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1.
Cancers (Basel) ; 15(10)2023 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-37345020

RESUMO

The complex molecular alterations that underlie cancer pathophysiology are studied in depth with omics methods using bulk tissue extracts. For spatially resolved tissue diagnostics using needle biopsy cores, however, histopathological analysis using stained FFPE tissue and the immunohistochemistry (IHC) of a few marker proteins is currently the main clinical focus. Today, spatial omics imaging using MSI or IRI is an emerging diagnostic technology for the identification and classification of various cancer types. However, to conserve tissue-specific metabolomic states, fast, reliable, and precise methods for the preparation of fresh-frozen (FF) tissue sections are crucial. Such methods are often incompatible with clinical practice, since spatial metabolomics and the routine histopathology of needle biopsies currently require two biopsies for FF and FFPE sampling, respectively. Therefore, we developed a device and corresponding laboratory and computational workflows for the multimodal spatial omics analysis of fresh-frozen, longitudinally sectioned needle biopsies to accompany standard FFPE histopathology of the same biopsy core. As a proof-of-concept, we analyzed surgical human liver cancer specimens using IRI and MSI with precise co-registration and, following FFPE processing, by sequential clinical pathology analysis of the same biopsy core. This workflow allowed for a spatial comparison between different spectral profiles and alterations in tissue histology, as well as a direct comparison for histological diagnosis without the need for an extra biopsy.

2.
In Vivo ; 37(2): 702-708, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36881085

RESUMO

BACKGROUND/AIM: The aim of this phantom study was to evaluate the learning curves of novices practicing how to place a cone-beam computed tomography (CBCT)-guided needle using a novel robotic assistance system (RAS). MATERIALS AND METHODS: Ten participants performed 18 punctures each with random trajectories in a phantom setting, supported by a RAS over 3 days. Precision, duration of the total intervention, duration of the needle placement, autonomy, and confidence of the participants were measured, displaying possible learning curves. RESULTS: No statistically significant differences were observed in terms of needle tip deviation during the trial days (mean deviation day 1: 2.82 mm; day 3: 3.07 mm; p=0.7056). During the trial days, the duration of the total intervention (mean duration: day 1: 11:22 min; day 3: 07:39 min; p<0.0001) and the duration of the needle placement decreased (mean duration: day 1: 03:17 min; day 3: 02:11 min; p<0.0001). In addition, autonomy (mean percentage of achievable points: day 1: 94%; day 3: 99%; p<0.0001) and confidence of the participants (mean percentage of achievable points: day 1: 78%; day 3: 91%; p<0.0001) increased significantly during the trial days. CONCLUSION: The participants were already able to carry out the intervention precisely using the RAS on the first day of the trial. Throughout the trial, the participants' performance improved in terms of duration and confidence.


Assuntos
Robótica , Humanos , Punções , Tomografia Computadorizada de Feixe Cônico
3.
J Am Coll Radiol ; 19(6): 733-743, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35476943

RESUMO

PURPOSE: The aim of this study was to investigate whether prostatic artery embolization (PAE) can be considered a long-term cost-effective treatment option in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in comparison to transurethral resection of the prostate (TURP). METHODS: The in-hospital costs of PAE and TURP in the United States were obtained from a recent cost analysis. Clinical outcomes including nature and rate of adverse events for TURP and PAE along with rates of retreatment because of complications or clinical failure were obtained from peer-reviewed literature. A decision tree-based Markov model was created, analyzing long-term cost-effectiveness for TURP and PAE from a US health care sector perspective. Cost-effectiveness over a time frame of 5 years was estimated while assuming a willingness to pay of $50,000 per quality-adjusted life-year (QALY). The primary outcome was incremental cost-effectiveness ratio. RESULTS: PAE resulted in overall cost of $6,464.92 and an expected outcome of 4.566 QALYs. In comparison, TURP cost $9,221.09 and resulted in expected outcome of 4.577 QALYs per treatment. The incremental cost-effectiveness ratio for TURP was $247,732.65 per QALY. On the basis of the willingness-to-pay threshold, PAE is cost effective compared with TURP. CONCLUSIONS: On the basis of our model, PAE in comparison with TURP can be regarded as a cost-effective treatment option for patients with lower urinary tract symptoms within the US health care system.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Artérias , Análise Custo-Benefício , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Próstata/irrigação sanguínea , Próstata/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento
4.
Urologe A ; 61(4): 374-383, 2022 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-35262753

RESUMO

BACKGROUND: Radiologic imaging is important for the detection, staging and follow-up of urological tumors. Basic therapy decisions for both oncological (surgical vs. systemic therapy, e.g. in testicular cancer) and non-oncological pathologies (interventional vs. conservative therapy, e.g. for ureteral stones) depend largely on the tomographic imaging performed. Due to its almost ubiquitous availability, speed and cost-effectiveness, computed tomography (CT) plays an important role not only in the clarification of abdominal trauma and non-traumatic emergencies, but also in staging and follow-up of oncological patients. However, the level of radiation exposure, impaired renal function and allergies to iodinated contrast media limit the use of CT. Magnetic resonance imaging (MRI) can be a good alternative for many areas of application in oncological and non-oncological imaging due to its high soft tissue differentiation and functional-specific protocols but without the use of ionizing radiation. AIM: In the following, the main indications of abdominal and pelvic CT and MRI in urology and their limitations are summarized. RESULTS: The areas of application between CT and MRI are increasingly overlapping, since the latest developments in CT continue to further reduce radiation exposure and increase contrast information, while the speed and robustness of MRI are significantly improving at the same time.


Assuntos
Neoplasias Testiculares , Doenças Urológicas , Meios de Contraste , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Tomografia Computadorizada por Raios X/métodos , Doenças Urológicas/diagnóstico por imagem
5.
Cardiovasc Intervent Radiol ; 45(1): 62-68, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34414495

RESUMO

PURPOSE: The study aimed to evaluate a new robotic assistance system (RAS) for needle placement in combination with a multi-axis C-arm angiography system for cone-beam computed tomography (CBCT) in a phantom setting. MATERIALS AND METHODS: The RAS consisted of a tool holder, dedicated planning software, and a mobile platform with a lightweight robotic arm to enable image-guided needle placement in conjunction with CBCT imaging. A CBCT scan of the phantom was performed to calibrate the robotic arm in the scan volume and to plan the different needle trajectories. The trajectory data were sent to the robot, which then positioned the tool holder along the trajectory. A 19G needle was then manually inserted into the phantom. During the control CBCT scan, the exact needle position was evaluated and any possible deviation from the target lesion measured. RESULTS: In total, 16 needle insertions targeting eight in- and out-of-plane sites were performed. Mean angular deviation from planned trajectory to actual needle trajectory was 1.12°. Mean deviation from target point and actual needle tip position was 2.74 mm, and mean deviation depth from the target lesion to the actual needle tip position was 2.14 mm. Mean time for needle placement was 361 s. Only differences in time required for needle placement between in- and out-of-plane trajectories (337 s vs. 380 s) were statistically significant (p = 0.0214). CONCLUSION: Using this RAS for image-guided percutaneous needle placement with CBCT was precise and efficient in the phantom setting.


Assuntos
Procedimentos Cirúrgicos Robóticos , Tomografia Computadorizada de Feixe Cônico , Humanos , Agulhas , Imagens de Fantasmas , Punções
6.
PLoS One ; 16(11): e0258896, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34731178

RESUMO

PURPOSE: Thoracic surgeons are currently asked to resect smaller and deeper lesions which are difficult to detect thoracoscopically. The growing number of those lesions arises both from lung cancer screening programs and from follow-up of extrathoracic malignancies. This study analyzed the routine use of a CT-aided thoracoscopic approach to small pulmonary nodules in the hybrid theatre and the resulting changes in the treatment pathway. METHODS: 50 patients were retrospectively included. The clinical indication for histological diagnosis was suspected metastasis in 46 patients. Technically, the radiological distance between the periphery of the lesion and the visceral pleura had to exceed the maximum diameter of the lesion for the patient to be included. A spiral wire was placed using intraoperative CT-based laser navigation to guide the thoracoscopic resection. RESULTS: The mean diameter of the lesions was 8.4 mm (SD 4.27 mm). 29.4 minutes (SD 28.5) were required on average for the wire placement and 42.3 minutes (SD 20.1) for the resection of the lesion. Histopathology confirmed the expected diagnosis in 30 of 52 lesions. In the remaining 22 lesions, 9 cases of primary lung cancer were detected while 12 patients showed a benign disease. CONCLUSION: Computer tomography assisted thoracoscopic surgery (CATS) enabled successful resection in all cases with minimal morbidity. The histological diagnosis led to a treatment change in 42% of the patients. The hybrid-CATS technique provides good access to deeply located small pulmonary nodules and could be particularly valuable in the emerging setting of lung cancer screening.


Assuntos
Nódulos Pulmonares Múltiplos/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Assistida por Computador , Cirurgia Torácica Vídeoassistida , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Metástase Neoplásica , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X
7.
Diagnostics (Basel) ; 11(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34829478

RESUMO

Abdominal aortic aneurysms (AAA) may remain clinically silent until they enlarge and patients present with a potentially lethal rupture. This necessitates early detection and elective treatment. The goal of this study was to develop an easy-to-train algorithm which is capable of automated AAA screening in CT scans and can be applied to an intra-hospital environment. Three deep convolutional neural networks (ResNet, VGG-16 and AlexNet) were adapted for 3D classification and applied to a dataset consisting of 187 heterogenous CT scans. The 3D ResNet outperformed both other networks. Across the five folds of the first training dataset it achieved an accuracy of 0.856 and an area under the curve (AUC) of 0.926. Subsequently, the algorithms performance was verified on a second data set containing 106 scans, where it ran fully automated and resulted in an accuracy of 0.953 and an AUC of 0.971. A layer-wise relevance propagation (LRP) made the decision process interpretable and showed that the network correctly focused on the aortic lumen. In conclusion, the deep learning-based screening proved to be robust and showed high performance even on a heterogeneous multi-center data set. Integration into hospital workflow and its effect on aneurysm management would be an exciting topic of future research.

8.
EJNMMI Radiopharm Chem ; 6(1): 22, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34228236

RESUMO

BACKGROUND: [68Ga]Ga-NeoB is a novel DOTA-coupled Gastrin Releasing Peptide Receptor (GRPR) antagonist with high affinity for GRPR and good in vivo stability. This study aimed at (1) the translation of preclinical results to the clinics and establish the preparation of [68Ga]Ga-NeoB using a GMP conform kit approach and a licensed 68Ge/68Ga generator and (2) to explore the application of [68Ga]Ga-NeoB in patients with gastrointestinal stromal tumors (GIST) before and/or after interventional treatment (selective internal radiotherapy, irreversible electroporation, microwave ablation). RESULTS: Validation of the production and quality control of [68Ga]Ga-NeoB for patient use had to be performed before starting the GMP production. Six independent batches of [68Ga]Ga-NeoB were produced, all met the quality and sterility criteria and yielded 712 ± 73 MBq of the radiotracer in a radiochemical purity of > 95% and a molar activity of 14.2 ± 1.5 GBq/µmol within 20 min synthesis time and additional 20 min quality control. Three patients (2 females, 1 male, 51-77 yrs. of age) with progressive gastrointestinal stromal tumor metastases in the liver or peritoneum not responsive to standard tyrosine kinase inhibitor therapy underwent both [68Ga]Ga-NeoB scans prior and after interventional therapy. Radiosynthesis of 68Ga-NeoB was performed using a kit approach under GMP conditions. No specific patient preparation such as fasting or hydration was required for [68Ga]Ga-NeoB PET/CT imaging. Contrast-enhanced PET/CT studies were performed. A delayed, second abdominal image after the administration of the of [68Ga]Ga-NeoB was acquired at 120 min post injection. CONCLUSIONS: A fully GMP compliant kit preparation of [68Ga]Ga-NeoB enabling the routine production of the tracer under GMP conditions was established for clinical routine PET/CT imaging of patients with metastatic GIST and proved to adequately visualize tumor deposits in the abdomen expressing GRPR. Patients could benefit from additional information derived from [68Ga]Ga-NeoB diagnosis to assess the presence of GRPR in the tumor tissue and monitor antitumor treatment.

9.
Z Gastroenterol ; 58(8): 773-777, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32785913

RESUMO

In recent years, immune checkpoint inhibitors (ICIs) were successfully introduced to cancer therapy, and these drugs have already become essential for the treatment of various noncurable tumors. However, monotherapy in advanced hepatocellular carcinoma (aHCC) failed to show statistically significant improvement.Recently, the combination of atezolizumab and bevacizumab demonstrated efficacy of combining ICI and VEGF inhibition, further substantiating previous data on synergistic mechanisms among respective substance classes.As TKI treatment is currently standard of care for aHCC, and ICIs are approved by the FDA and available in many areas of the world, numerous patients may have been treated with monotherapy of those drugs. However, it remains unclear if failure to monotherapy has an impact on combination therapy. We therefore report a patient well responding to combination therapy despite previous failures to TKI and ICI monotherapy.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Compostos de Fenilureia/uso terapêutico , Quinolinas/uso terapêutico , Quimioterapia Combinada , Humanos , Resultado do Tratamento
10.
Cancers (Basel) ; 12(2)2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-32012709

RESUMO

Radioembolization with 90Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the present systematic review was to summarize the evidence of contralateral liver hypertrophy and oncological outcome following unilateral treatment with radioembolization. A systematic literature search using the MEDLINE, EMBASE, and Cochrane libraries for studies published between 2008 and 2020 was performed. A total of 16 studies, comprising 602 patients, were included. The median kinetic growth rate per week of the contralateral liver lobe was 0.7% and declined slightly over time. The local tumor control was 84%. Surgical resection after radioembolization was carried out in 109 out of 362 patients (30%). Although the available data suggest that radioembolization prior to major hepatectomy is safe with a promising oncological outcome, the definitive role of radioembolization requires assessment within controlled clinical trials.

11.
Anticancer Res ; 39(6): 3053-3057, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177148

RESUMO

AIM: Evaluation of osteoid osteoma (OO) perfusion characteristics pre and post microwave ablation (MWA) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with clinical follow-up. MATERIALS AND METHODS: Patients with OO underwent T1-weighted 3D DCE-MRI at 3.0T pre and post MWA. Signal intensity (SI) and perfusion of lesions was measured. Patients answered a questionnaire for clinical follow-up. RESULTS: A total of 24 patients were included (mean age of 28 years; nine females); 21 DCE-MRI datasets were of sufficient quality for analysis. The mean SI of lesions, plasma flow, volume of distribution and pain level all decreased statistically significantly after ablation. CONCLUSION: Quantitative MRI-perfusion analysis allows for objective treatment evaluation after MWA of OO, plasma flow and volume of distribution seem to be reliable indicators for successful thermoablation. MWA is an effective treatment option for OO with a low risk profile and significant pain reduction after treatment.


Assuntos
Técnicas de Ablação , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Angiografia por Ressonância Magnética , Micro-Ondas/uso terapêutico , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Imagem de Perfusão/métodos , Técnicas de Ablação/efeitos adversos , Adolescente , Adulto , Neoplasias Ósseas/irrigação sanguínea , Neoplasias Ósseas/patologia , Criança , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Osteoma Osteoide/irrigação sanguínea , Osteoma Osteoide/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Z Med Phys ; 29(1): 5-15, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30049550

RESUMO

For selective internal radiation therapy (SIRT) the calculation of the 3D distribution of spheres based on individual blood flow properties is still an open and relevant research question. The purpose of this work is to develop and analyze a new treatment planning method for SIRT to calculate the absorbed dose distribution. For this intention, flow dynamics of the SIRT-spheres inside the blood vessels was simulated. The challenge is treatment planning solely using high-resolution imaging data available before treatment. The resolution required to reliably predict the sphere distribution and hence the dose was investigated. For this purpose, arteries of the liver were segmented from a contrast-enhanced angiographic CT. Due to the limited resolution of the given CT, smaller vessels were generated via a vessel model. A combined 1D/3D-flow simulation model was implemented to simulate the final 3D distribution of spheres and dose. Results were evaluated against experimental data from Y90-PET. Analysis showed that the resolution of the vessels within the angiographic CT of about 0.5mm should be improved to a limit of about 150µm to reach a reliable prediction.


Assuntos
Hemorreologia , Artéria Hepática/fisiologia , Neoplasias Hepáticas/radioterapia , Microesferas , Radiometria/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Angiografia por Tomografia Computadorizada , Simulação por Computador , Artéria Hepática/diagnóstico por imagem , Humanos , Hidrodinâmica , Imageamento Tridimensional , Neoplasias Hepáticas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Dosagem Radioterapêutica , Circulação Renal
13.
Heart Rhythm ; 15(12): 1872-1879, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30017817

RESUMO

BACKGROUND: Irreversible electroporation (IRE) is a novel tumor ablative therapy technique, using electric fields to induce apoptosis in target tissues. Whether these electric pulses of high field strength can cause cardiac damage and/or ablation-induced arrhythmias is unclear. OBJECTIVE: The purpose of this study was to systematically evaluate the safety of electrocardiogram (ECG)-gated IRE with regard to cardiac side effects. METHODS: In all patients, 12-lead ECG and signal-averaged ECG (SAECG) recordings were performed before and after IRE and 24-hour Holter recording on the day of the IRE procedure. Venous blood samples (N-terminal pro-brain-type natriuretic peptide [NT-proBNP], high-sensitive troponin I [hsTnI]) were obtained before and 4 and 16 hours after the procedure. Patients with abnormal findings were reevaluated after 3 months. RESULTS: In total, 26 patients with an oncologic indication for IRE (11 females, mean age 62.9 years) were prospectively enrolled. Nine patients (34.6%) showed an increase in hsTnI and 21 patients (80.8%) an increase in NT-proBNP after ablation. Fifteen patients (57%) developed arrhythmias related to the procedure. One patient, in whom hsTnI and NT-proBNP had increased, developed multiple, nonsustained ventricular tachycardia events. In another patient, atrial fibrillation was triggered twice in 2 separate procedures. Twelve patients had clinically benign arrhythmias. SAECG was negative in all patients. CONCLUSION: Subclinical myocardial injury and nonfatal cardiac arrhythmias can occur in the context of IRE treatment. Although no sustained cardiac injuries could be found at 3-month follow-up, we propose implementation of a cardiac safety algorithm consisting of cardiac biomarkers and ECG monitoring when IRE is conducted.


Assuntos
Arritmias Cardíacas/etiologia , Eletrocardiografia , Eletroquimioterapia/efeitos adversos , Neoplasias/tratamento farmacológico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Eletroquimioterapia/métodos , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Cardiovasc Intervent Radiol ; 41(4): 639-644, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29159685

RESUMO

PURPOSE: To evaluate a commercially available robotic assistance device for computed tomography-guided diagnostic and therapeutic interventions, compared to regular, manually performed CT scan-guided interventions in terms of precision, exposure to radiation to the patient and intervention time. MATERIALS AND METHODS: Over a period of 6 months, 55 consecutive patients were recruited and treated using robotic assistance and compared to a control group of 101 patients previously treated with a regular CT scan-guided, manual approach. Evaluated parameters were precision (deviation from planned target and number of needle replacements), radiation exposure to the patient and intervention time. Evaluations were performed with regard to complexity (in-plane vs out-of-plane interventions) and type of anesthesia (general vs local). RESULTS: Parameters related to precision were in general significantly better in the robotic assistance group (p < 0.01) with a mean deviation of 1.2 mm (± 1.6 mm) compared to 2.6 mm (± 1.1 mm) in the comparison group. Compared to manual procedure, the mean intervention time was reduced by 15 min (± 5.4 min) on average for an out-of-plane needle placement in the robotic group. There was no increase of exposure to radiation to the patient while radiation exposure for the physician was reduced to zero when the navigation system was used. CONCLUSION: Compared to manual placement, the use of a robotic assistance device in out-of-plane CT-guided interventions under general anesthesia allows for probe placement with high precision. Intervention time is reduced with no increase of exposure to radiation to the patient.


Assuntos
Radiografia Intervencionista/métodos , Robótica/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Masculino , Estudos Prospectivos , Doses de Radiação , Fatores de Tempo
15.
Anticancer Res ; 37(10): 5681-5685, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28982886

RESUMO

AIM: Prospective comparison of cone beam C-Arm CT based parenchymal liver blood volume (PLBV) and dynamic volume perfusion CT (dVPCT) measurements in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolisation (TACE) with drug-eluting beads (DEB). PATIENTS AND METHODS: In 16 patients, changes of PLBV and dVPCT measurements [arterial liver parenchyma (ALP); temporal maximum intensity projection (MIP); hepatic perfusion index (HPI); portal venous parenchyma] were correlated to one another and to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). RESULTS: After TACE, the following parameters showed a statistically significant change (p<0.05) in mean value: PLBV: -4.85 ml/100 ml, ALP: -4.14 ml/100 ml/min, MIP: -0.23 Houndsfield units, HPI: -5.39%, and mRECIST: -20.53 mm. Pre-to-post TACE differences in PLBV showed only weak to very weak correlation to dVPCT parameters (r2<0.24). CONCLUSION: Although PLBV and dVPCT parameters showed only a weak to very weak correlation, both methods validly assessed changes in arterial tumor vascularity after DEB TACE.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Tomografia Computadorizada de Feixe Cônico , Circulação Hepática , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Tomografia Computadorizada Multidetectores , Imagem de Perfusão/métodos , Idoso , Angiografia , Velocidade do Fluxo Sanguíneo , Volume Sanguíneo , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/patologia , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/patologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
16.
Cardiovasc Intervent Radiol ; 40(8): 1147-1154, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28488106

RESUMO

PURPOSE: To evaluate the hemodynamic effect of percutaneous transluminal intervention (PTI) on stenosis of the superficial femoral (SFA) and popliteal arteries (PA) using time-density curves (TDCs) derived from digital subtraction angiography (DSA) series in correlation with ultrasound peak systolic velocity ratio (PSVR) and ankle brachial index (ABI). MATERIALS AND METHODS: DSA series of SFA or PA of patients with symptomatic peripheral arterial occlusive disease was obtained with a flat-panel angiography system with intention-to-treat. In DSA series acquired before and after PTI, TDCs were analyzed proximal and distal of each stenosis using parametric color coding (PCC). For correlation, ABI and PSVR measurements pre- and post-PTI were recorded for all patients. RESULTS: In total, 25 stenoses of the SFA or PA were treated by PTI in 22 patients (17 male, 5 female, mean age 68 years). After treatment, peak-to-peak (PTP) times between TDCs proximal and distal to the treated vessel segment decreased statistically significantly (p = 0.01) on average from PTP = 1.9 ± 1.7 s to mean PTP = 1 ± 1 s. ABI and PSVR also changed statistically significantly after treatment (pretreatment ABI = 0.7 ± 0.2, PSVR = 4.2 ± 1.9; post-ABI = 0.9 ± 0.2, PSVR = 1.3 ± 0.4, both p < 0.05). Correlation parameters did not show a strong correlation between change in TDC and clinical parameters ABI and PSVR. CONCLUSION: Using PCC for analyzing contrast medium dynamics in DSA series is clinically useful for evaluating stenoses of the SFA and PA and for immediate treatment control after PTA. LEVEL OF EVIDENCE: Case series, IV.


Assuntos
Angiografia Digital/métodos , Angioplastia/métodos , Artéria Femoral/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Idoso , Índice Tornozelo-Braço , Feminino , Humanos , Masculino , Resultado do Tratamento
17.
Invest Radiol ; 52(6): 374-380, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28141614

RESUMO

OBJECTIVES: Minimally invasive resection of small, deep intrapulmonary lesions can be challenging due to the difficulty of localizing them during video-assisted thoracoscopic surgery (VATS). We report our preliminary results evaluating the feasibility of an image-guided, minimally invasive, 1-stop-shop approach for the resection of small, deep intrapulmonary lesions in a hybrid operating room (OR). MATERIALS AND METHODS: Fifteen patients (5 men, 10 women; mean age, 63 years) with a total of 16 solitary, deep intrapulmonary nodules of unknown malignant status were identified for intraoperative wire marking. Patients were placed on the operating table for resection by VATS. A marking wire was placed within the lesion under 3D laser and fluoroscopic guidance using a cone beam computed tomography system. Then, wedge resection by VATS was performed in the same setting without repositioning the patient. RESULTS: Complete resection with adequate safety margins was confirmed for all lesions. Marking wire placement facilitated resection in 15 of 16 lesions. Eleven lesions proved to be malignant, either primary or secondary; 5 were benign. Mean lesion size was 7.7 mm; mean distance to the pleural surface was 15.1 mm (mean lesion depth-diameter ratio, 2.2). Mean procedural time for marking wire placement was 35 minutes; mean VATS duration was 36 minutes. CONCLUSIONS: Computed tomography-assisted thoracoscopic surgery is a new, safe, and effective procedure for minimally invasive resection of small, deeply localized intrapulmonary lesions. The benefits of computed tomography-assisted thoracoscopic surgery are 1. One-stop-shop procedure, 2. Lower risk for the patient (no patient relocation, no marking wire loss), and 3. No need to coordinate scheduling between the CT room and OR.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Neoplasias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Estudos de Viabilidade , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
18.
In Vivo ; 30(5): 651-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27566086

RESUMO

AIM: To evaluate the clinical feasibility of a newly developed, fully automatic vessel segmentation software with automatic structured bone elimination (ASBE) using graph-matching and subvoxel analysis. MATERIALS AND METHODS: Dual energy computed tomography angiography (DECTA) data of 108 vessel segments were evaluated using the ASBE software and a commercial software against the digital subtraction angiography (DSA) standard of reference. RESULTS: Using the ASBE software, sensitivity increased from 87.1% to 96.8% and data concordance with DSA increased from 64.5% to 88.6%, whereas specificity slightly decreased (79.2% vs. 87%) compared to the commercial software. Data concordance between ASBE software and DSA was especially high in severely stenosed (grade of stenosis >75%) blood vessels. CONCLUSION: ASBE showed good concordance with the DSA standard of reference and non-inferiority compared to the commercial segmentation software. The main advantage of the ASBE software lies in its full automation and, thus, lower susceptibility to user prone errors.


Assuntos
Angiografia Digital , Angiografia por Tomografia Computadorizada , Extremidade Inferior/diagnóstico por imagem , Pelve/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/patologia , Meios de Contraste , Humanos , Processamento de Imagem Assistida por Computador , Extremidade Inferior/patologia , Pelve/patologia , Software
19.
In Vivo ; 30(5): 657-62, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27566087

RESUMO

BACKGROUND/AIM: Renal denervation (RDN) has been considered a promising therapy option for patients suffering from therapy-resistant hypertension. Besides, in blood-pressure regularization, the kidneys play a fundamental role in sodium ((23)Na) homeostasis. This study assesses the effect of RDN on renal (23)Na concentration using (23)Na magnetic resonance imaging (MRI). PATIENTS AND METHODS: Two patients with therapy-resistant hypertension underwent RDN. (23)Na-MRI, (1)H-MRI, including diffusion weighted imaging (DWI), as well as endothelial dysfunction assessment, were performed 1 day prior, as well as 1, 30 and 90 days after RDN. RESULTS: The renal corticomedullary (23)Na gradient did not change after RDN for all time points. Additionally, functional imaging and retinal vessel parameters were not influenced by RDN. Results regarding blood pressure changes and arterial stiffness, as well as patients' clinical outcome, were heterogeneous. CONCLUSION: RDN does not seem to alter renal (23)Na concentration gradients, as measured by MRI.


Assuntos
Pressão Sanguínea , Vasoespasmo Coronário/cirurgia , Denervação/métodos , Hipertensão/cirurgia , Rim/cirurgia , Adulto , Idoso , Vasoespasmo Coronário/diagnóstico por imagem , Vasoespasmo Coronário/patologia , Denervação/efeitos adversos , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/patologia , Rim/diagnóstico por imagem , Rim/patologia , Imageamento por Ressonância Magnética , Sódio/metabolismo , Radioisótopos de Sódio/administração & dosagem , Resultado do Tratamento , Rigidez Vascular/fisiologia
20.
In Vivo ; 30(5): 707-12, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27566095

RESUMO

AIM: To evaluate drug-eluting beads (DEB) for transarterial chemoembolization (TACE) in patients with Barcelona Clinic Liver Cancer (BCLC) A to D suffering from hepatocellular carcinoma. MATERIAL AND METHODS: The progression-free interval (PFI), survival and laboratory findings of 46 patients were retrospectively analyzed after DEB TACE. RESULTS: The mean survival interval was 16.93 months. The BCLC A/B group had significantly (p=0.01) longer survival compared to C/D: 20.44 and 10.36 months. Mean PFI was 10.75 months with a significantly (p=0.002) longer PFI of the BCLC A/B group (12.71 months) compared to BCLC C/D (3.91 months). In terms of possible adverse events (AEs) significant changes (p<0.05) were observed in cholinesterase, white blood cells, alkaline phosphatase and C-reactive protein. CONCLUSION: Mean survival and PFI results in the BCLC A/B patient group were comparable to historical controls. In addition, the results suggest that patients with BCLC stage C/D also benefited from DEB TACE.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Doxorrubicina/administração & dosagem , Neoplasias Hepáticas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica , Intervalo Livre de Doença , Stents Farmacológicos , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
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