To assess the feasibility of multi-detector computed tomography angiography (MDCTA) volumetry for the quantification and grading of acute non-cerebral, non-gastrointestinal bleeding.
MethodsThis retrospective, single-center study investigated consecutive patients with MDCTA positive for active non-cerebral, non-gastrointestinal bleeding, between January 2020 and June 2020. Outcome measures were the quantification of active extravasation at the arterial and parenchymal phase using volumetry measurements, the calculation of active bleeding rate and bleeding grading, 30-day mortality rate, identification of independent predictors of mortality and correlation between volumetric analysis, various clinical features, and the decision to proceed with an intervention.
ResultsIn total 30 patients (17 females; 56.6%; mean age 70.0?±?16.0 years) were analyzed. Volumetric analysis was feasible in all cases resulting in excellent inter-observer variability (interclass correlation coefficient 0.999 for arterial and 0.919 for venous volume measurements). Mean volume of contrast extravasation was 1.06?±?1.09 ml and 3.07?±?2.48 ml at the arterial and parenchymal phases, respectively. Mean bleeding rate was 6.95?±?7.82 ml/min. High bleeding volume at arterial phase (grade 4 bleeding) was the only independent predictor of 30-day mortality (HR 1383.58; p?=?0.042). There was a positive correlation between bleeding volume at arterial phase (rs?=?0.340; p?=?0.033) and arterial bleeding rate (rs?=?0.381; p?=?0.019) with the decision to proceed with an intervention. Bleeding volume of 0.6 ml was the cutoff value for the prediction of intervention (sensitivity 96.3%; specificity 66.7%).
ConclusionsMDCTA volumetric analysis for the quantification and grading of acute hemorrhage was feasible with excellent inter-observer agreement. The proposed bleeding grading system could optimize decision making and predict clinical outcomes.
相似文献The objectives of this study were to compare arterial and venous contrast medium extravasation in severe pelvic injury detected by ante- and post-mortem multi-detector CT (MDCT) and determine whether vascular injury is associated with certain types of pelvic fracture.
MethodsWe retrospectively included two different cohorts of blunt pelvic trauma with contrast medium extravasation shown by MDCT. The first group comprised 49 polytrauma patients; the second included 45 dead bodies undergoing multi-phase post-mortem CT-angiography (MPMCTA). Two radiologists jointly reviewed each examination concerning type, site of bleeding and pattern of underlying pelvic ring fracture.
ResultsAll 49 polytrauma patients demonstrated arterial bleeding, immediately undergoing subsequent angiography; 42 (85%) had pelvic fractures, but no venous bleeding was disclosed. MPMCTA of 45 bodies revealed arterial (n = 33, 73%) and venous (n = 35, 78%) bleeding and pelvic fractures (n = 41, 91%). Pelvic fracture locations were significantly correlated with ten arterial and six venous bleeding sites in dead bodies, with five arterial bleeding sites in polytrauma patients.
In dead bodies, arterial haemorrhage was significantly correlated with the severity of pelvic fracture according to Tile classification (p = 0.01), unlike venous bleeding (p = 0.34).
ConclusionsIn severe pelvic injury, certain acute bleeding sites were significantly correlated with underlying pelvic fracture locations. MPMCTA revealed more venous lesions than MDCT in polytrauma patients. Future investigations should evaluate the proportional contribution of venous bleeding to overall pelvic haemorrhage as well as its clinical significance.
相似文献With improving nutrition and health, athletes have grown taller and heavier over the past century. Since there is no weight restriction in the heavyweight class, secular changes in anthropometric measurements of heavyweight boxers may mirror those of contemporary general populations.
ObjectivesWe aimed to (1) examine secular trends in adiposity and musculoskeletal measurements in heavyweight boxers, (2) determine anthropometric differences between champions and unsuccessful challengers.
MethodsDetailed demographics taken at time of contest (first official World Championship to current contest: 1889–2019) were collected from media archives.
ResultsAll 237 boxers (83 champions, 154 challengers) contesting a recognised heavyweight World Championships were identified. They had mean (±?SD) age?=?28.9?±?4.1 years, height?=?187.3?±?6.5 cm, reach?=?195.2?±?9.4 cm, weight?=?97.5?±?11.5 kg, BMI?=?27.8?±?2.4 kg/m2 and waist?=?87.9?±?6.2 cm. Contest years explained 25.9% (p?<?0.001) of the variance in BMI for champions and 30.9% (p?<?0.001) for challengers, 9.1% (p?<?0.071) in WC for champions and 19.9% (p?<?0.001) for challengers. Contest years correlated with height (r?=?0.531, p?<?0.001), reach (r?=?0.341, p?<?0.001), weight (r?=?0.603, p?<?0.001) and BMI (r?=?0.370, p?=?0.001) among all documented boxers, and with waist only in challengers (r?=?0.349, p?<?0.001) but not in champions (r?=?0.078, p?=?0.509). Compared with challengers, champions had greater stature by +?3.4 cm (p?<?0.001), reach +?3.6 cm (p?=?0.005) and weight +?3.7 kg (p?=?0.017), with similar BMI and waist. Champions had larger biceps and forearms but did not differ from challengers in other musculoskeletal dimensions.
ConclusionsOver 130 years elite heavyweight boxers have increased in size (BMI) and reach but waists in champions have remained static. Being heavier, taller with longer and bigger arms, but with similar in BMI and waist, appear to be differentiating factors between champions and challengers.
相似文献Regular physical activity is a good strategy to maintain the health of athletes, and prevent pain and decreased joint flexibility during the pandemic. On the other hand, higher sedentary time during the pandemic period can have deleterious effects. The objective of this study was to compare physical activity levels, sedentary time, and sleep parameters during the pre-COVID period and the COVID-19 pandemic period in young badminton athletes.
MethodsFifteen young badminton athletes were evaluated during a pre-COVID period (July 2019) and during the COVID-19 period (July 2020). Sleep parameters, physical activity level, and sedentary time were measured using a tri-axial accelerometer. Participants wore the accelerometer on their dominant wrist for 7 days consecutively. In addition, the average of each sleep parameter [time in bed and total sleep time in hours per day, sleep efficiency (%), wake after sleep onset (WASO, total per day), and sleep latency (minutes per day)] was reported over the 7-day period.
ResultsAthletes presented increased sedentary time (pre-COVID?=?7.0?±?1.1 vs.COVID-19?=?8.9?±?1.9 h/day, p?=?0.004, d?=?1.30) and significant decreases in the total PA observed in counts per day (pre-COVID?=?2,967,064.4?±?671,544.1 vs. COVID-19?=?1,868,210.2?±?449,768.4 counts/day, p?=?0.001, d?=?1.99), time in vigorous PA (pre-COVID?=?7.7?±?0.9 vs. COVID-19?=?6.1?±?1.2 h/day, p?=?0.001, d?=?1.56), and time in moderate-to-vigorous PA (pre-COVID?=?8.1?±?0.9 vs. COVID-19?=?6.5?±?1.3 h/day, p?=?0.001, d?=?1.48). There were no significant differences for time in light and moderate PA or in sleep parameters (p?>?0.05).
ConclusionYoung badminton athletes presented increased sedentary time, and decreased total physical activity, time in MVPA, and time in vigorous activities during the COVID-19 pandemic compared to the pre-COVID period, however, there were no significant differences in sleep parameters.
相似文献Purpose
To compare patient outcomes following magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) ordered for suspected pulmonary embolism (PE).Methods
In this IRB-approved, single-center, retrospective, case-control study, we reviewed the medical records of all patients evaluated for PE with MRA during a 5-year period along with age- and sex-matched controls evaluated with CTA. Only the first instance of PE evaluation during the study period was included. After application of our exclusion criteria to both study arms, the analysis included 1173 subjects. The primary endpoint was major adverse PE-related event (MAPE), which we defined as major bleeding, venous thromboembolism, or death during the 6 months following the index imaging test (MRA or CTA), obtained through medical record review. Logistic regression, chi-square test for independence, and Fisher’s exact test were used with a p?<?0.05 threshold.Results
The overall 6-month MAPE rate following MRA (5.4%) was lower than following CTA (13.6%, p?<?0.01). Amongst outpatients, the MAPE rate was lower for MRA (3.7%) than for CTA (8.0%, p?=?0.01). Accounting for age, sex, referral source, BMI, and Wells’ score, patients were less likely to suffer MAPE than those who underwent CTA, with an odds ratio of 0.44 [0.24, 0.80]. Technical success rate did not differ significantly between MRA (92.6%) and CTA (90.5%) groups (p?=?0.41).Conclusion
Within the inherent limitations of a retrospective case-controlled analysis, we observed that the rate of MAPE was lower (more favorable) for patients following pulmonary MRA for the primary evaluation of suspected PE than following CTA.To report our experience using a multilevel patient management algorithm to direct transarterial embolization (TAE) in managing spontaneous intramuscular hematoma (SIMH).
Materials and MethodsFrom May 2006 to January 2014, twenty-seven patients with SIMH had been referred for TAE to our Radiology department. Clinical status and coagulation characteristics of the patients are analyzed. An algorithm integrating CT findings is suggested to manage SIMH. Patients were classified into three groups: Type I, SIMH with no active bleeding (AB); Type II, SIMH with AB and no muscular fascia rupture (MFR); and Type III, SIMH with MFR and AB. Type II is furthermore subcategorized as IIa, IIb and IIc. Types IIb, IIc and III were considered for TAE. The method of embolization as well as the material been used are described. Continuous variables are presented as mean ± SD. Categorical variables are reported as percentages. Technical success, clinical success, complications and 30-day mortality (d30 M) were analyzed.
ResultsTwo patients (7.5%) had Type IIb, four (15%) Type IIc and 21 (77.5%) presented Type III. The detailed CT and CTA findings, embolization procedure and materials used are described. Technical success was 96% with a complication rate of 4%. Clinical success was 88%. The bleeding-related thirty-day mortality was 15% (all with Type III).
ConclusionTAE is a safe and efficient technique to control bleeding that should be considered in selected SIMH as soon as possible. The proposed algorithm integrating CT features provides a comprehensive chart to select patients for TAE.
Level of Evidence4.
相似文献Purpose
To compare image quality and radiation dose of high-pitch computed tomography angiography(CTA) of the aortic valve-aortic root complex with and without prospective ECG-gating compared to a retrospectively ECG-gated standard-pitch acquisition.Materials and Methods
120 patients(mean age 68?±?13 years) were examined using a 128-slice dual-source CT system using prospectively ECG-gated high-pitch(group A; n?=?40), non-ECG-gated high-pitch(group B; n?=?40) or retrospectively ECG-gated standard-pitch(C; n?=?40) acquisition techniques. Image quality of the aortic root, valve and ascending aorta including the coronary ostia was assessed by two independent readers. Image noise was measured, radiation dose estimates were calculated.Results
Interobserver agreement was good(κ?=?0.64–0.78). Image quality was diagnostic in 38/40 patients(group A), 37/40(B) and 38/40(C) with no significant difference in number of patients with diagnostic image quality among all groups (p?=?0.56). Significantly more patients showed excellent image quality in group A compared to groups B and C(each, p?<?0.01). Average image noise was significantly different between all groups(p?<?0.05). Mean radiation dose estimates in groups A and B(each; 2.4?±?0.3 mSv) were significantly lower compared to group C(17.5?±?4.4 mSv; p?<?0.01).Conclusion
High-pitch dual-source CTA provides diagnostic image quality of the aortic valve-aortic root complex even without ECG-gating at 86% less radiation dose when compared to a standard-pitch ECG-gated acquisition. 相似文献We hypothesize that the combination of transarterial embolization (TAE) plus inhibition of lactate export will limit anaerobic metabolism and reduce tumor survival compared to TAE alone. The purpose of this study was to test this hypothesis in a rat model of hepatocellular carcinoma (HCC).
MethodsRat N1-S1 hepatoma cells were assayed in vitro using the Seahorse XF analyzer to measure extracellular acidification (lactate excretion) comparing effects of the addition of caffeic acid (CA) or ferulic acid (FA) or UK-5099 with control. Monocarboxylate transporter Slc16a3 was knocked down by RNAi. N1S1 tumors were orthotopically implanted in rats and 4 groups evaluated: (1) Control, (2) TAE-only, (3) TAE plus CA, and (4) TAE plus FA. Tumor size was determined by ultrasound and analyzed by repeated measures statistics. Tumors harvested at 4 weeks were examined by microscopy.
ResultsSeahorse assays showed that CA and FA caused a significant reduction by >90% in lactate efflux by N1S1 tumor cells (p < 0.01). Knockdown of Slc16a3 prevented inhibition by CA. In vivo tumors grew 30-fold in volume over 4 weeks in untreated controls. By comparison, TAE resulted in near cessation of growth (10% in 4-week time period). However, both TAE + CA and TAE + FA caused a significant reduction of tumor volumes (87 and 72%, respectively) compared to control and TAE (p < 0.05). Pathologic evaluation revealed residual tumor in the TAE group but no residual viable tumor cells in the TAE + CA and TAE + FA groups.
ConclusionAddition of CA or FA enhances the effectiveness of TAE therapy for HCC in part by blocking lactate efflux.
相似文献Introduction
High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck.Methods
CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols.Results
Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3?±?16.5 versus 57.3?±?14.8; p?=?0.50) and venous segments (15.8?±?6.7 versus 18.9?±?8.9; p?=?0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p?<?0.0001) as well as along the brachiocephalic trunk (p?<?0.0001), the subclavian arteries (p?<?0.0001), proximal common carotid arteries (p?=?0.01), and vertebral V1 segments (p?<?0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35 % (218.2?±?30 versus 141.8?±?20 mGy?×?cm).Conclusions
Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis. 相似文献Objectives
Contrast media (CM) extravasation is a well-known complication of CT angiography (CTA). Our prospective randomized control study aimed to assess whether a four-phasic CM administration protocol reduces the risk of extravasation compared to the routinely used three-phasic protocol in coronary CTA.Methods
Patients referred to coronary CTA due to suspected coronary artery disease were included in the study. All patients received 400 mg/ml iomeprol CM injected with dual-syringe automated injector. Patients were randomized into a three-phasic injection-protocol group, with a CM bolus of 85 ml followed by 40 ml of 75%:25% saline/CM mixture and 30 ml saline chaser bolus; and a four-phasic injection-protocol group, with a saline pacer bolus of 10 ml injected at a lower flow rate before the three-phasic protocol.Results
2,445 consecutive patients were enrolled (mean age 60.6?±?12.1 years; females 43.6%). Overall rate of extravasation was 0.9% (23/2,445): 1.4% (17/1,229) in the three-phasic group and 0.5% (6/1,216) in the four-phasic group (p?=?0.034).Conclusions
Four-phasic CM administration protocol is easy to implement in the clinical routine at no extra cost. The extravasation rate is reduced by 65% with the application of the four-phasic protocol compared to the three-phasic protocol in coronary CTA.Key Points
? Four-phasic CM injection-protocol reduces extravasation rate by 65% compared to three-phasic. ? The saline pacer bolus substantially reduces the risk of CM extravasation. ? The implementation of four-phasic injection-protocol is at no cost.Objectives
Deep inferior epigastric perforator (DIEP) flaps have become the state of the art in breast reconstruction. We compared the diagnostic performance of multidetector computed tomography (CTA) and magnetic resonance angiography (MRA) in DIEP flap planning.Methods
Twenty-three women (mean age 48.0 years, range 26–72 years) underwent preoperative blinded evaluation using 64-slice CTA and 1.5-T MRA. Perforator identification, measurement of their calibre, intramuscular course (IMC), assessment of direct venous connections (DVC) with main superficial veins, superficial venous communications (SVC) between the right and left hemi-abdomen and deep inferior epigastric artery (DIEA) branching type were performed. Surgery was carried out by the same team. Intraoperative findings were the standard of reference.Results
Accuracy in identifying dominant perforators was 91.3 % for both techniques and mean error in calibre measurement 1.18?±?0.35 mm for CTA and 1.63?±?0.39 mm for MRA. Accuracy in assessing perforator IMCs was 97.1 % for CTA and 88.4 % for MRA, DVC 94.4 % for both techniques, SVC 91.3 % as well, and DIEA branching type 100 % for CTA and 91.3 % for MRA. Image acquisition and interpretation time was 21?±?3 min for CTA (35?±?5 min for MRA).Conclusions
In a strategy to optimise DIEP flap planning avoiding radiation exposure, MRA can be proposed alternatively to CTA.Key points
? Identification of deep inferior epigastric perforators (DIEP) is important before breast reconstruction. ? Both CT and MR angiography are accurate in identifying DIEA perforator branches. ? CTA and MRA are equivalent in demonstrating perforator-venous connections. ? MRA can be proposed as an alternative to CTA in DIEP planning. 相似文献Objective
Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE).Materials and Methods
We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG.Results
The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE.Conclusion
We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis. 相似文献Many endurance athletes use foam rolling (FR) to decrease muscle soreness, but it is unclear whether FR effectively treats soreness in this population. Moreover, the effects of FR in highly trained runners are unknown. The aim of this study was to use downhill running (DHR) to induce muscle soreness in runners and to determine the influence of FR on soreness and running performance when compared to sham compression tights.
MethodsParticipants performed a running economy (RE) test at 75% of 5-km race speed and a 3-km time trial (TT). In a crossover design, subjects then completed DHR followed by either a FR protocol or wearing sham compression tights. Two days post-DHR, subjects repeated the RE and TT tests. Crossover visits occurred 2–4 weeks later. During RE tests, VO2 and rating of perceived exertion (RPE) were recorded. Passive and active soreness were measured on a scale of 0 (no soreness) to 10 (extreme soreness).
ResultsEight runners (aged 31?±?7 years; four females; VO2peak 57?±?7 ml kg?1 min?1) completed the study. Both treatment conditions experienced passive (p?=?0.026) and active soreness (p = 0.012) induced by DHR. Active soreness 2 days post-DHR was significantly lower after FR than after sham compression tights (p?=?0.025). With tights, there was a trend for an increased RPE compared to pre-DHR (p?=?0.056).
ConclusionsFoam rolling decreases leg soreness in well-trained runners and attenuates soreness-related increases in perceived exertion during sub-maximal running.
相似文献