Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States

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Progressive dyspnea associated with a crazy-paving appearance on a chest computed tomography scan

A ‘crazy-paving’ appearance of the lungs on computed tomography scanning of the chest was first described nearly 20 years ago in patients with pulmonary alveolar proteinosis, and was thought to be characteristic of this condition. However, this pattern has subsequently been reported in a variety of pulmonary diseases and is now considered to be nonspecific. The present report describes a case of a 74-year-old man in whom congestive heart failure presented with a crazy-paving appearance of the lungs on a chest computed tomography scan. This uncommon association illustrates the importance of the correlation of clinical and radiographic information.     

Mesenteric inflammatory veno-occlusive disorder: a rare entity mimicking inflammatory bowel disorder

Mesenteric inflammatory veno-occlusive disorder (MIVOD) is a rare variety of inflammatory bowel disease. In addition to the case presentation, pathogenesis, and conflicting clinical, endoscopic, and computed tomography findings, we present for the first time the angiographic findings that would provide important clues to distinguish MIVOD from the chronic idiopathic variety of inflammatory bowel disease and confirm the diagnosis of MIVOD. Final diagnosis is made on full-thickness biopsy. Although medical treatment of MIVOD is unsuccessful, surgical resection of the involved segment results in resolution of symptoms.     

Additive value of low-dose dobutamine to technetium-99m sestamibi-gated single-photon emission computed tomography for prediction of wall motion improvement in patients undergoing coronary artery bypass graft

BACKGROUND: The two most useful methods for myocardial viability assessment are perfusion imaging and dobutamine echocardiography. HYPOTHESIS: The present study investigated the additive value of a new method, dobutamine technetium 99m (99mTc)-sestamibi-gated single-photon emission computed tomography (SPECT), which combines these two modalities, to the prediction of wall motion improvement after revascularization. METHODS: Fifty-five consecutive patients with ischemic cardiomyopathy, who were referred for viability evaluation, underwent resting and dobutamine (dose, 5-10 microkg/kg/min) gated SPECT with 99mTc-sestamibi. Of these patients, 36 underwent coronary artery bypass graft (CABG) within 1 month of the study and 32 had repeat resting gated SPECT within 1 year. Global and regional wall motion, wall thickness, and perfusion were simultaneously analyzed at rest and after dobutamine using the 20-segment model; the sestamibi uptake and wall motion response to dobutamine of each segment were rated quantitatively. Based on these findings, the segments were categorized as normal, viable, or nonviable. The predictive values for wall motion improvement were assessed by perfusion, using cutoffs of 50 and 60% of sestamibi uptake, and thereafter by the addition of dobutamine response in the segments that were rated nonviable. RESULTS: Of the 1,080 myocardial segments studied, 906 (84%) had abnormal wall motion and were analyzed for viability. Concordance between perfusion and wall motion response to dobutamine was 60% with the 50% cutoff of sestamibi uptake, and increased to 65% with the 60% sestamibi cutoff (p < 0.04). The respective predictive values of wall motion improvement using the 50 and 60% cutoff points were as follows: sensitivity 93 and 70%, respectively, (p < 0.01); specificity 59 and 86% (p < 0.001), respectively; accuracy 77% for both. The addition of the wall motion response to dobutamine to the assessment of the nonviable segments by perfusion (60% cutoff) increased the sensitivity from 70 to 85% (p = 0.001) and the negative predictive value from 70 to 81% (p = 0.009); the positive predictive value remained high (86 vs. 82%). No additive value of wall motion response to dobutamine was demonstrated for nonviable segments by perfusion with a 50% cutoff. CONCLUSION: Dobutamine sestamibi-gated SPECT is a feasible method for the analysis of myocardial perfusion, function, and contractile reserve of individual myocardial segments in patients with ischemic cardiomyopathy. Viability assessment based on a threshold of 60% uptake of sestamibi, with the addition of the wall motion response to dobutamine in the nonviable segments, seems to yield better predictive values for wall motion improvement after CABG.     

Magnetic resonance imaging for evaluating neurogenic dysphagia

Dysphagia due to CNS pathology usually stems from one of two patterns of disease: (1) bilateral corticobulbar tract dysfunction (“pseudobulbar palsy”) or (2) pontomedullary dysfunction (“bulbar palsy”). Computed tomography (CT) has proved to be useful for evaluating the brainstem in patients with neurogenic dysphagia. Nonetheless, artifacts are common in CT imaging of the posterior fossa. Also, direct sagittal imaging is not usually obtainable by CT in adult patients. Magnetic resonance imaging (MRI), in contrast to CT, simultaneously gathers sequential images in the same plane and can obtain direct reconstructions in any plane of interest. MRI has proven to be more sensitive than CT in demonstrating lesions of the brain, such as demyelinating (e.g., multiple sclerosis) and ischemic diseases, (Brant-Zawadzki et al. 1984, Bradley et al. 1984, Bydder et al. 1982, Sheldon et al. 1985) as well as neoplastic masses that may produce neurogenic dysphagia (Lee et al. 1985, Zimmerman et al. 1986). Five patients with dysphagia are reported for whom MRI was valuable in detecting and characterizing their lesions of the brainstem and the cerebral hemispheres.     

原发性肝癌合并胆管梗阻的影像诊断与介入治疗

目的　探讨原发性肝癌合并胆管梗阻的影像诊断与介入治疗价值。方法　对 2 6例原发性肝癌合并胆管梗阻者进行回顾性分析 ,所有患者均行超声和CT检查 ,18例行MRI检查 ,11例行PTC检查 ,10例行ERCP检查 ,12例行胆道内支架置入术 ,2 2例经肝动脉化疗栓塞 (TACE)治疗。结果　 2 6例患者经超声、CT、MRI、PTC和ERCP等影像学检查后获得正确诊断。 12例患者分别置入了 4枚塑料内支架和 8枚金属支架 ,技术成功率为 10 0 % ,均有明显的减黄效果 ,患者术后 1周的血清胆红素水平由术前的 ( 2 96± 67) μmol/L降至 ( 10 4± 5 2 ) μmol/L(P <0 .0 5 )。 2 2例患者成功地进行了TACE治疗。结论　超声、CT、MRI和胆管造影检查对原发性肝癌合并胆管梗阻有较高的诊断价值 ,其相互补充有助于本病的正确诊断。胆道内支架置入术与TACE等介入治疗是其有效的治疗方法。     

冠状动脉旁路移植术前13N-NH3/18F-FDG PET显像检测冬眠心肌的临床研究

目的 探讨PET/CT检测冬眠心肌数量预测伴有心功能不全的冠状动脉粥样硬化性心脏病（以下简称冠心病）患者冠状动脉旁路移植术（CABG）后左心室射血分数（LVEF）改善的价值并寻找与心脏主要不良事件（MACE）相关的影响因素。方法 收集46例LVEF严重减低（≤ 40%）且接受CABG的冠心病患者,术前均接受超声心动图检查,且行¹³N-NH₃/¹⁸F-FDG PET/CT心肌灌注-代谢显像评估冬眠心肌数量,于术后3~32个月复查超声心动图,评价LVEF情况,并追踪MACE发生情况。根据术后LVEF将患者分为LVEF改善组和LVEF未改善组,筛选两组有统计学差异的因素,并以二元Logistic回归分析术后LVEF改善的影响因素;采用ROC曲线确定预测CABG术后LVEF能否改善的冬眠心肌数量的界值;根据随访中发生MACE与否将患者分为两组,分析与MACE发生的相关因素。结果 与LVEF未改善组比较,术后LVEF改善组冬眠心肌数量较多,瘢痕心肌数量较少,患者术前左心室收缩末期容积（LVESV）较小,差异均有统计学意义（P均<0.05）;冬眠心肌数量及术前LVESV是CABG术后影响LVEF改善的独立因子;冬眠心肌预测LVEF改善的界值为21%;与MACE事件发生有关的因素为二尖瓣重度反流。结论 PET/CT检测冬眠心肌数量对预测伴心功能不全冠心病患者CABG后LVEF改善情况具有重要价值。     

卵巢癌脾脏转移瘤18F-FDG PET/CT表现

目的 观察卵巢癌脾脏转移瘤的¹⁸F-FDG PET/CT表现。方法 回顾性分析经病理及临床随访证实的21例卵巢癌脾脏转移瘤患者的¹⁸F-FDG PET/CT表现,分析病灶最大标准摄取值（SUV_max）与最大径的相关性。结果 21例中,17例单发,4例多发,共28个病灶。13个病灶¹⁸F-FDG PET/CT表现为类圆形低密度影,其中9个病灶边界清晰,4个病灶边界不清;4个病灶密度不均匀,内见坏死、囊变,余9个病灶密度均匀。15个病灶表现为类圆形等密度影,边界不清,密度均匀。28个病灶均呈¹⁸F-FDG高摄取,其中21个病灶¹⁸F-FDG摄取均匀,7个病灶¹⁸F-FDG摄取不均匀。卵巢癌脾脏转移瘤的SUV_max为8.04±3.92,最大径为（2.23±1.02） cm,SUV_max与最大径呈正相关（r=0.687,P<0.001）。21例中,5例肿瘤仅累及脾脏;16例累及其他部位。结论 卵巢癌脾脏转移瘤的¹⁸F-FDG PET/CT表现具有一定特征性。