RESUMO
PURPOSE: To determine the effectiveness of uterine arterial embolization as a primary therapy in the management of symptomatic leiomyomas. MATERIALS AND METHODS: Uterine arterial embolization was performed in 53 patients (age range, 33-58 years) with menorrhagia, bulk-related symptoms (frequency of urination, sensation of pressure, sensation of mass), or both, due to leiomyomas. The effectiveness of this therapy in the control of symptoms and the patients' acceptance of the treatment were measured by means of the information from patient interviews 3 months after the procedure. RESULTS: Fifty-two (98%) of the 53 patients had technically successful procedures and were interviewed 3 months after embolization. Forty-six (88%) of these patients reported marked improvement in their abnormal bleeding. Twenty-nine (94%) of the 31 patients with bulk-related symptoms reported marked improvement in these symptoms. Follow-up ultrasonographic examinations showed a mean 46% reduction in uterine volume. Forty-one patients interviewed (79%) would choose this procedure again, eight (15%) would consider choosing this procedure again, and only three (6%) would choose another treatment option. CONCLUSION: Uterine arterial embolization is an effective therapy in the management of symptomatic leiomyomas and may prove to be a valuable alternative to myomectomy, hysterectomy, or other surgical procedures. Further investigation is warranted.
Assuntos
Embolização Terapêutica , Leiomioma/terapia , Qualidade de Vida , Neoplasias Uterinas/terapia , Adulto , Angiografia , Feminino , Humanos , Leiomioma/irrigação sanguínea , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento , Neoplasias Uterinas/irrigação sanguíneaRESUMO
Radiology plays a key role in the diagnosis and treatment of renal inflammatory diseases. The efficacious use of the various imaging modalities in evaluating renal inflammatory disease requires knowledge of their attributes as well as their weaknesses. We review the available studies and use of contrast agents, and illustrate radiologic findings in specific inflammatory disease processes.
Assuntos
Infecções Bacterianas/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Humanos , Métodos , Pielonefrite/diagnóstico por imagem , RadiografiaRESUMO
Six patients with lesions involving the foramen ovale are presented and analyzed. Anatomy, pathology and imaging of diseases occurring in the vicinity of the foramen ovale are reviewed. Computerized tomography (CT) and magnetic resonance imaging (MRI) are complimentary in the evaluation of pathology in this region. CT is better able to evaluate bony detail while MR imaging is useful in detailing the anatomical extent and tissue characteristics.
Assuntos
Encefalopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neoplasias Cranianas/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adulto , Idoso , Encefalopatias/patologia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma/diagnóstico por imagem , Neuroma/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Neoplasias Cranianas/patologia , Osso Esfenoide/patologia , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/patologiaAssuntos
Linfonodos/patologia , Pescoço , Humanos , Linfonodos/diagnóstico por imagem , Linfadenite/diagnóstico , Linfadenite/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XAssuntos
Pescoço , Neoplasias de Tecidos Moles/diagnóstico , Humanos , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/diagnóstico por imagem , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Nineteen patients with complex partial seizures refractory to medical treatment were examined with routine electroencephalography (EEG), video EEG monitoring, computed tomography or magnetic resonance imaging, neuropsychological tests and interictal single photon emission computed tomography (SPECT) with I-123 iodoamphetamine (INT). In 18 patients, SPECT identified areas of focal reduction in tracer uptake that correlated with the epileptogenic focus identified on the EEG. In addition, SPECT disclosed other areas of neurologic dysfunction as elicited on neuropsychological tests. Thus, IMP SPECT is a useful tool for localizing epileptogenic foci and their associated dynamic deficits.
Assuntos
Anfetaminas , Encéfalo/diagnóstico por imagem , Epilepsias Parciais/diagnóstico por imagem , Radioisótopos do Iodo , Tomografia Computadorizada de Emissão , Adolescente , Adulto , Idoso , Encéfalo/patologia , Eletroencefalografia , Epilepsias Parciais/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tomografia Computadorizada por Raios XRESUMO
Sixty-five mass lesions of parotid origin were evaluated using thin-section high-resolution computed tomography to ascertain histologic specificity. All patients were studied after infusion of intravenous contrast media. Factors judged included the extent of glandular involvement, invasion of adjacent soft tissues, degree of postcontrast computed tomography density (relative to muscle), and the presence of calcification.
Assuntos
Adenolinfoma/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Humanos , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Glândula Parótida/diagnóstico por imagem , Sialadenite/diagnóstico por imagemRESUMO
Erosions of the ossicular chain that occurred as a complication of noncholesteatomatous chronic otitis media were studied with computed tomography (CT) in 55 patients. The incus (particularly the long and lenticular processes) was the ossicle most commonly involved (50 cases). Coronal and axial CT sections were complementary in the diagnosis of these erosions. Fibrous replacement of the incudostapedial articulation was diagnosed in four cases on axial CT scans when an unusually wide joint was present.
Assuntos
Ossículos da Orelha/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Otopatias/diagnóstico por imagem , HumanosRESUMO
Twenty-two patients with synthetic ossicular replacements were studied with computed tomography (CT). Twelve patients had total ossicular replacement prostheses (TORPs), and ten patients had partial ossicular replacement prostheses (PORPs). Good results were achieved in 12 patients (eight with TORPs and four with PORPs). Four of these prostheses were clearly visible on CT scans, six were discernible, and two were not identified. In the ten patients with unsatisfactory surgical results, CT was performed before surgical revision. It disclosed subluxation of the prosthesis in four patients and fibrous tissue fixation in four. In two patients the CT scan appeared normal; surgery disclosed lateralization of the graft with a nonfunctioning interface.
Assuntos
Ossículos da Orelha/diagnóstico por imagem , Próteses e Implantes , Tomografia Computadorizada por Raios X , Ossículos da Orelha/cirurgia , HumanosRESUMO
Complete incus disarticulation may be a complication of trauma, chronic otitis, or prosthetic stapedectomy. Purposeful incus disarticulation (with incus interposition) is used as a method of ossicular reconstruction. CT has been a valuable diagnostic tool for preoperative location of the incus in the former disorders and for determination of the status of the ossiculoplasty in the latter.
Assuntos
Ossículos da Orelha/lesões , Bigorna/lesões , Luxações Articulares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Luxações Articulares/etiologiaRESUMO
Computed tomography (CT) was used to study 25 patients with congenital conductive hearing loss and normal external auditory canals. Deformities were subdivided according to ossicular, fenestral, and cholesteatomatous origin. Isolated ossicular deformities were found in 14 patients (five bilateral), cholesteatoma in eight, oval-window nondevelopment (with ossicular deformity) in one, and normal studies in two (congenital stapes fixation at the level of the annular ligament). Ossicular deformities may be subdivided into incudostapedial disconnections into incudostapedial disconnections (most common), malleoincudal fixations, and stapes fixations. Most are due to developmental anomaly of the first or second branchial arch. The stapes has a dual origin (second arch and otic capsule). A cholesteatoma is defined as congenital only if there is no history of otitis and the tympanic membrane is intact. In this series, six were in the middle ear proper, and two were within the attic beyond otoscopic view. Their CT appearance, with one exception, was essentially identical to that of acquired lesions.
Assuntos
Surdez/congênito , Orelha Média/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Surdez/diagnóstico por imagem , Orelha Média/anormalidades , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
We used computed tomography (CT) to evaluate 44 patients who had undergone stapedectomy with insertion of a prosthesis. Several patients had poor surgical results, including recurrent conductive hearing loss, vertigo, and sensorineural hearing loss. Conductive hearing loss occurring immediately after the procedure was most often caused by anatomic limitations or surgical technique. Causes of delayed or recurrent conductive hearing loss included reparative granuloma formation, incus necrosis (at the attachment of the wire), prosthesis subluxation (most often posterior), and regrowth of otosclerosis, which occasionally is further complicated by incus dislocation. We found that CT is often diagnostic when these complications occur. Immediate sensorineural hearing loss or vertigo can be self-limited if caused by serous labyrinthitis. When delayed, these symptoms may be due to perilymph fistula. If caused by the latter, CT may not yield abnormal findings unless subluxation of the prosthesis into the vestibule has occurred.
Assuntos
Orelha Média/diagnóstico por imagem , Próteses e Implantes , Cirurgia do Estribo , Adulto , Idoso , Otopatias/etiologia , Feminino , Granuloma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/cirurgia , Politetrafluoretileno , Complicações Pós-Operatórias , Recidiva , Aço Inoxidável , Tomografia Computadorizada por Raios XRESUMO
Computed tomography has replaced conventional multidirectional tomography in the imaging of patients with the presumed diagnosis of otosclerosis. In addition to obliterative disease, which was easily diagnosed with multidirectional tomography, anterior and posterior foci of varying sizes can now also be visualized preoperatively. Active cochlear otosclerosis (otospongiosis) is diagnosed in the presence of foci of demineralization in the otic capsule. Diagnosis of these entities has been of great interest to our referring otologic surgeons.
Assuntos
Cóclea/diagnóstico por imagem , Otosclerose/diagnóstico por imagem , Janela da Cóclea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Ossification of the membranous labyrinth (labyrinthitis ossificans) develops as the final result of many inflammatory processes, for example, meningitis, blood-borne septic emboli, middle ear infection, and cholesteatoma. Labyrinthine ossification may also occur as a result of previous labyrinthectomy or secondary to trauma. Seven cases of labyrinthine ossification accompanied by severe vertigo and total hearing loss in the affected ear are discussed. The computed tomographic appearance of varying degrees of ossification, the clinical and surgical circumstances from which this disorder may develop, and the various approaches to labyrinthectomy are described.
Assuntos
Doenças do Labirinto/diagnóstico por imagem , Labirintite/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Criança , Feminino , Perda Auditiva/etiologia , Humanos , Labirintite/complicações , Masculino , Ossificação Heterotópica/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Vertigem/etiologiaRESUMO
Dysplasias of the external auditory canal can be evaluated with high resolution CT using proper technique. Images are studied to determine the type of atresia (membranous or bony) and the thickness of the associated atretic plate (if present). Other findings sought include the degree of pneumatization, the status of the fenestrae, the size of the tympanic cavity, and the location of both the mandibular condyle and the facial nerve canal.
Assuntos
Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Meato Acústico Externo/anormalidades , Tomografia Computadorizada por Raios X , Criança , Pré-Escolar , Meato Acústico Externo/diagnóstico por imagem , Ossículos da Orelha/anormalidades , Orelha Interna/anormalidades , Feminino , Humanos , Lactente , MasculinoRESUMO
High-resolution computed tomography (CT) is evolving as the most valuable radiographic study when detailed information about the status of the temporomandibular joint is needed. High-resolution CT is faster, less invasive, and in most cases much more accurate than other imaging modalities used in the past. Erosive, hypertrophic, and ankylosing arthropathies are illustrated, as are condylar dislocations secondary to acute trauma, chronic trauma, and neoplasm. A detailed discussion of the common problem of the anterior displaced meniscus is undertaken.
Assuntos
Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Adulto , Artrite/diagnóstico por imagem , Criança , Estudos de Avaliação como Assunto , Humanos , Luxações Articulares/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
High resolution computed tomography (CT) has been a mainstay in the preoperative evaluation of odontogenic lesions. Unsurpassed bony detail is complemented by exquisite delineation of the soft tissue mass itself. Our experience with these lesions is presented. Selected illustrations are supplemented by pathologic review.
Assuntos
Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Maxilares/diagnóstico por imagem , Cistos Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , HumanosRESUMO
Ninety patients who had suspected or confirmed fenestral or cochlear otosclerosis underwent CT examination. Foci of demineralization in the otic capsule were discovered in 20 ears (12 patients). Audiometric studies of the 12 patients revealed sensorineural hearing loss (SNHL) with distinct correlation of CT findings with progressivity and with involvement of the frequency level subtended by the specific area of the cochlea involved. Foci of abnormal increased density, presumably representing the healed phase of this disorder, were found less frequently than expected. There was a predilection for the basilar turn. All patients had static SNHL in the higher frequencies. The healed phase of this disorder is probably not consistently diagnosable with CT.
Assuntos
Cóclea/diagnóstico por imagem , Otosclerose/diagnóstico por imagem , Adulto , Idoso , Audiometria , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Doenças do Labirinto/complicações , Doenças do Labirinto/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Otosclerose/complicações , Tomografia Computadorizada por Raios XRESUMO
Postinflammatory ossicular fixation is a common problem encountered by the otologic surgeon upon exploration because of conductive hearing loss in patients with chronic otitis media. These nonotosclerotic noncongenital lesions take three pathologic forms: fibrous tissue fixation (chronic adhesive otitis media), hyalinization of collagen (tympanosclerosis), and new bone formation (fibro-osseous sclerosis). Fibrous tissue fixation appears on CT as nonbony, noncalcific soft-tissue debris encasing some or all of the ossicular chain. Tympanosclerosis appears as unifocal or multifocal punctate or weblike calcifications in the middle ear cavity or on the tympanic membrane. This debris may be in direct apposition to the ossicular chain or may replace the suspensory ligaments in symptomatic patients. New bone formation has been identified only in the attic and is the least common manifestation. Thick bony webs or generalized bony encasement may be present at CT. More than 300 patients with the clinical diagnosis of chronic otitis media have been examined. This study encompasses 23 proved cases.