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1.
Radiology ; 293(2): 343-349, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31502935

RESUMO

Background Accurate assessment of local resectability of pancreatic cancer at initial workup is critical to determine the most appropriate management strategy among up-front operation, neoadjuvant treatment, or palliative treatment. Purpose To investigate the interobserver agreement of the preoperative CT classification of the local resectability of pancreatic cancer and to determine if radiologist experience level impacts evaluation, and to evaluate the reader performance in assessing resectability at CT in a subset of patients with a reference standard for local resectability. Materials and Methods This retrospective study was composed of patients with pathologic-analysis-confirmed pancreatic cancers between January 2013 and December 2014 who underwent baseline multiphasic contrast agent-enhanced CT. Eight board-certified radiologists with different levels of experience (more experienced, ≥6 years, n = 4; less experienced, 1st- or 2nd-year fellows, n = 4) reviewed the CT images and classified cancers as resectable, borderline resectable, or unresectable. Interobserver agreements were determined for all reviewers and subgroups of reviewers stratified according to experience (more vs less) by using Fleiss κ statistics. In patients with reference standards for local resectability, diagnostic performances of each reviewer were assessed by using receiver operating characteristic curve analysis. Results There were 110 patients (mean age, 61 years ± 11; 60 men) who were evaluated. Overall interobserver agreements were moderate for resectability classification (κ = 0.48; 95% confidence interval: 0.45, 0.50). Only 30.0% of patients (33 of 110) were given the same resectability classification from all reviewers. More experienced reviewers demonstrated higher agreement in category assignments than less experienced reviewers (κ = 0.55 [95% confidence interval: 0.50, 0.60] vs 0.43 [95% confidence interval: 0.38, 0.49], respectively). For prediction at CT of margin-negative (ie, R0) resections (n = 82), areas under the receiver operating characteristic curve of all reviewers were greater than 0.80 (range, 0.83-0.96). However, borderline resectable cancers showed diverse R0 rates ranging from 0% to 74% depending on the reviewers. Conclusion Considerable interobserver variability exists in the assignment at CT of the local resectability of pancreatic cancer, even among experienced radiologists. © RSNA, 2019 Online supplemental material is available for this article.


Assuntos
Competência Clínica , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Idoso , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Retrospectivos
2.
Diabetes Obes Metab ; 20(1): 141-147, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28671751

RESUMO

AIMS: The relationship between directly measured body fat and all-cause mortality has been rarely studied. The aim of this study was to evaluate the predictive significance of computed tomography (CT)-measured body fat, including both visceral fat area (VFA) and subcutaneous fat area (SFA), for mortality. METHODS: The study included 36 656 participants who underwent abdominal CT as part of a health check-up at a single university-affiliated healthcare center in 2007 to 2015. Of those, 32 593 participants with data regarding vital status as of May 2016 were included in the final analysis. The main factors evaluated were VFA, SFA and visceral-to-subcutaneous fat area ratio (VSR), and the primary outcome was all-cause mortality. RESULTS: There were 253 deaths during a mean follow-up of 5.7 years. Increased SFA was associated with decreased all-cause mortality, whereas an increased VFA and VSR were related to increased all-cause mortality. Compared with the predictive power of body mass index (BMI), SFA and VSR showed a larger area under the curve than did BMI. In Kaplan-Meier survival curve analysis, increased SFA and VSR were associated with decreased and increased hazard of all-cause death, respectively. However, in multivariate Cox proportional hazard regression analysis, only VSR was independently associated with all-cause mortality. Moreover, this relationship was paralleled by the harmful impact of increased VSR on metabolic profiles. CONCLUSION: Increased VSR was an independent predictor of all-cause mortality. This suggests that the location of fat deposits may be more important than the actual amount of body fat.


Assuntos
Adiposidade , Complicações do Diabetes/diagnóstico por imagem , Resistência à Insulina , Gordura Intra-Abdominal/diagnóstico por imagem , Obesidade Abdominal/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Gordura Subcutânea Abdominal/diagnóstico por imagem , Adulto , Algoritmos , Índice de Massa Corporal , Estudos de Coortes , Complicações do Diabetes/metabolismo , Complicações do Diabetes/mortalidade , Feminino , Seguimentos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Obesidade/complicações , Obesidade/metabolismo , Obesidade/mortalidade , Obesidade Abdominal/complicações , Obesidade Abdominal/metabolismo , Obesidade Abdominal/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X
3.
Radiology ; 278(1): 257-64, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26121121

RESUMO

PURPOSE: To investigate the diagnostic performance of acoustic structure quantification (ASQ) for the assessment of hepatic steatosis by using hydrogen 1 ((1)H) magnetic resonance (MR) spectroscopy as the reference standard and to compare ASQ with hepatorenal ratio. MATERIALS AND METHODS: This prospective study was approved by an institutional review board, and informed written consent was obtained from all participants. ASQ and MR spectroscopy were performed in 89 participants (mean age, 41.48 years ± 14.16; 35 men, 54 women) without history of chronic liver disease. Obtained were focal disturbance (FD) ratio by using ASQ, hepatic fat fraction (HFF) by using MR spectroscopy, and hepatorenal ratio by using a histogram. Correlation coefficient, intraclass correlation coefficient, and receiver operating curve analyses were performed. RESULTS: FD ratio measured with ASQ had a strong linear correlation with HFF measured with MR spectroscopy after logarithmic transformation of both variables (r = -0.87; P < .001). By using HFF of 5.79% as a cutoff value of 10% hepatic steatosis, 29 of 89 participants (32.6%) were categorized into the group with hepatic steatosis of 10% or greater (mean HFF, 13.18% ± 4.89). The area under curve of the FD ratio for diagnosing hepatic steatosis 10% or greater was 0.959 (95% confidence interval: 0.895, 0.990) with sensitivity of 86.2% (95% confidence interval: 68.3%, 96.0%) and specificity of 100% (95% confidence interval: 94.0%, 100.0%) by using a cutoff value of 0.1; the area under curve and specificity of the FD ratio were significantly higher than those of the hepatorenal ratio (respectively, 0.772 and 73.3%; respective P values, .001 and <.001). CONCLUSION: This pilot study in a cohort of patients with hepatic steatosis without other parenchymal disease suggested ASQ may be valuable for the quantification of hepatic steatosis and detection of hepatic steatosis 10% or greater in living liver donors.


Assuntos
Fígado Gorduroso/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Testes de Função Hepática , Transplante de Fígado , Doadores Vivos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia
4.
Molecules ; 17(9): 10446-58, 2012 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-22945025

RESUMO

Simple synthesis of modafinil derivatives and their biological activity are described. The key synthetic strategies involve substitution and coupling reactions. We determined the anti-inflammatory effects of modafinil derivatives in cultured BV2 cells by measuring the inhibition of nitrite production and expression of iNOS and COX-2 after LPS stimulation. It was found that for sulfide analogues introduction of aliphatic groups on the amide part (compounds 11a­d) resulted in lower anti-inflammatory activity compared with cyclic or aromatic moieties (compounds 11e­k). However, for the sulfoxide analogues, introduction of aliphatic moieties (compounds 12a­d) showed higher anti-inflammatory activity than cyclic or aromatic fragments (compounds 12e­k) in BV-2 microglia cells.


Assuntos
Anti-Inflamatórios não Esteroides/síntese química , Anti-Inflamatórios não Esteroides/farmacologia , Compostos Benzidrílicos , Ciclo-Oxigenase 2/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Nitritos/antagonistas & inibidores , Anti-Inflamatórios não Esteroides/química , Antioxidantes/síntese química , Antioxidantes/química , Antioxidantes/farmacologia , Compostos Benzidrílicos/química , Compostos Benzidrílicos/farmacologia , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Humanos , Lipopolissacarídeos/imunologia , Modafinila , Óxido Nítrico/metabolismo , Safrol/análogos & derivados , Safrol/química , Sulfetos/química
5.
Molecules ; 16(12): 10409-19, 2011 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-22173334

RESUMO

Simple synthesis and biological activities of modafinil derivatives are described. The key reactions include condensation of acid and propargyl alcohol, subsequent 1,3-dipolar cycloaddition reaction of alkynes and (3-azido-propyl)cyclohexane or (4-azido-butyl)benzene in the presence of sodium ascorbate and CuSO4·5H2O in excellent yield. They were then evaluated for the suppression of LPS-induced NO generation in vitro. It was found that all compounds showed moderate effects for suppression of LPS-induced NO generation.


Assuntos
Compostos Benzidrílicos/síntese química , Compostos Benzidrílicos/farmacologia , Triazóis/síntese química , Triazóis/farmacologia , Animais , Compostos Benzidrílicos/química , Linhagem Celular , Ésteres/síntese química , Ésteres/química , Ésteres/farmacologia , Camundongos , Microglia/citologia , Microglia/efeitos dos fármacos , Microglia/metabolismo , Modafinila , Óxido Nítrico/metabolismo , Triazóis/química
6.
Int J Cardiovasc Imaging ; 27 Suppl 1: 61-71, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22009020

RESUMO

We aimed to evaluate the diagnostic performance of dual-source computed tomography coronary angiography (DSCT-CA) in the measurement of the ascending aorta (AA) diameter and compare the AA diameter in patients with severe bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) stenosis. Eighty-eight consecutive patients (50 men, mean age 60.3 ± 13 year) with severe aortic stenosis (AS) underwent DSCT-CA before aortic valve surgery. Seventy-four of the 88 patients underwent cardiovascular magnetic resonance (CMR). The internal diameter of AA was measured from early-systole with DSCT-CA and CMR by 2 radiologists independently at 4 levels (aortic annulus, sinuses of Valsalva, sinotubular junction, and tubular portion at the right pulmonary artery). The patients were divided in to 2 groups (BAV [n = 53]; TAV [n = 35]) according to operative findings. Patients with BAV were significantly younger than those with TAV (P = 0.0035). Inter-observer agreement of AA diameters at 4 levels with DSCT-CA and CMR was excellent (intraclass correlation coefficient = 0.89-0.97). Also, the DSCT-CA and CMR measurements of the AA diameter strongly correlated (r = 0.871-0.976). Mean diameter of the AA by DSCT-CA was significantly larger in patients with BAV (34.4 ± 8.2 mm) as compared to those with TAV (30.6 ± 5.5 mm). The diameters at the sinuses of Valsalva, sinotubular junction, and tubular portion were significantly larger in BAV than in TAV. Twenty-two of 53 (41.5%) patients with BAV and 2 of 35 (5.7%) patients with TAV had AA dilatation > 45 mm. DSCT-CA allows accurate assessment of the AA diameters in patients with severe AS. Patients with severe BAV stenosis had larger AA diameters and higher prevalence of AA dilatation > 45 mm as compared to those with severe TAV stenosis.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Pesos e Medidas Corporais/métodos , Tomografia Computadorizada por Raios X/métodos , Estenose da Valva Tricúspide/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/patologia , Estenose da Valva Aórtica/patologia , Aortografia/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/patologia , Estenose da Valva Tricúspide/patologia
7.
J Comput Assist Tomogr ; 35(5): 535-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21926844

RESUMO

OBJECTIVES: The objective of the study was to retrospectively evaluate (a) which clinical/laboratory features are associated with the presence of diffuse gallbladder wall thickening (DGWT) in cirrhotic patients and (b) whether the degree of DGWT is correlated with such clinical/laboratory variables. METHODS: After excluding patients with DGWT or laboratory test abnormalities from known causes unrelated to liver cirrhosis, a retrospective review of liver computed tomography obtained from 242 consecutive cirrhotic patients was performed by 2 radiologists in consensus to determine the presence of DGWT of greater than 3 mm in thickness and, if present, to measure the degree of DGWT defined as maximal thickness. Univariate and multivariate analysis were performed to evaluate association between presence/degree of DGWT and clinical/laboratory features. RESULTS: Of 242 patients, 73 (30.2%) had DGWT. Diffuse gallbladder wall thickening was seen in 7.6% (12/157) of patients with Child-Pugh class A, 61.1% (33/54) of class B, and 90.3% (28/31) of class C (P < 0.001). The presence of ascites, lower platelet count, and lower albumin level were independently associated with the presence of DGWT (P < 0.01, P = 0.01, and P = 0.02, respectively). However, these factors did not show significant correlation with the degree of DGWT. CONCLUSIONS: The presence of DGWT in cirrhotic patients is associated with the presence of ascites, lower platelet count, and lower albumin level. The degree of DGWT is not correlated with such variables.


Assuntos
Doenças da Vesícula Biliar/diagnóstico por imagem , Cirrose Hepática/complicações , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Ascite/diagnóstico por imagem , Distribuição de Qui-Quadrado , Meios de Contraste , Feminino , Doenças da Vesícula Biliar/patologia , Humanos , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Albumina Sérica/análise
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