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1.
Volumetric and functional evaluation of the gluteus maximus muscle after augmentation gluteoplasty using silicone implants.
Serra, F, Aboudib, JH, Neto, JIS, Cossich, VRA, Rodrigues, NCP, de Oliveira, KF, Marques, RG
Plastic and reconstructive surgery. 2015;(3):533e-541e
Abstract
BACKGROUND The gluteal muscles have been very important throughout the evolution of mankind for the adoption of the bipedal posture. Over the past 15 years, the intramuscular technique has become popular and has been improved, with enhanced results and reduced levels of postoperative complications. The insertion of gluteal implants within the musculature may be an intrinsic compression factor of these muscles. The objective of the present study was to evaluate the gluteus maximus function and its variation over a 12-month period after the insertion of the implant. METHODS This was a prospective, controlled, clinical study. All subjects were female patients, with anthropometric characteristics and body mass index within preset limits to establish similar groups. Isokinetic test gluteus computed tomographic scans and clinical nutritional assessment were conducted in four stages during the study period: preoperatively and 3, 6, and 12 months after surgery. RESULTS The study group presented 6.14 percent muscle atrophy to the left and 6.43 percent muscle atrophy to the right after the procedure. Muscle strength presented differences in hip flexion and adduction tests. CONCLUSIONS The gluteus maximus muscle presents atrophy secondarily to gluteal augmentation surgery with implants. Variations in gluteus maximus muscle strength should not be attributed primarily to the surgical procedure or to the implants; physiologic and multifactorial variations should also be considered. Strength and volume variations did not show a significant correlation. Gluteal augmentation with implants was effective in improving the waist-to-hip ratio and in changing the anthropometric pattern from android to gynoid. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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2.
Fluctuations in eGFR in relation to unenhanced and enhanced MRI and CT outpatients.
Azzouz, M, Rømsing, J, Thomsen, HS
European journal of radiology. 2014;(6):886-892
Abstract
OBJECTIVE To study fluctuations in estimated glomerular filtration rate (eGFR) in relation to contrast medium (CM) enhanced magnetic resonance imaging (MRI) and computed tomography (CT) compared to control groups in outpatients. MATERIALS AND METHODS eGFR was determined right before the imaging procedure and three days later at the department or at the patient's home. The iodine-based and gadolinium-based contrast media were the same as used for all other examinations at the department. RESULTS A total of 716 patients completed the study. There was a statistically significant, but not clinically relevant rise in eGFR after three days in all four groups. The average eGFR variation was 4.8 ml/min/1.73 m(2). There were large variations in eGFR between the two measurements in 45.8% of the patients as they had a change greater than ± 10 ml/min/1.73 m(2). Only three patients fulfilled the contrast-induced nephropathy (CIN) requirement when the definition s-creatinine ≥ 44 μmol/l (0.5mg/dl) was used. CONCLUSIONS eGFR in outpatients undergoing MRI or CT did vary independently of whether the patient received contrast or not. The findings probably reflect the natural variations in s-creatinine levels. This should be taken into consideration when CIN is studied.
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3.
Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study.
Morbelli, S, Ghigliotti, G, Spinella, G, Marini, C, Bossert, I, Cimmino, M, Pane, B, Rousas, N, Cittadini, G, Massollo, M, et al
The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of.... 2014;(3):299-309
Abstract
AIM: The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. METHODS Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. RESULT FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes' count (P<0.02). Carotid metabolism was directly correlated with monocytes' count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). CONCLUSION The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.
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4.
Imaging the early response to chemotherapy in advanced lung cancer with diffusion-weighted magnetic resonance imaging compared to fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography.
Tsuchida, T, Morikawa, M, Demura, Y, Umeda, Y, Okazawa, H, Kimura, H
Journal of magnetic resonance imaging : JMRI. 2013;(1):80-8
Abstract
PURPOSE To evaluate the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) for assessment of the early response to chemotherapy and outcome in patients with advanced lung cancer through comparison with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT). MATERIALS AND METHODS Twenty-eight lung cancer patients underwent DW-MRI, FDG-PET, and CT before and after one course of chemotherapy. Changes in the apparent diffusion coefficient (ΔADC), the mean standardized uptake value (ΔSUV), and the maximum diameter (ΔMD) were measured and compared. According to the response evaluation criteria, patients were divided into two groups, responders and nonresponders, and progression-free survival (PFS) and overall survival (OS) were estimated. RESULTS The relationship between ΔADC and ΔSUV had the highest correlation coefficient. A cutoff value of ΔADC between responders and nonresponders was estimated as 21.5%. PFS and OS between responders and nonresponders were significantly different on DW-MRI (PFS, P = 0.012; OS, P = 0.006) and on FDG-PET (PFS, P = 0.017; OS, P = 0.036), but not on CT (PFS, P = 0.105; OS, P = 0.051). CONCLUSION DW-MRI can be used to predict prognosis in patients with advanced lung cancer.
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5.
Iodine-131 SPET/CT and 18F-FDG PET/CT for the identification and localization of mediastinal lymph node metastases from differentiated thyroid carcinoma.
Xu, YH, Shen, CT, Xue, YL, Qiu, ZL, Luo, QY
Hellenic journal of nuclear medicine. 2013;(3):199-203
Abstract
Mediastinal lymph node metastases (MLNM) from differentiated thyroid carcinoma (DTC) are considered difficult to diagnose. The aim of this study was to assess the value of iodine-131 (131I) single photon emission tomography/computed tomography (SPET/CT) and of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for the diagnosis of MLNM from DTC. Five hundred and eleven consecutive patients operated for DTC and treated with 131I for ablation of the remnant thyroid and/or for treatment of metastases were enrolled in the study and underwent an 131I whole body scan (131I-WBS). Thirty seven sites of increased 131I uptake, on the 131I-WBS that could be an indication for MLNM were re-evaluated by a 131I-SPET/CT scan. Thirty four other patients with negative 131I-WBS but having elevated serum thyroglobulin (Tg), were examined by 18F-FDG PET/CT to possibly diagnose MLNM. A total of 44 DTC patients with MLNM were identified, among the above 37 and 34 cases: 25/37 (67.6%) cases were examined and identified by 131I-SPET/CT and 19/34 (55.9%) cases by 18F-FDG PET/CT. A total of 25 and 19 cases were identified. The male-to-female ratio and the average age in patients with 18F-FDG-avid MLNM were significantly higher than in patients with 131I-avid MLNM. Among the above 44 patients, 40 patients had superior mediastinal nodal metastases, 9 had aortic nodal metastases and only 1 inferior mediastinal nodal metastases. A patient could have metastases in more than one site. In conclusion, our study suggests that in 511 operated DTC patients, treated for remnant ablation and/or for metastases and examined by 131I-WBS, there were 37 cases doubtful of having MLNM in the 131I-WBS and 34 cases doubtful, because of negative 131I-WBS and elevated Tg. The 131I-SPET/CT scan was sensitive for detecting MLNM in 25 of the 37 cases and the 18F-FDG PET/CT in 19 of the 34 cases. These hybrid imaging modalities, when applied as above, were suitable for detecting more MLNM and thus, better supporting treatment planning in these DTC patients.
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6.
Advanced Hepatocellular Carcinoma: early evaluation of response to targeted therapy and prognostic value of Perfusion CT and Dynamic Contrast Enhanced-Ultrasound. Preliminary results.
Frampas, E, Lassau, N, Zappa, M, Vullierme, MP, Koscielny, S, Vilgrain, V
European journal of radiology. 2013;(5):e205-11
Abstract
PURPOSE To investigate whether there is any correlation between standard endpoints and tumor perfusion measurements with Perfusion CT and Dynamic Contrast-Enhanced Ultrasonography (DCE-US) in patients with advanced Hepatocellular Carcinoma (HCC) treated with targeted therapy. MATERIALS AND METHODS Nineteen patients were evaluated during targeted therapy (sorafenib n=16, sunitinib n=3). Changes in tumor perfusion measurements between baseline and month 1 were assessed and compared using RECIST progression criteria at month 2. RESULTS Median time to progression according to RECIST was 117 days and median time to death was 208 days. Perfusion CT values before treatment were significantly increased in HCC compared to the surrounding liver (n=17, P<.02). Eleven patients received complete examinations with both techniques at baseline and month 1. A non-significant decrease was found in all Perfusion CT values between RECIST nonprogressors (n=7) and progressors (n=4): mean Blood Volume: -27.9 vs. -11.1% and mean Blood Flow: -25.0 vs. -11.7% respectively. With DCE-US, opposite changes were found (mean Area Under the Curve AUC: -38.3 vs. 436.3%). RECIST progression at month 2 was significantly correlated with a threshold 40% decrease in AUC (P=.015). None of the patients with a decrease in AUC≥40% was a progressor at month 2. CONCLUSION Despite perfusion changes with both Perfusion CT and DCE-US in patients receiving treatment, only DCE-US at month 1 (with a decrease in the AUC of more than 40%) predicted non-progression at month 2 and may be a potential surrogate marker of tumor response during targeted therapy.
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7.
N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency department.
Hsu, TF, Huang, MK, Yu, SH, Yen, DH, Kao, WF, Chen, YC, Huang, MS
Internal medicine (Tokyo, Japan). 2012;(19):2709-14
Abstract
OBJECTIVE To evaluate the use of N-acetylcysteine (NAC), a potent antioxidant, to prevent contrast-induced nephropathy (CIN). METHODS We prospectively studied 209 patients (106 in the NAC group and 103 in the control group) who received contrast-enhanced computed tomography (CECT) in the emergency department (ED). The NAC group received intravenous NAC (600 mg) before CECT imaging to prevent CIN. Both the NAC and control groups were treated using a standardized hydration strategy, where clinically feasible. RESULTS The patients' mean age was 79.6±9.8 years. The prevalence of hypertension, diabetes, and chronic kidney disease (CKD) were 63.2%, 27.3%, and 21.5%, respectively. The baseline clinical characteristics were similar between the two groups except for their body weight (p=0.011), amount of contrast material administered (p=0.049) and prevalence of CKD (p=0.002). The incidence of CIN was 7.5% in the NAC group and 14.6% in the control group. The adjusted odds ratio was 0.305 (95% confidence interval: 0.097 to 0.960, p=0.042). All-cause mortality was 7.5% in the NAC group and 12.6% in the control group, which was not significantly different. Temporary hemodialysis was required in 0% of subjects in the NAC group and 1.0% in the control group, which was not a statistically significant difference. CONCLUSION A single dose of NAC before CECT imaging can prevent CIN in an ED setting. However, it does not improve the mortality rate or the need for dialysis.
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8.
Optimal dose of contrast medium for depiction of hypervascular HCC on dynamic MDCT.
Fujigai, T, Kumano, S, Okada, M, Hyodo, T, Imaoka, I, Yagyu, Y, Ashikaga, R, Ishii, K, Murakami, T
European journal of radiology. 2012;(11):2978-83
Abstract
PURPOSE The purpose of this study is to prospectively investigate the optimal dose of contrast medium for the depiction of hypervascular hepatocellular carcinoma (HCC) during the hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) of dynamic MDCT. MATERIALS AND METHODS The study included 128 patients, out of these patients, 36 patients were found to have 56 hypervascular HCCs. Sixty-three patients were assigned to receive a dose of 525 mgI/kg with protocol A, and 62 received a dose of 630 mgI/kg with protocol B. Measurements of the attenuation values of the abdominal aorta, portal vein, hepatic vein, hepatic parenchyma and HCC during the HAP, PVP and DP were taken. Tumor-liver contrast (TLC) was calculated from the attenuation value of the hepatic parenchyma and HCC. RESULTS The aortic attenuation value with protocol B (351, 166, and 132 HU) was significantly higher than that with protocol A (313, 153, and 120 HU) during all the phases, (P<0.01 for all phases). The hepatic enhancement from unenhanced baseline with protocol B (25.2, 63.6, 50.6 HU) was significantly higher than that with protocol A (20.2, 55.1 and 43.0 HU) during all the phases, (P<0.01 for all phases). The TLC with protocol B (37.4, -11.8 and -13.6 HU) was significantly higher than that with protocol A (28.0, -9.8 and -12.1 HU) during HAP (P=0.042). CONCLUSION The administration of 630 mgI/kg of body weight depicts hypervascular HCC more clearly during HAP and shows sufficient hepatic enhancement of 50 HU during DP.
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9.
Metastatic renal carcinoma: evaluation of antiangiogenic therapy with dynamic contrast-enhanced CT.
Fournier, LS, Oudard, S, Thiam, R, Trinquart, L, Banu, E, Medioni, J, Balvay, D, Chatellier, G, Frija, G, Cuenod, CA
Radiology. 2010;(2):511-8
Abstract
PURPOSE To determine whether tumor perfusion parameters assessed by using dynamic contrast material-enhanced computed tomography (CT) could help predict and detect response in patients receiving antiangiogenic therapy for metastatic renal cell carcinoma. MATERIALS AND METHODS Institutional ethics committee approval and informed consent were obtained. In two phase-III trials involving 51 patients with metastatic renal cell carcinoma (38 men, 13 women; age range, 30-80 years) receiving antiangiogenic drugs (sorafenib [n = 10], sunitinib [n = 22]), a placebo (n = 12), or interferon alfa (n = 7), serial dynamic contrast-enhanced CT was performed, during 90 seconds before and after injection of 80 mL of iobitridol. Perfusion parameters of a target metastatic tumor (tumor blood flow [TBF], tumor blood volume [TBV], mean transit time, and vascular permeability-surface area product) were calculated. Values before and after treatment were compared by using a Wilcoxon signed rank test, and relative changes in groups were compared by using the Wilcoxon rank sum test. Results were compared with Response Evaluation Criteria in Solid Tumors response and with progression-free and overall survival by using Kaplan-Meier curves. RESULTS Among patients receiving antiangiogenic drugs, baseline perfusion parameters were higher in responders than in stable patients (TBF = 245.3 vs 119.5 mL/min/100 mL, P = .04; TBV = 15.5 vs 8.2 mL/100 mL, P = .02) but were not significantly predictive of survival. After the first cycle of treatment, there was a significant decrease in TBF (162.5 vs 76.7 mL/min/100 mL, P = .0002) and TBV (9.1 vs 3.9 mL/100 mL, P < .0001) in patients receiving antiangiogenic treatment. CONCLUSION Renal carcinoma perfusion parameters determined with dynamic contrast-enhanced CT can help predict biologic response to antiangiogenic drugs before beginning therapy and help detect an effect after a single cycle of treatment.
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10.
Contrast-enhanced ultrasound versus computed tomographic angiography for surveillance of endovascular abdominal aortic aneurysm repair.
Ten Bosch, JA, Rouwet, EV, Peters, CT, Jansen, L, Verhagen, HJ, Prins, MH, Teijink, JA
Journal of vascular and interventional radiology : JVIR. 2010;(5):638-43
Abstract
PURPOSE To compare diagnostic accuracy between contrast-enhanced ultrasound (US) and computed tomographic (CT) angiography to detect changes in abdominal aortic aneurysm (AAA) size and endoleaks during follow-up after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS Between May 2006 and December 2008, 83 patients were consecutively enrolled for contrast-enhanced US and CT angiography imaging during surveillance after EVAR, yielding 127 paired examinations. Comparative analysis was performed for the anteroposterior and transverse maximal diameters of the aneurysm sac and for the presence or absence of endoleak, as determined by US and CT angiography. RESULTS Contrast-enhanced US demonstrated significantly more endoleaks, predominantly of type II, compared with CT angiography (53% vs 22% of cases). The number of observed agreements was 77 of 127 (61%), indicating a low level of agreement (kappa value of 0.237). US was as accurate as CT angiography in the assessment of maximal aneurysm sac diameters, as shown by Bland-Altman analyses and low coefficients of variation (8.0% and 8.6%, respectively). The interobserver variability for AAA size measurement by US was low, given the interclass correlation coefficients of 0.99 and 0.98 for anteroposterior and transverse maximal diameters, respectively. CONCLUSIONS Contrast-enhanced US may be an alternative to CT angiography in the follow-up of patients after EVAR. As US reduces exposure to the biologic hazards associated with lifelong annual CT angiography, including cumulative radiation dose and nephrotoxic contrast agent load, contrast-enhanced US might be considered as a substitute for CT angiography in the surveillance of patients after EVAR.