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1.
Andreas Gutzeit Aleksis Doert Johannes M. Froehlich Boris P. Eckhardt Andreas Meili Patrick Scherr Daniel T. Schmid Nicole Graf Constantin A. von Weymarn Edwin M. M. Willemse Christoph A. Binkert 《Skeletal radiology》2010,39(4):333-343
Purpose
To prospectively compare the diagnostic accuracy of diffusion-weighted whole body imaging with background whole body signal suppression (DWIBS) with skeletal scintigraphy for the diagnosis and differentiation of skeletal lesions in patients suffering from prostate or breast cancer.Material and Methods
A diagnostic cohort of 36 patients was included in skeletal scintigraphy and 1.5 T DWIBS MRI. Based on morphology and signal intensity patterns, two readers each identified and classified independently, under blinded conditions, all lesions into three groups: (1) malignant, (2) unclear if malignant or benign and (3) benign. Finally, for the definition of the gold standard all available imaging techniques and follow-up over a minimum of 6 months were considered.Results
Overall, 45 circumscribed bone metastases and 107 benign lesions were found. DWIBS performed significantly better in detecting malignant skeletal lesions in patients with more than 10 lesions (sensitivity: 0.97/0.91) compared to skeletal scintigraphy (sensitivity: 0.48/0.42). No statistical difference could be found between DWIBS (0.58/0.33) and skeletal scintigraphy (0.67/0.58) in the sensitivity values for malignant skeletal lesions in patients with less than 5 lesions. For benign lesions, scintigraphy scored best with a sensitivity of 0.93/0.87 compared to 0.20/0.13 for DWIBS. Interobserver agreement with Cohen’s kappa coefficient was calculated as 0.784 in the case of scintigraphy and 0.663 for DWIBS.Conclusion
With respect to staging, in prostate and breast carcinoma, the DWIBS technique is not superior to skeletal scintigraphy, but ranks equally. However, in the cases with many bone lesions, markedly more metastases could be discovered using the DWIBS technique than skeletal scintigraphy. 相似文献2.
Purpose
We evaluated with magnetic resonance imaging (MRI) the degradation and osteointegration features of a new type of bioabsorbable interference (BioRCI) screw composed of poly-L-lactic acid and hydroxyapatite (PLLA-HA) used for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction.Materials and methods
Thirty-one patients underwent arthroscopic surgery for ACL reconstruction using doubled gracilis and semitendinosus tendons fixed to the tibial tunnel with PLLA-HA (BioRCI-HA) screws. Two groups of patients were evaluated, one group 10–13 months after surgery and the other after 30–40 months. The standard knee ligament evaluation form of the International Knee Documentation Committee (IKDC) was used for clinical assessment and MRI for the radiological assessment.Results
MRI after 10–13 months revealed findings referable to healing and integration of the bone-graft-screw system, findings that disappeared at later follow-up examinations. The BioRCI-HA screw remained constantly visible in all patients, although with changes in signal intensity over time.Conclusions
BioRCI-HA screws allow adequate primary stability and superior osteoconduction and biocompatibility in comparison with plain PLLA screws. The absence of ferromagnetic artefacts allows accurate MRI follow-up and adequate evaluation of ligament synovialisation, screw degradation and graft osteointegration. 相似文献3.
T. De Coninck L. Jans G. Sys W. Huysse T. Verstraeten R. Forsyth B. Poffyn K. Verstraete 《European radiology》2013,23(11):3140-3152
Objectives
To determine whether dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can differentiate benign from malignant cartilage tumours compared to standard MRI. To investigate whether a cutoff value could be determined to differentiate enchondroma from low-grade chondrosarcoma (CS) more accurately.Methods
One hundred six patients were included in this retrospective study: 75 with enchondromas (mean age?=?41 years) and 31 with CS (mean age?=?47 years). Within this population, a subgroup of patients was selected with the tumour arising in a long bone. At the time of diagnosis, the tumours were evaluated on MRI, including standard MRI, DCE-MRI, and region-of-interest (ROI) analysis to obtain information on tumour vascularisation and perfusion.Results
The main cutoff value to differentiate enchondroma from CS contained a two-fold more relative enhancement compared with muscle, combined with a 4.5 (= 76°) slope value, with 100 % sensitivity and 63.3 % specificity. The prediction of CS diagnosis with DCE-MRI had 93.4 % accuracy. The accuracy of the standard MRI parameters was equal to the DCE-MRI parameters.Conclusions
Standard MRI and DCE-MRI both play an important and complementary role in differentiating enchondroma from low-grade CS. A combination of both imaging techniques leads to the highest diagnostic accuracy for differentiating cartilaginous tumours.Key Points
? DCE-MRI plays an important role in differentiating benign from malignant cartilage tumours. ? Retrospective study defined a threshold for 100 % detection of chondrosarcoma with DCE-MRI. ? The threshold values were relative enhancement?=?2 and slope?=?4.5. ? One hundred per cent chondrosarcoma detection corresponds with 36.7 % false-positive diagnosis of enchondroma. ? Standard MRI is complementary to DCE-MRI in differentiating cartilaginous tumours. 相似文献4.
Introduction
Risk of further haemorrhage in patients suffering from arteriovenous malformation (AVM) would be eliminated only if complete obliteration of the AVM is obtained. Therefore, these patients frequently need long-term follow-up. Conventional catheter angiography (CCA) with a risk of 0.5 %.to 1.6 % of significant neurological complications has traditionally been used for this purpose. However, magnetic resonance imaging (MRI) at 3T may be a safer alternative. The aim of this study was to evaluate if MRI at 3T can accurately evaluate closure of AVM in 2 years after stereotactic radiosurgery.Methods
Twenty-three patients with both MRI at 3T and a CCA study were examined. The residual AVMs were evaluated by MRI at 3T against CCA in a prospective study.Results
The time interval between radiosurgery and neuroimaging was on average of 25 months (range, 15–30 months) for MRI study and 33 months (range, 25–46 months) for CCA study. Ten patients showed closure of the AVM on MRI, all of which were confirmed on CCA.Conclusion
There was a complete agreement between late MRI at 3T scan and CCA in evaluation of AVM patency. 相似文献5.
P. Balageas F. Cornelis Y. Le Bras R. Hubrecht J. C. Bernhard J. M. Ferrière A. Ravaud N. Grenier 《European radiology》2013,23(7):1925-1932
Objectives
To evaluate survival and outcomes after percutaneous radiofrequency ablation (RFA) of malignant renal tumours in high-risk patients with long-term follow-up.Methods
Between 2002 and 2009, 62 patients (71 tumours), with a median age of 73.5 years (20–87), consecutively treated with RFA under ultrasound or computed tomography guidance for malignant renal tumours were retrospectively selected and prospectively followed until 2012, including 25 patients (40.3 %) with solitary kidney and 7 cystic cancers. Maximal tumour diameters were between 8 and 46 mm (median: 23 mm).Results
Radiofrequency ablation was technically possible for all patients. Mean follow-up was 38.8 months (range: 18–78 months). Primary and secondary technique effectiveness was 95.2 % and 98.4 % per patient respectively. The rates of local tumour progression and metastatic evolution were 3.2 % and 9.7 % per patient and were associated with tumour size >4 cm (P?=?0.005). The disease-free survival rates were 88.3 % and 61.9 % at 3 and 5 years. No significant difference in glomerular filtration rates before and after the procedure was observed (P?=?0.107). The major complications rate was 5.9 % per session with an increased risk in the case of central locations (P?=?0.006).Conclusions
Percutaneous renal RFA appears to be safe and effective with useful nephron-sparing results.Key Points
? Radiofrequency ablation (RFA) is a well-tolerated technique according to mid-term results. ? RFA for malignant renal tumours preserved renal function in high-risk patients. ? Mid-term efficacy of RFA was close to that of formal conservative surgery. ? Tumour size and central location limit the efficacy and safety of RFA. 相似文献6.
F. Fiocchi V. Iotti G. Ligabue A. Pecchi G. Luppi B. Bagni F. Rivasi P. Torricelli 《La Radiologia medica》2010,115(6):906-919
Purpose
This study aimed to evaluate the role of contrastenhanced magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) in the assessment of local recurrence of rectal cancer.Materials and methods
Among 200 patients scheduled for CT follow-up, 60 (48 low risk; 12 high risk) were selected due to CT findings suspicious for or suggestive of local recurrence. Patients underwent contrast-enhanced MRI and PET-CT within 2 weeks. Biopsy was considered the gold standard in 39 cases and follow-up at 6 and 12 months in the remaining 21.Results
Local recurrence was confirmed by histology in 15 cases (7 low risk; 8 high risk) and was excluded in 21 cases by long-term follow-up and in 24 by histology. Sensitivity, specificity, positive and negative predictive value and accuracy were 86.7%, 68.9%, 48.1%, 93.9% and 73.3% for contrast-enhanced MRI and 93.3%, 68.9%, 50%, 96.9% and 75% for PET-CT.Conclusions
Contrast-enhanced MRI and PET-CT can help in the detection of local recurrence of rectal cancer, even though their roles in early detection remains debatable, as the value of these techniques in current surveillance protocols is still to be defined. 相似文献7.
Isabelle Thomassin-Naggara Sophie Dechoux Claire Bonneau Audrey Morel Roman Rouzier Marie-France Carette Emile Daraï Marc Bazot 《European radiology》2013,23(8):2306-2314
Purpose
To retrospectively evaluate the ability of magnetic resonance imaging (MRI) to differentiate malignant from benign myometrial tumours.Methods
Fifty-one women underwent MRI before surgery for evaluation of a solitary myometrial tumour. At histopathology, there were 25 uncertain or malignant mesenchymal tumours and 26 benign leiomyomas. Conventional morphological MRI criteria were recorded in addition to b 1,000 signal intensity and apparent diffusion coefficient (ADC). Odds ratios (OR) were calculated for each criterion. A multivariate analysis was performed to construct an interpretation model.Results
The significant criteria for prediction of malignancy were high b 1,000 signal intensity (OR?=?+∞), intermediate T2-weighted signal intensity (OR?=?+∞), mean ADC (OR?=?25.1), patient age (OR?=?20.1), intra-tumoral haemorrhage (OR?=?21.35), endometrial thickening (OR?=?11), T2-weighted signal heterogeneity (OR?=?10.2), menopausal status (OR?=?9.7), heterogeneous enhancement (OR?=?8) and non-myometrial origin on MRI (OR?=?4.9). In the recursive partitioning model, using b 1,000 signal intensity, T2 signal intensity, mean ADC, and patient age, the model correctly classified benign and malignant tumours in 47 of the 51 cases (92.4 %).Conclusion
We have developed an interpretation model usable in routine practice for myometrial tumours discovered at MRI including T2 signal, b 1,000 signal and ADC measurement.Key Points
? MRI is widely used to differentiate benign from malignant myometrial tumours. ? By combining T2-weighted, b 1,000 and ADC features, MRI is 92.4?% accurate. ? DWI may limit misdiagnoses of uterine sarcoma as benign leiomyoma. ? Patient age is important when considering a solitary myometrial tumour. 相似文献8.
Harry J. Griffiths M.D. Roby C. Thompson Jr. M.D. Howard R. Galloway B.M. B.S. FRACR Lenore I. Everson M.D. Jin-Suck Suh M.D. 《Skeletal radiology》1991,20(7):513-516
Three patients with solitary osteochondromas which were increasing in size have been recently examined. Plain films were available on all patients; two patients had MR studies, and two had CT scans. In all three cases, malignant transformation of the osteochondroma was suspected from the cross-sectional imaging studies, but pathologic examination proved that these patients all had bursa formation without any evidence of malignancy. The incidence of this rare complication of solitary osteochondroma is discussed. Ultrasound is also recommended for the evaluation of enlarging solitary osteochondromas. 相似文献
9.
Perretta T Pistolese CA Bolacchi F Cossu E Fiaschetti V Simonetti G 《La Radiologia medica》2008,113(6):830-840
Purpose
The aim of this study was to evaluate a handheld vacuum-assisted device for magnetic resonance imaging (MRI)-guided breast biopsy.Materials and methods
In 47 patients, a total of 47 suspicious breast lesions (mean maximum diameter 9 mm) seen with MRI (no suspicious changes on breast ultrasound or mammography) were sampled using a 10-gauge vacuum-assisted breast biopsy (VAB) device under MRI guidance. Histology of biopsy specimens was compared with final histology after surgery or with follow-up in benign lesions.Results
Technical success was achieved in all biopsies. Histological results from VAB revealed malignancy in 15 lesions (32%), atypical ductal hyperplasia in four lesions (8%) and benign findings in 28 lesions (60%). One of four lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery. One of seven lesions showing ductal carcinoma was upgraded to invasive carcinoma after surgery. Two lesions diagnosed as infiltrating carcinoma by VAB were not validated at excisional biopsy due to complete removal of the lesion during the procedure. During the follow-up (mean 18 months) of histologically benign lesions, we observed no cases of breast cancer development. Because of morphological changes on follow-up MRI scans, two lesions underwent surgical excision, which confirmed their benign nature. Besides minor complications (massive bleeding, n=1) requiring no further therapeutic intervention, no complications occurred.Conclusions
MRI-guided biopsy of breast lesions using a handheld vacuum-assisted device is a safe and effective method for the workup of suspicious lesions seen on breast MRI alone. 相似文献10.
Matthieu J. C. M. Rutten Gert-Jan Spaargaren Ton van Loon Maarten C. de Waal Malefijt Lambertus A. L. M. Kiemeney Gerrit J. Jager 《European radiology》2010,20(2):450-457
Objective
To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT).Methods
In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings.Results
Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p?=?0.15).Conclusions
MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant. 相似文献11.
Patellofemoral osteoarthritis after Insall’s proximal realignment for recurrent patellar dislocation
Karl F. Schüttler Johannes Struewer Philip P. Roessler Markus Gesslein Marga B. Rominger Ewgeni Ziring Turgay Efe 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2623-2628
Purpose
The aim of the present study was to retrospectively investigate the development of patellofemoral osteoarthritis after the historical Insall’s proximal realignment for patellar stabilisation in patients with recurrent patellar dislocation. Furthermore, risk factors for recurrent patellar dislocation and for patellofemoral osteoarthritis development were evaluated.Methods
Forty-two patients underwent patellofemoral stabilising surgery by the historic Insall’s proximal realignment; they were evaluated with a mean follow-up period of 52 months. Plain radiography was used to document osteoarthritic changes by using the Iwano classification. MRIs obtained at the latest follow-up were evaluated for patellofemoral cartilage lesions. Univariate and multivariate logistic regression analyses were performed to evaluate the influence of trochlear dysplasia, tibial tubercle–trochlear groove distance and patellar height on redislocation. Pearson’s χ 2 and the Spearman’s correlation tests were used to assess a possible correlation between trochlear dysplasia and patellar dislocation, as well as between instability and development of patellofemoral osteoarthritis.Results
At the latest follow-up, plain radiographs showed a significant increase in patellofemoral osteoarthritis (grades II–IV according to the Iwano classification) in 18 patients (43 %) compared with 4 patients (10 %) at the time of surgery (P = 0.001). Patellofemoral cartilage lesions (grades II–IV) were detected in 18 patients (43 %) on MRI. Nine patients (21 %) had at least one incidence of redislocation at follow-up. Estimated redislocation-associated risk factors could not be determined. Trochlear dysplasia had a significant impact on patellofemoral osteoarthritis development (P = 0.001), whereas recurrent patellar instability had none (n.s.).Conclusion
Insall’s proximal realignment technique leads to a significant progression of patellofemoral osteoarthritis. No risk factors for redislocation could be found; however, the presence of trochlear dysplasia did correlate with patellofemoral osteoarthritis.Level of evidence
IV. 相似文献12.
M.C. Martina P.P. Campanino F. Caraffo C. Marcuccio F. Gunetti L. Colla M.C. Cassinis G. Gandini 《La Radiologia medica》2010,115(2):287-300
Purpose
This study was conducted to evaluate the role and clinical impact of dynamic magnetic resonance imaging (MRI) in the diagnosis and follow-up of acute pyelonephritis (APN).Materials and methods
We retrospectively reviewed 442 consecutive renal MRI examinations (279 diagnostic and 163 follow-up) performed in 285 patients (mean age 42.17 years), 35 of whom were kidney transplant recipients with a clinical suspicion of APN.Results
MRI showed signal abnormalities suggestive of APN in 125/244 (51.2%) patients with native kidneys. Except for two examinations performed without paramagnetic contrast material, the inflammatory foci appeared as areas of nonenhancement: single in 39/123 cases, multiple in 84/123, unilateral in 60/84 and bilateral in 24/84. Abscesses were present in 40/123 (32.5%) positive cases. During follow-up, we observed complete normalisation of MRI signs in 86/103 patients; 17/103 (16.5%) cases evolved into fibrosis and scarring. In 15/35 (42.8%) patients with transplanted kidney, MRI was positive for APN.Conclusions
Renal MRI is an effective tool for the diagnosis and follow-up of APN both in patients not at risk and those at higher risk, such as those with a transplanted kidney. The high costs of the examination are offset by better treatment planning and early complication detection. 相似文献13.
Introduction
Dysembryoplastic neuroepithelial tumors (DNET) are classically considered as benign, cortically based tumors that are stable. However, there were case reports that suggested DNET may not be as benign as previously thought. The purpose of our study was to identify atypical location, characteristics, and behavior of DNET in children.Methods
The MRI images of 51 patients with pathologically proven DNET were retrospectively reviewed. The following were assessed: tumor location, neuroimaging appearances including hemorrhage, calcification and edema, tumor growth preoperatively and after subtotal resection, tumor recurrence, malignant transformation, and metastatic seeding.Results
Two (3.9 %) patients had intraventricular lesions, three (5.9 %) had associated edema, three (5.9 %) had calcifications, and one (2 %) had hemorrhage on preoperative CT and MRI. Sixteen of 51 (31.4 %) lesions exhibited enhancement post gadolinium administration. Six of 29 (20.7 %) preoperative lesions that had follow-up imaging were enlarging prior to surgery. In 6 of 18 (33.3 %) with subtotal resection, there was an increase in size of the residual tumor. Tumor recurrence at the surgical bed occurred in 3 of 30 (10 %) patients who had gross total resection. Two of 51 (3.9 %) cases developed secondary lesions distant to the primary tumor; the secondary lesions were within the lateral ventricles.Conclusion
In children, DNET may have atypical location, characteristics and behavior, including growth of primary or residual lesions and multifocal tumor. These findings emphasize the need for follow-up of patients with DNET post-resection. 相似文献14.
Marianna Thomas A. M. Davies A. J. Stirling R. J. Grimer M. Grainger Steven L. J. James 《Skeletal radiology》2014,43(2):179-189
Objective
Sacrectomy and ilio-lumbar reconstruction is an uncommonly performed complex surgical procedure for the treatment of sacral neoplasia. There are many challenges in the post-operative period including the potential for tumor recurrence, infection, and construct failure. We present our experience of this patient cohort and describe the complications and imaging appearances that can be encountered during the follow-up period.Materials and methods
Retrospective review of our Orthopaedic Oncology database was undertaken which has been collected over a 30-year period to identify patients that had undergone sacrectomy and ilio-lumbar reconstruction. Pre and post-operative imaging including radiographs, CT, and MRI was reviewed. These were viewed by two experienced musculoskeletal radiologists with consensus opinion if there was disagreement over the imaging findings. Data regarding patient demographics, tumor type, and dimensions was collected. Serial review of radiographs, CT, and MRI was performed to assess implant position and integrity, strut graft position and union, and for the presence of recurrence within the surgical bed.Results
Five male and two female patients (mean age 36 years, age range 15–54 years) were treated with this procedure. Histological diagnoses included chordoma, chondrosarcoma, osteosarcoma, and spindle cell sarcoma. Mean maximal tumor size on pre-operative imaging was 10.7 cm (range, 6–16 cm). Post-operative follow-up ranged from 10–46 months. A total of 76 imaging studies were reviewed. Commonly identified complications included vertical rod and cross-connector fracture and screw loosening. Fibula strut graft non-union and fracture was also evident on imaging review. Two patients demonstrated disease recurrence during the follow-up period.Conclusions
This study demonstrates the spectrum and frequency of complications that can occur following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia. 相似文献15.
Cheuk DK Sabin ND Hossain M Wozniak A Naik M Rodriguez-Galindo C Krasin MJ Shulkin BL 《European journal of nuclear medicine and molecular imaging》2012,39(7):1097-1106
Purpose
While FDG PET/CT for the evaluation of nasopharyngeal carcinoma (NPC) in adult patients has documented advantages and disadvantages compared with conventional imaging, to our knowledge, no studies of FDG PET/CT for the evaluation of NPC in pediatric patients have been performed. In this investigation, we studied the utility of FDG PET/CT in children with NPC.Methods
The study group comprised 18 children with biopsy-proven NPC who underwent FDG PET/CT and MRI (total 38 pairs of images). All baseline and follow-up FDG PET/CT and MRI studies were independently reviewed for restaging of disease.Results
The concordance between FDG PET/CT and MRI in T, N, and overall staging was 29%, 64%, and 43%, respectively. Compared with MRI, FDG PET/CT yielded lower T and overall staging and showed less cervical and retropharyngeal lymphadenopathy. The concordance between follow-up FDG PET/CT and MRI was 79% overall and 100% 9?months after therapy. In patients who achieved complete remission, FDG PET/CT showed disease clearance 3–6?months earlier than MRI. There were no false-positive or false-negative FDG PET/CT scans during follow-up.Conclusion
FDG PET/CT may underestimate tumor extent and regional lymphadenopathy compared with MRI at the time of diagnosis, but it helps to detect metastases and clarify ambiguous findings. FDG PET/CT is sensitive and specific for follow-up and enables earlier determination of disease remission. FDG PET/CT is a valuable imaging modality for the evaluation and monitoring of NPC in pediatric patients. 相似文献16.
Clinical/methodical issue
Robust and reliable imaging methods are required to estimate the skeletal tumor load in multiple myeloma, as well as for the diagnosis of extraskeletal manifestations. Imaging also plays an essential role in the assessment of fracture risk and of vertebral fractures.Standard radiological methods
The conventional skeletal survey has been the gold standard in the imaging of multiple myeloma for many years.Methodical innovations
Other modalities which have been investigated and are in use are whole-body computed tomography (WBCT), 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET-CT) and whole-body magnetic resonance imaging (WBMRI). These techniques are able to depict both mineralized bone and the bone marrow with a high sensitivity for myeloma lesions.Performance
Several studies have shown that cross-sectional imaging is superior to the skeletal survey in the detection of myeloma lesions and WBMRI has been shown to be significantly more sensitive than WBCT for the detection of focal myeloma lesions as well as for diffuse infiltration. The FDG PET-CT technique has a sensitivity comparable to WBMRI.Achievements
Due to the higher sensitivity in the detection of myeloma lesions WBCT and WBMRI should replace the skeletal survey.Practical recommendations
A WBCT should be performed if there is suspicion of multiple myeloma. If no focal lesions are found WBMRI or at least MRI of the spine and pelvis should be additionally performed if available. If WBMRI has been initially performed and focal lesions are present, an additional WBCT may be performed to assess the extent of bone destruction and fracture risk. In cases of monoclonal gammopathy of undetermined significance (MGUS), solitary and smoldering myeloma, a WBMRI, if available, should be performed in addition to WBCT. 相似文献17.
L. Natale A. De Vita C. Baldari A. Meduri M. Pieroni A. Lombardo F. Crea L. Bonomo 《La Radiologia medica》2012,117(8):1309-1319
Purpose
The exact incidence of myocarditis is unknown, as the diagnosis is frequently delayed or missed. Clinical presentation and disease course are extremely variable, as there may be acute onset with acute coronary syndrome, or cardiogenic shock, or progressive heart failure or arrhythmias. The purpose of this study was to identify prognostic factors on magnetic resonance imaging (MRI) performed in patients with bioptically proven myocarditis at presentation and after 6 months.Materials and methods
Fifty-six consecutive patients with different presentations of myocarditis (20 with acute coronary syndrome, 20 with heart failure, 16 with arrhythmias) were enrolled. All patients underwent B-mode echocardiography (echo) and tissue Doppler imaging, coronarography, ventriculography, endomyocardial biopsy and contrast-enhanced MRI examination, as well as clinical and echo follow-up at 6 months.Results
At 6-month follow-up, patients were divided in two groups according to values of end-systolic volume and ejection fraction: patients with negative remodelling and those with positive remodelling. Late enhancement was found to be an independent predictor of negative remodelling.Conclusions
Contrast-enhanced MRI is useful both in the diagnosis and as a prognostic indicator in the clinical suspicion of myocarditis. 相似文献18.
Roberto Orecchia Viviana Vitolo Maria Rosaria Fiore Piero Fossati Alberto Iannalfi Barbara Vischioni Anurita Srivastava Jeffrey Tuan Mario Ciocca Silvia Molinelli Alfredo Mirandola Gloria Vilches Andrea Mairani Barbara Tagaste Marco Riboldi Giulia Fontana Guido Baroni Sandro Rossi Marco Krengli 《La Radiologia medica》2014,119(4):277-282
Purpose
The Italian National Centre for Oncological Hadrontherapy (Centro Nazionale di Adroterapia Oncologica, CNAO), equipped with a proton and ion synchrotron, started clinical activity in September 2011. The clinical and technical characteristics of the first ten proton beam radiotherapy treatments are reported.Materials and methods
Ten patients, six males and four females (age range 27–73 years, median 55.5), were treated with proton beam radiotherapy. After one to two surgical procedures, seven patients received a histological diagnosis of chordoma (of the skull base in three cases, the cervical spine in one case and the sacrum in three cases) and three of low-grade chondrosarcoma (skull base). Prescribed doses were 74 GyE for chordoma and 70 GyE for chondrosarcoma at 2 GyE/fraction delivered 5 days per week.Results
Treatment was well tolerated without toxicity-related interruptions. The maximal acute toxicity was grade 2, with oropharyngeal mucositis, nausea and vomiting for the skull base tumours, and grade 2 dermatitis for the sacral tumours. After 6–12 months of follow-up, no patient developed tumour progression.Conclusions
The analysis of the first ten patients treated with proton therapy at CNAO showed that this treatment was feasible and safe. Currently, patient accrual into these as well as other approved protocols is continuing, and a longer follow-up period is needed to assess tumour control and late toxicity. 相似文献19.
Carolina Serrano Alicia Laborda Juan M. Lozano Hugo Caballero Antonio Sebastián Jorge Lopera Miguel Ángel de Gregorio 《Cardiovascular and interventional radiology》2013,36(6):1614-1623
Purpose
To present the 7-year experience of the treatment of benign and malignant tracheobronchial stenoses using metallic stents.Patients and Methods
One hundred twenty-three stents were inserted in 86 patients (74 benign and 12 malignant stenoses). Ninety-seven stents were placed in the trachea and 26 in the bronchi. The procedures were performed under fluoroscopic and flexible bronchoscopic guidance with the patient under light sedation. In cases of severe stenotic lesions or obstructions, laser resection was performed before stent placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals.Results
The technical success was 100 %. Dyspnea disappearance, forced expiratory volume in the first second, and pulmonary functional data improvement was observed in all patients (p < 0.001). Complications were detected in 23 patients (26.7 %). Mean follow-up time was 6.3 ± 1.2 months in patients with malignant lesions and 76.2 ± 2.3 months patients with in benign lesions. By the end of the study, 100 % of patients with malignant pathology and 6.7 % of patients with benign lesions had died.Conclusion
Endoluminal treatment of tracheobronchial stenosis with metallic stents is a therapeutic alternative in patients who are poor candidates for surgery. In unresectable malignant lesions, the benefit of metallic stenting is unquestionable. In benign lesions, the results are satisfactory, but sometimes other interventions are required to treat complications. New stent technology may improve these results. 相似文献20.