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  • 1
    Language: English
    In: Radiology, September 2018, Vol.288(3), pp.901-908
    Description: History A 65-year-old woman presented to her primary care physician with a history of progressive abdominal pain mainly in the upper quadrants, nausea, and edema in the bilateral symmetric lower extremities. Other symptoms and use of medication or related drugs were denied. Physical examination findings were normal. The serum lactate dehydrogenase level was 302 U/L (5.04 μkat/L) (reference range, 〈247 U/L [4.12 μkat/L]), and all other laboratory data were within normal ranges. Electrocardiography and chest radiography revealed no abnormalities. The patient underwent contrast material-enhanced (100 mL of iomeprol [400 mg iodine per milliliter], Iomeron; Bracco Imaging) CT of the chest, abdomen, and pelvis; dynamic contrast-enhanced (13 mL of gadobenate dimeglumine, Multihance; Bracco Imaging) MRI of the chest and abdomen; and transthoracic echocardiography and cavography for further evaluation.
    Keywords: Leiomyosarcoma -- Diagnostic Imaging ; Vascular Neoplasms -- Diagnostic Imaging ; Vena Cava, Inferior -- Diagnostic Imaging
    ISSN: 00338419
    E-ISSN: 1527-1315
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  • 2
    Language: English
    In: Radiology, May 2018, Vol.287(2), pp.715-718
    ISSN: 00338419
    E-ISSN: 1527-1315
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  • 3
    Language: English
    In: World journal of gastroenterology, 14 March 2011, Vol.17(10), pp.1267-75
    Description: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology, Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.
    Keywords: Hepatocellular Carcinoma ; Portal ; Shunt ; Thrombosis ; Transarterial Chemoembolization ; Anastomosis, Surgical ; Carcinoma, Hepatocellular -- Therapy ; Chemoembolization, Therapeutic -- Adverse Effects ; Liver Neoplasms -- Therapy ; Portal Vein -- Pathology ; Venous Thrombosis -- Etiology
    ISSN: 10079327
    E-ISSN: 2219-2840
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  • 4
    In: International Journal of Cancer, 01 March 2014, Vol.134(5), pp.1225-1231
    Description: The aims of the study were to evaluate therapeutic efficacy and to determine the prognostic factors for treatment success in patients with liver metastases from colorectal cancer (CRC) treated with transarterial chemoembolization (TACE). A total of 564 patients (mean age, 60.3 years) with liver metastases of CRC were repeatedly treated with TACE. In total, 3,384 TACE procedures were performed (mean, six sessions per patient). The local chemotherapy protocol consisted of mitomycin C alone (43.1%), mitomycin C with gemcitabine (27.1%), mitomycin C with irinotecan (15.6%) or mitomycin C with irinotecan and cisplatin (15.6%). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated using magnetic resonance imaging or computed tomography. The change in tumor size was calculated and the response was evaluated according to the RECIST‐Criteria. Survival rates were calculated according to the Kaplan–Meier method. Prognostic factors for patient's survival were evaluated using log‐rank test. Evaluation of local tumor control showed partial response in 16.7%, stable disease in 48.2% and progressive disease in 16.7%. The 1‐year survival rate after chemoembolization was 62%, the 2‐year survival rate was 28% and the 3‐year survival rate was 7%. Median survival from the start of chemoembolization treatment was 14.3 months. The indication ( = 0.001) and initial tumor response ( = 0.015) were statistically significant factors for patient's survival. TACE is a minimally invasive therapy option for controlling local metastases and improving survival time in patients with hepatic metastases from CRC. TN stage, extrahepatic metastases, number of lesions, tumor location within the liver and choice of chemotherapy protocol of TACE are none significant factors for patient's survival. What's new? About two‐thirds of colorectal cancer patients develop life‐threatening liver metastases, for which the only potentially curative therapy is resection. But only a small proportion of patients are candidates for resection, and those who undergo resection may suffer from intrahepatic recurrence. Here, transarterial chemoembolization (TACE), a minimally invasive procedure, was explored for colorectal cancer liver metastases. TACE was performed repeatedly for each of more than 560 patients. Following treatment, 48.2 percent of patients had stable disease, and the 1‐year survival rate was 62 percent. Initial tumor response was a significant prognostic factor for patient survival after TACE.
    Keywords: Chemoembolization ; Liver Metastases ; Colorectal Cancer
    ISSN: 0020-7136
    E-ISSN: 1097-0215
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  • 5
    Language: English
    In: Imaging in Medicine, Oct, 2012, Vol.4(5), p.505(9)
    Description: Aims: To evaluate the radiation dose and image quality of an adult cone-beam CT (CBCT) with oil-based (OBC) and water-soluble contrast (WSC) material. Materials Methods: A total of 44 patients, range: 46-82 years, (male:female - 26:18) who underwent CBCT examination during transarterial chemoembolization. Each patient received two CBCT scans; energy used: 94.4 #177; 4.75 kV (mean #177; standard deviation), current: 424 #177; 132 mA for WSC and 94.5 #177; 4.7 kV, 423.5 #177; 132 mA for OBC. The volume of WSC material injected was 12 ml and OBC was 4 ml. Results: WSC examination showed significantly (p 0.05) decreased (5.83%) dose-area product compared with OBC. Hounsfield unit, noise, signal-noise ratio and contrast-noise ratio was higher for OBC (49.4, 19.44, 38 and 58%, respectively) compared with WSC (p 0.05). Qualitative assessment of WSC data (median: 2, interquartile range: 1.5-2.5) showed higher image quality compared with OBC data (2.7, interquartile range: 2.3-3.9). Conclusion: A detectable reduction of radiation dose was achieved with WSC compared with OBC in CBCT imaging. Quantitative image-quality parameters reflect higher values for OBC compared with WSC in the liver parenchyma. Subjective analysis showed an exactly opposite result due to the streak artifacts from OBC material.
    Keywords: Angiography -- Usage ; Radiotherapy -- Dosage And Administration ; Liver Tumors -- Care And Treatment ; Liver Tumors -- Diagnosis ; Contrast Media (Chemicals) -- Usage
    ISSN: 1755-5191
    E-ISSN: 17555205
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  • 6
    In: Circulation, 2015, Vol.132(20), pp.1931-1936
    Keywords: Medicine ; Anatomy & Physiology;
    ISSN: 0009-7322
    E-ISSN: 15244539
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  • 7
    Language: English
    In: World journal of radiology, 28 June 2010, Vol.2(6), pp.224-9
    Description: In this review, the gold standard imaging techniques for the head and neck and the latest upcoming techniques are presented, by comparing computed tomography (CT), magnetic resonance imaging and positron emission tomography-CT, as well as ultrasound, depending on the examined area. The advantages and disadvantages of each examination protocol are presented. This article illustrates the connection between the imaging technique and the examined area. Therefore, the head and neck area is divided into different sections such as bony structures, nervous system, mucous membranes and squamous epithelium, glandular tissue, and lymphatic tissue and vessels. Finally, the latest techniques in the field of head and neck imaging such as multidetector CT, dual-energy CT, flash CT, magnetic resonance angiography, spectroscopy, and diffusion tensor tractography using 3 tesla magnetic resonance are discussed.
    Keywords: Bones ; Computed Tomography ; Head and Neck ; Magnetic Resonance Imaging ; Positron Emission Tomography ; Tumors
    E-ISSN: 1949-8470
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  • 8
    In: Spine, 2013, Vol.38(20), pp.1730-1736
    Description: STUDY DESIGN.: A novel randomized, controlled, unblinded clinical trial comparing 2 procedural interventions for painful osteoporotic vertebral compression fractures. OBJECTIVE.: The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly biased cement flow and vertebroplasty. The secondary study objective was to compare adjacent level fracture rates and vertebral body height for these 2 intervention methods. SUMMARY OF BACKGROUND DATA.: Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures. Uncontrolled cement flow in the posterior direction can result in leakage into the vertebral veins or spinal canal, leading to potentially serious clinical complications. METHODS.: Seventy-seven patients with painful osteoporotic vertebral compression fractures were enrolled. Patients were randomized 2:1 for treatment with CDKS (49 patients, 65 levels) or vertebroplasty (28 patients, 39 levels). Cement leakage was evaluated from radiographs and computed tomographic scans. Three- and 12-month follow-ups included additional radiographs and computed tomographic scans to assess changes in vertebral body height and the incidence of new fractures. RESULTS.: Treatment with CDKS significantly reduced the number of levels with leaks and the total number of leaks per level, as compared with vertebroplasty (P = 0.0132 and P = 0.0012, respectively). Significantly, fewer lateral cortical and spinal canal leaks (posterior leaks) occurred in the CDKS group (P = 0.0050, P = 0.02260, respectively). Three adjacent level fractures occurred in the vertebroplasty group, as compared with 2 in the CDKS group. Vertebral body height maintenance was equivalent. CONCLUSION.: Cement directed kyphoplasty effectively reduces posterior cement leakage, reducing the risk of leakage related complications.Level of Evidence: 2
    Keywords: Aged–Adverse Effects ; Aged, 80 and Over–Therapeutic Use ; Bone Cements–Diagnostic Imaging ; Extravasation of Diagnostic and Therapeutic Materials–Etiology ; Female–Surgery ; Follow-Up Studies–Adverse Effects ; Fractures, Compression–Methods ; Humans–Surgery ; Kyphoplasty–Diagnostic Imaging ; Male–Etiology ; Middle Aged–Surgery ; Osteoporotic Fractures–Diagnostic Imaging ; Postoperative Complications–Surgery ; Prospective Studies–Adverse Effects ; Spinal Fractures–Methods ; Spine–Methods ; Tomography, X-Ray Computed–Methods ; Treatment Outcome–Methods ; Vertebroplasty–Methods ; Bone Cements;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 9
    Language: English
    In: BioMed Research International, 2014
    Description: This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings.
    Keywords: Magnetic Resonance Imaging – Methods ; Rheumatoid Arthritis – Care and Treatment ; Temporomandibular Joint Disorders – Diagnosis
    ISSN: 2314-6133
    Source: Cengage Learning, Inc.
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  • 10
    Language: English
    In: European Journal of Radiology, 2011, Vol.80(2), pp.612-619
    Description: The purpose of this study was to evaluate image fusion in dual energy computed tomography for detecting various anatomic structures based on the effect on contrast enhancement, contrast-to-noise ratio, signal-to-noise ratio and image quality. Forty patients underwent a CT neck with dual energy mode (DECT under a Somatom Definition flash Dual Source CT scanner (Siemens, Forchheim, Germany)). Tube voltage: 80-kV and Sn140-kV; tube current: 110 and 290 mA s; collimation-2 × 32 × 0.6 mm. Raw data were reconstructed using a soft convolution kernel (D30f). Fused images were calculated using a spectrum of weighting factors (0.0, 0.3, 0.6 0.8 and 1.0) generating different ratios between the 80- and Sn140-kV images (e.g. factor 0.6 corresponds to 60% of their information from the 80-kV image, and 40% from the Sn140-kV image). CT values and SNRs measured in the ascending aorta, thyroid gland, fat, muscle, CSF, spinal cord, bone marrow and brain. In addition, CNR values calculated for aorta, thyroid, muscle and brain. Subjective image quality evaluated using a 5-point grading scale. Results compared using paired -tests and nonparametric-paired Wilcoxon–Wilcox-test. Statistically significant increases in mean CT values noted in anatomic structures when increasing weighting factors used (all ≤ 0.001). For example, mean CT values derived from the contrast enhanced aorta were 149.2 ± 12.8 Hounsfield Units (HU), 204.8 ± 14.4 HU, 267.5 ± 18.6 HU, 311.9 ± 22.3 HU, 347.3 ± 24.7 HU, when the weighting factors 0.0, 0.3, 0.6, 0.8 and 1.0 were used. The highest SNR and CNR values were found in materials when the weighting factor 0.6 used. The difference CNR between the weighting factors 0.6 and 0.3 was statistically significant in the contrast enhanced aorta and thyroid gland ( = 0.012 and = 0.016, respectively). Visual image assessment for image quality showed the highest score for the data reconstructed using the weighting factor 0.6. Different fusion factors used to create images in DECT cause statistically significant differences in CT value, SNR, CNR and image quality. Best results obtained using the weighting factor 0.6 for all anatomic structures used in this study.
    Keywords: Contrast to Noise Ratio (Cnr) ; Image Quality ; Dual Source CT (Dsct) ; Dual Energy Fusion ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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