento da Radioterapia Assistida por Computador , Tomografia Computadorizada por Raios X , Humanos , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Prospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Dosagem Radioterapêutica , Idoso de 80 Anos ou mais , Variações Dependentes do Observador , Carga Tumoral
2.
Abdom Radiol (NY) ; 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38954000

RESUMO

PURPOSE: To evaluate the diagnostic performance of bowel wall enhancement for diagnosing concomitant bowel ischemia in patients with parietal pneumatosis (PI) diagnosed at abdominal CT. MATERIALS AND METHODS: From January 1, 2012 to December 31, 2021, 226 consecutive patients who presented with PI on abdominal CT from any bowel segment were included. Variables at the time of the CT were retrospectively extracted from medical charts. CT examinations were blindly analyzed by two independent radiologists. The third reader classified all disagreement of bowel enhancement in three categories: (1) normal bowel enhancement; (2) doubtful bowel wall enhancement; (3) absent bowel wall enhancement. Multivariable logistic regression analysis was performed. Concomitant bowel ischemia was defined as requirement of bowel resection specifically due to ischemic lesion in operated patients and death from bowel ischemia in non-operated patients. RESULTS: Overall, 78/226 (35%) patients had PI associated with concomitant bowel ischemia. At multivariate analysis, Only absence or doubtful bowel wall enhancement was associated with concomitant bowel ischemia (OR = 167.73 95%CI [23.39-4349.81], P < 0,001) and acute mesenteric ischemia associated with PP (OR = 67.94; 95%CI [5.18-3262.36], P < 0.009). Among the 82 patients who underwent a laparotomy for suspected bowel ischemia, rate of non-therapeutic laparotomy increased from 15/59 (25%), 2/6 (50%) and 16/17 (94%) when bowel wall enhancement was absent, doubtful and normal respectively. CONCLUSION: Absence of enhancement of the bowel wall is the primary feature associated with concomitant bowel ischemia. It should be carefully assessed when PI is detected to avoid non-therapeutic laparotomy.

5.
Sci Rep ; 13(1): 22714, 2023 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-38123632

RESUMO

This study aimed to establish quantitative references of the normal bowel wall iodine concentration (BWIC) using dual energy CT (DECT). This single-center retrospective study included 248 patients with no history of gastrointestinal disease who underwent abdominal contrast-enhanced DECT between January and April 2022. The BWIC was normalized by the iodine concentration of upper abdominal organs (BWICorgan,) and the iodine concentration (IC) of the aorta (BWICaorta). BWIC decreased from the stomach to the rectum (mean 2.16 ± 0.63 vs. 2.19 ± 0.63 vs. 2.1 ± 0.58 vs. 1.67 ± 0.47 vs. 1.31 ± 0.4 vs. 1.18 ± 0.34 vs. 0.94 ± 0.26 mgI/mL for the stomach, duodenum, jejunum, ileum, right colon, left colon and rectum, respectively; P < 0.001). By multivariate analysis, BWIC was associated with a higher BMI (OR:1.01, 95% CI 1.00-1.02, P < 0.001) and with a higher injected contrast dose (OR: 1.51; 95% CI 1.36-1.66, P < 0.001 and 2.06; 95% CI 1.88-2.26, P < 0.001 for 500 mgI/kg and 600 mgI/kg doses taking 400 mgI/kg dose as reference). The BWICorgan was shown independent from patients and contrast-related variables while the BWICaorta was not. BWIC varies according to bowel segments and is dependent on the total iodine dose injected. It shall be normalized with the IC of the upper abdominal organs.


Assuntos
Meios de Contraste , Iodo , Humanos , Iodo/análise , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Jejuno
6.
Eur J Radiol ; 167: 111075, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37683330

RESUMO

PURPOSE: To assess the predictive value of combining CT and clinical findings for predicting 10-day mortality in critically ill patients in shock. MATERIALS AND METHODS: From January 1, 2018, to December 31, 2021, 289 consecutives critically ill patients in shock who underwent a contrast enhanced CT were included. Variables at the time of the CT were retrospectively extracted from medical charts. CT examinations were blindly analyzed by two independent radiologists. Multivariable analysis was performed, combining clinical and CT features. A simple survival score for 10-day mortality prediction was built and validated in a further independent external cohort of 70 patients. RESULTS: 10-day mortality rate was 135/289 (47%) in the study sample. At multivariate analysis, catecholamine infusion (OR = 2.11; 95%CI [1.21-4.18], P = 0.011), lactates level > 5 mmol/l (OR = 3.54; 95%CI [1.94-6.54], P < 0.001); total bilirubin > 50 mg/l (OR = 1.79 CI 95% [1.03-3.13], P = 0.039); small bowel dilation (OR = 1.82; 95%CI [1.01-3.32], P = 0.047); diffuse kidney infarction (OR = 2.76; 95%CI [1.26-6.37], P = 0.013) and superior mesentery artery < 5 mm (OR = 1.96; 95%CI [1.10-3.49], P = 0.021) were associated with 10-days mortality. The AUC of the combined model was 0.79; 95%CI [0.74-0.85] in the study sample and 0.87; 95%CI [0.71-0.91] in the validation cohort. CONCLUSION: The combination of CT imaging features and clinical data should emerge as a novel approach to predict short-term mortality in critically ill patients in shock.


Assuntos
Estado Terminal , Ácido Láctico , Humanos , Estudos Retrospectivos , Prognóstico , Tomografia Computadorizada por Raios X
8.
J Thorac Imaging ; 38(5): 315-324, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37603106

RESUMO

PURPOSE: The main objective of this study was to identify risk factors for post-percutaneous transthoracic lung biopsy (PTLB) pneumothorax and to establish and validate a predictive score for pneumothorax occurrence to identify patients eligible for outpatient care. MATERIAL AND METHODS: Patients who underwent PTLB between November 1, 2012 and March 1, 2017 were retrospectively evaluated for clinical and radiologic factors potentially related to pneumothorax occurrence. Multivariate logistic regression was used to identify risk factors, and the model coefficient for each factor was used to compute a score. Then, a validation cohort was prospectively evaluated from March 2018 to October 2019. RESULTS: Among the 498 eligible patients in the study cohort, pneumothorax occurred in 124 patients (24.9%) and required drainage in 34 patients (6.8%). Pneumothorax risk factors were chronic obstructive pulmonary disease (OR 95% CI 2.28[1.18-4.43]), several passages through the pleura (OR 95% CI 7.71[1.95-30.48]), an anterior biopsy approach (OR 95% CI 6.36 3.82-10.58]), skin-to-pleura distance ≤30 mm (OR 95% CI 2.25[1.09-6.65]), and aerial effusion >10 mm (OR 95% CI 9.27 [5.16-16.65]). Among the 236 patients in the prospective validation cohort, pneumothorax occurred in 18% and 8% were drained. A negative score (<73 points) predicted a probability of pneumothorax occurrence of 7.4% and late evacuation of 2.5% (OR 95% CI respectively 0.18[0.08-0.39] and 0.15[0.04-0.55]) and suggested a reduced length of hospital stay (P=0.009). CONCLUSION: This predictive score for pneumothorax secondary to PTLB has high prognostic performance and accuracy to direct patients toward outpatient management. CLINICAL TRIALS: NCT03488043.


Assuntos
Pneumotórax , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Estudos Retrospectivos , Fatores de Risco , Tomografia
9.
Br J Radiol ; 96(1151): 20230232, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37493183

RESUMO

Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of AMI is ideally made with dynamic contrast-enhanced CT but the diagnosis may be made on portal-venous phase images in appropriate clinical settings. AMI is diagnosed on CT based on the identification of vascular impairment and bowel ischaemic injury with no other cause. Moreover, radiologists must evaluate the probability of bowel necrosis, which will influence the treatment options.AMI is usually separated into different entities: arterial, venous, non-occlusive and ischaemic colitis. Arterial AMI can be occlusive or stenotic, the dominant causes being atherothrombosis, embolism and isolated superior mesenteric artery (SMA) dissection. The main finding in the bowel is decreased wall enhancement, and necrosis can be suspected when dilatation >25 mm is identified. Venous AMI is related to superior mesenteric vein (SMV) thrombosis as a result of a thrombophilic state (acquired or inherited), local injury (cancer, inflammation or trauma) or underlying SMV insufficiency. The dominant features in the bowel are hypoattenuating wall thickening with submucosal oedema. Decreased enhancement of the involved bowel suggests necrosis. Non-occlusive mesenteric ischaemia (NOMI) is related to impaired SMA flow following global hypoperfusion associated with low-flow states. There are numerous findings in the bowel characterised by diffuse extension. An absence of bowel enhancement and a thin bowel wall suggest necrosis in NOMI. Finally, ischaemic colitis is a sub-entity of arterial AMI and reflects localised colon ischaemia-reperfusion injury. The main CT finding is a thickened colon wall with fat stranding, which seems to be unrelated to SMA or inferior mesenteric artery lesions. A precise identification and description of vascular lesions, bowel involvement and features associated with transmural necrosis is needed to determine patient treatment and outcome.


Assuntos
Colite Isquêmica , Enteropatias , Isquemia Mesentérica , Acidente Vascular Cerebral , Humanos , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/complicações , Colite Isquêmica/complicações , Intestinos/diagnóstico por imagem , Necrose , Estudos Retrospectivos
11.
Diagn Interv Imaging ; 104(5): 248-257, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36740536

RESUMO

PURPOSE: The purpose of this study was to evaluate whether concomitant left gastric vein embolization (LGVE) during transjugular intrahepatic portosystemic shunt (TIPS) for acute variceal hemorrhage could reduce the risk of bleeding recurrence. MATERIAL AND METHOD: A national multicenter observational study was conducted in 14 centers between January 2019 and December 2020. All cirrhotic patients who underwent TIPS placement for acute variceal bleeding were included. During TIPS procedure, size of left gastric vein (LGV), performance of LGVE, material used for LGVE and portosystemic pressure gradient (PPG) before and after TIPS placement were collected. A propensity score for the occurrence of LGVE was calculated to assess effect of LGVE on rebleeding recurrence at six weeks and one year. RESULTS: A total of 356 patients were included (mean age 57.3 ± 10.8 [standard deviation] years; 283/356 [79%] men). Median follow-up was 11.2 months [interquartile range: 1.2, 13.3]. The main indication for TIPS was pre-emptive TIPS (162/356; 46%), rebleeding despite secondary prophylaxis (105/356; 29%), and salvage TIPS (89/356; 25%). Overall, 128/356 (36%) patients underwent LGVE during TIPS procedure. At six weeks and one year, rebleeding-free survival did not differ significantly between patients who underwent LGVE and those who did not (6/128 [5%] vs. 15/228 [7%] at six weeks, and 11/128 [5%] vs. 22/228 [7%] at one year, P = 0.622 and P = 0.889 respectively). A total of 55 pairs of patients were retained after propensity score matching. In patients without LGVE, the rebleeding rate was not different from those with LGVE (3/55 [5%] vs. 4/55 [7%], P > 0.99, and 5/55 [9%] vs. 6/55[11%], P > 0.99, at six weeks and one year respectively). Multivariable analysis identified PPG after TIPS placement as the only predictor of bleeding recurrence (hazard ratio = 1.09; 95% confidence interval: 1.02-1.18; P = 0.012). CONCLUSION: In this multicenter national real-life study, we did not observe any benefit of concomitant LGVE during TIPS placement for acute variceal bleeding on bleeding recurrence rate.


Assuntos
Varizes Esofágicas e Gástricas , Derivação Portossistêmica Transjugular Intra-Hepática , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Feminino , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Recidiva , Veia Porta
12.
Curr Opin Clin Nutr Metab Care ; 26(2): 167-173, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36728870

RESUMO

PURPOSE OF REVIEW: To evaluate the significance of blood lactate increase during enteral nutrition in the critically ill, and to propose diagnostic and therapeutic strategies. RECENT FINDINGS: Acute mesenteric ischemia occurs in approximately 1% of critically ill patients treated with catecholamine. Recent literature suggests that enteral nutrition is a risk factor of acute mesenteric ischemia, in particular in case of low cardiac output, by a mechanism of nonocclusive mesenteric ischemia. The association of clinical, biological, and computed tomography imaging might help to evaluate the reversibility of acute mesenteric ischemia. SUMMARY: As enteral nutrition induces an increased metabolic work of the gut, the inadequation between oxygen delivery and demand exposes the gut to a phenomenon of nonocclusive mesenteric ischemia. Before initiation of enteral nutrition,, and before each increase of the enteral nutrition dose, the risk factors of nonocclusive mesenteric ischemia should be searched in order to prevent it. While under enteral nutrition, increased lactate concentration while receiving enteral nutrition requires the urgent search for nonocclusive mesenteric ischemia, and the adaptation of enteral nutrition (reduction, stop, and/or switch to parenteral nutrition or tolerate early nutrient restriction). Early signs of nonocclusive mesenteric ischemia should be searched in order to allow for a rapid diagnosis, before development of irreversible transmural necrosis. After the diagnosis of acute mesenteric ischemia, improving the balance between oxygen demand and delivery to the gut, evaluating the reversibility of the gut ischemia, and performing urgent resection in case of irreversible transmural necrosis should be the main objectives. After the resolution of acute mesenteric ischemia, the benefit risk analysis of enteral nutrition reintroduction should be evaluated.


Assuntos
Nutrição Enteral , Isquemia Mesentérica , Humanos , Nutrição Enteral/métodos , Estado Terminal/terapia , Necrose , Lactatos , Oxigênio
13.
World J Surg ; 47(4): 975-984, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36648518

RESUMO

BACKGROUND: Identifying the 30% of adhesive small bowel obstructions (aSBO) for which conservative management will require surgery is essential. The association between the previously described radiological score and failure of the conservative management of aSBO remains to be confirmed in a large prospective multicentric cohort. Our aim was to assess the risk factors of failure of the conservative management of aSBO considering the radiological score. MATERIAL AND METHODS: This prospective observational study took place in 15 French centers over 3 months. Consecutive patients experiencing aSBO with no early surgery were included. The six radiological features from the Angers radiological computed tomography (CT) score were noted (beak sign, closed loop, focal or diffuse intraperitoneal liquid, focal or diffuse mesenteric haziness, focal or diffuse mesenteric liquid, and diameter of the most dilated small bowel loop > 40 mm). RESULTS: Two hundred and seventy nine patients with aSBO were screened. Sixty patients (21.5%) underwent early surgery, and 219 (78.5%) had primary conservative management. In the end, 218 patients were included in the analysis of the risk factors for conservative treatment failure. Among them, 162 (74.3%) had had successful management while for 56 (25.7%) management had failed. In multivariate analysis, a history of surgery was not a significant risk factor for the failure of conservative treatment (OR = 0.11; 95%CI = 0-1.23). A previous episode of aSBO was protective against the failure of conservative treatment (OR = 0.36; 95%CI = 0.15-0.85) and an Angers CT score ≥ 5 as the only individual risk factor (OR = 2.39; 95%CI = 1.01-5.69). CONCLUSION: The radiological score of aSBO is a promising tool in improving the management of aSBO patients. A first episode of aSBO and/or a radiological score ≥5 should lead physicians to consider early surgical management.


Assuntos
Tratamento Conservador , Obstrução Intestinal , Humanos , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Tomografia Computadorizada por Raios X , Fatores de Risco , Ira , Resultado do Tratamento
14.
Ann Intensive Care ; 12(1): 117, 2022 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-36565393

RESUMO

BACKGROUND: Although risk factors of occlusive acute mesenteric ischemia are well known, triggering factors of nonocclusive mesenteric ischemia (NOMI) remain unclear. Alongside to the known risk factors for NOMI, the role of atherosclerosis is not fully elucidated. The purpose of our study was to evaluate whether abdominal atherosclerosis is a risk factor for NOMI. METHODS: From January 2018 to December 2021, all consecutive patients admitted to the intensive care unit who underwent contrast-enhanced CT for suspicion of NOMI were evaluated for inclusion. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. The cohorts were matched by a 1:1 propensity score based on the patient clinical, biological data, and abdominal CT features associated with NOMI. Noncontrast CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA), and common iliac artery according to the Agatston method. Analyses were performed before and after propensity score matching. RESULTS: Among the 165 critically ill patients included, 59 (36%) had NOMI. Before matching analysis, the SMA and total abdominal Agatston calcium scores were not different between patients without and with NOMI (52.00 [IQR = 0, 473] vs. 137.00 [IQR = 0, 259], P = 0.857, respectively, and 7253 [IQR = 1220, 21738] versus 5802 [IQR = 2075, 15,084]; P = 0.723). The results were similar after matching 38 patients with NOMI and 38 without: 153 [IQR = 0, 665] versus 85 [IQR = 0, 240] (P = 0.312) for the SMA calcium score, and 7915 [IQR = 1812, 21561] versus 4139 [IQR = 1440, 9858] (P = 0.170) for the total abdominal Agatston calcium score. CONCLUSION: Our results suggest that atherosclerosis is not a risk factor for NOMI in critically ill patients.

15.
Diagn Interv Imaging ; 103(12): 594-600, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35780054

RESUMO

PURPOSE: The main objective of this study was to compare radiologists' performance without and with artificial intelligence (AI) assistance for the detection of bone fractures from trauma emergencies. MATERIALS AND METHODS: Five hundred consecutive patients (232 women, 268 men) with a mean age of 37 ± 28 (SD) years (age range: 0.25-99 years) were retrospectively included. Three radiologists independently interpreted radiographs without then with AI assistance after a 1-month minimum washout period. The ground truth was determined by consensus reading between musculoskeletal radiologists and AI results. Patient-wise sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for fracture detection and reading time were compared between unassisted and AI-assisted readings of radiologists. Their performances were also assessed by receiver operating characteristic (ROC) curves. RESULTS: AI improved the patient-wise sensitivity of radiologists for fracture detection by 20% (95% confidence interval [CI]: 14-26), P< 0.001) and their specificity by 0.6% (95% CI: -0.9-1.5; P = 0.47). It increased the PPV by 2.9% (95% CI: 0.4-5.4; P = 0.08) and the NPV by 10% (95% CI: 6.8-13.3; P < 0.001). Thanks to AI, the area under the ROC curve for fracture detection of readers increased respectively by 10.6%, 10.2% and 9.9%. Their mean reading time per patient decreased by respectively 10, 16 and 12 s (P < 0.001). CONCLUSIONS: AI-assisted radiologists work better and faster compared to unassisted radiologists. AI is of great aid to radiologists in daily trauma emergencies, and could reduce the cost of missed fractures.


Assuntos
Inteligência Artificial , Fraturas Ósseas , Masculino , Humanos , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Lactente , Pré-Escolar , Idoso de 80 Anos ou mais , Fluxo de Trabalho , Estudos Retrospectivos , Emergências , Radiologistas
16.
Transpl Int ; 35: 10292, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35721468

RESUMO

Background: Anastomotic biliary stricture (ABS) remains the most frequent complication after liver transplantation (LT). This study aimed to identify new anastomotic biliary stricture risk factors, with a specific focus on postoperative events. Additionally, ABS management and impact on patient and graft survival were assessed. Methods: All consecutive patients who underwent LT with duct-to-duct anastomosis between 2010 and 2019 were included. All patients who died within 90 days after LT due to non-ABS-related causes were excluded. Results: Among 240 patients, 65 (27.1%) developed ABS after a median time of 142 days (range, 13-1265). Median follow-up was 49 months (7-126). Upon multivariable analysis, donor BMI (OR=0.509, p = 0.037), post-LT CMV primoinfection (OR = 5.244, p < 0.001) or reactivation (OR = 2.421, p = 0.015) and the occurrence of post-LT anastomotic biliary fistula (OR = 2.691, p = 0.021) were associated with ABS. Anastomotic technical difficulty did not independently impact the risk of ABS (OR = 1.923, p = 0.051). First-line ABS treatment was systematically endoscopic (100%), and required a median of 2 (range, 1-11) procedures per patient. Repeat LT was not required in patients developing ABS. The occurrence of ABS was not associated with overall patient survival (p = 0.912) nor graft survival (p = 0.521). Conclusion: The risk of developing ABS after LT seems driven by the occurrence of postoperative events such as CMV infection and anastomotic fistula. In this regard, the role of CMV prophylaxis warrants further investigations.


Assuntos
Colestase , Infecções por Citomegalovirus , Transplante de Fígado , Anastomose Cirúrgica/efeitos adversos , Colestase/etiologia , Colestase/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/terapia , Citomegalovirus , Infecções por Citomegalovirus/complicações , Humanos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
17.
Eur Radiol ; 32(10): 6646-6657, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35763093

RESUMO

OBJECTIVES: The purpose of this study was to identify the preoperative CT features that are associated with inadvertent enterotomy (IE) during adhesive small bowel obstruction (ASBO) surgery. METHODS: From January 2015 to December 2019, all patients with ASBO who underwent an abdominal CT were reviewed. Abdominal CT were retrospectively reviewed by two radiologists with a consensus read in case of disagreement. IE during ASBO surgery was retrospectively recorded. Univariate and multivariate analyses of CT features associated with IE were performed and a simple CT score was built to stratify the risk of IE. This score was validated in an independent retrospective cohort. Abdominal CT of the validation cohort was reviewed by a third independent reader. RESULTS: Among the 368 patients with ASBO during the study period, 169 were surgically treated, including 129 ASBO for single adhesive band and 40 for matted adhesions. Among these, there were 47 IE. By multivariate analysis, angulation of the transitional zone (OR = 4.19, 95% CI [1.10-18.09]), diffuse intestinal adhesions (OR = 4.87, 95% CI [1.37-19.76]), a fat notch sign (OR = 0.32, 95% CI [0.12-0.85]), and mesenteric haziness (OR = 0.13, 95% CI [0.03-0.48]) were independently associated with inadvertent enterotomy occurrence. The simple CT score built to stratify risk of IE displayed an AUC of 0.85 (95% CI [0.80-0.90]) in the study sample and 0.88 (95% CI [0.80-0.96]) in the validation cohort. CONCLUSION: A simple preoperative CT score is able to inform the surgeon about a high risk of IE and therefore influence the surgical procedure. KEY POINTS: • In this retrospective study of 169 patients undergoing abdominal surgery for adhesive small bowel obstruction, 47 (28%) inadvertent enterotomy occurred. • A simple preoperative CT score enables accurate stratification of inadvertent enterotomy risk (area under the curve 0.85). • By multivariable analysis, diffuse intestinal adhesions and angulation of the transitional zone were predictive of inadvertent enterotomy occurrence.


Assuntos
Adesivos , Obstrução Intestinal , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
18.
PLoS One ; 17(5): e0266965, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35617294

RESUMO

Although coronary artery disease (CAD) and advanced liver fibrosis (AdLF) are commonly associated in patients with non-alcoholic fatty liver disease (NAFLD), the prevalence of AdLF and the diagnostic performance of non-invasive fibrosis tests (NITs) in CAD patients remains unknown. We aimed to prospectively screen for AdLF in patients with documented CAD using NITs and Fibroscan. High and intermediate zones of NITs were combined to define AdLF. AdLF was suspected whenever APRI ≥ 0.5, Forns index ≥ 4.2, NAFLD fibrosis score (NFS) ≥ -1.455/0.12 for age

Assuntos
Doença da Artéria Coronariana , Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica , Idoso , Biópsia/efeitos adversos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Fibrose , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/diagnóstico por imagem , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem
19.
Diagn Interv Imaging ; 103(9): 401-407, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35501284

RESUMO

PURPOSE: The purpose of this study was to evaluate the relationship between liver spontaneous attenuation (LSA) on computed tomography (CT) reflecting the degree of steatosis, and the severity of acute pancreatitis (AP). MATERIALS AND METHODS: All consecutive patients admitted from December 2014 to September 2020 for an episode of AP were retrospectively reviewed. LSA was evaluated on early CT examination and all abdominal CT examinations were reviewed by two abdominal radiologists. Severity of AP was categorized using Atlanta classification and CT severity index. Univariable and multivariable statistical analyses were performed. RESULTS: A total of 467 patients were included. There were 297 men and 170 women, with a mean age of 57 ± 19 (SD) years (range: 18-98 years). Among them, 236 patients (51%) had acute biliary pancreatitis, 134 (29%) had acute alcoholic pancreatitis and 97 (20%) had AP due to other etiologies. A total of 44 (9%) patients had severe AP and 423 (91%) had non severe AP. Median LSA was significantly lower in patients with severe AP (36 Hounsfield units [HU]; interquartile range [IQR]:18; 54) than in patients with non-severe AP (45 HU; IQR: 35; 51) (P < 0.001). In patients with alcoholic AP, median LSA was significantly lower in patients with severe AP (29 HU; IQR: 3; 43) than in those with non-severe AP (42 HU; IQR: 27; 50) (P = 0.022). At multivariable analysis, the third and fourth quartiles of liver spontaneous attenuation values (i.e., < 45 HU/>30 HU and < 30 HU) were independently associated with severe AP (OR, 3.23; 95% CI: 1.33-51.2; P = 0.038 and OR, 8.82; 95% CI: 1.91-69.7; P = 0.014; respectively). CONCLUSION: LSA on CT is associated with clinical severity of AP and may be used as an additional marker of disease severity.


Assuntos
Pancreatite , Doença Aguda , Adulto , Idoso , Biomarcadores , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/diagnóstico por imagem , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos
20.
Insights Imaging ; 13(1): 68, 2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35394226

RESUMO

Echinococcosis is a parasitic disease caused by two zoonotic tapeworms (cestodes) of the Echinocococcus genus. It can be classified as either alveolar or cystic echinococcosis. Although the two forms differ significantly in terms of imaging findings, they share similarities in terms of management and treatment. In parallel to medical treatment with albendazole (ABZ), and surgery, historically used in these diseases, various imaging-guided interventional procedures have recently emerged (drainage, stenting, or Puncture, aspiration, injection, and reaspiration (PAIR)). These options open up a new range of therapeutic options. As in oncology, multidisciplinary consultation meetings now play a major role in adapted management and patient care in hepatic echinococcosis. Consequently, diagnostic imaging and interventional expertise have brought radiologists to the fore as important members of these multidisciplinary team. The radiologist will need to evaluate parasite activity in both forms of the disease, to guide the choice of the appropriate therapy from among medical treatment, interventional radiology procedures and/or surgical treatment. Knowledge of the specific complications of the two forms of echinococcosis will also help radiologists to discuss the appropriate treatment and management. The aim of this review is to describe the core knowledge that what a radiologist should possess to actively participate in multidisciplinary meetings about hepatic echinococcosis. We discuss the role of imaging, from diagnosis to treatment, in alveolar (AE) and cystic echinococcosis (CE), respectively.

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