Endometrióza postihuje přibližně 10 % žen ve fertilním věku a její hluboká infiltrující forma způsobuje závažné důsledky na plodnost, klinické potíže dle postižených orgánů (močový a trávicí trakt) a bolest, která výrazně ovlivňuje kvalitu života. Resekční výkony na postižených orgánech bývají složité a často si vyžadují multioborový přístup. Resekce v terénu těžké hluboké infiltrující endometriózy je komplikovaná obtížnou identifikací resekční linie. I když jsme schopni většinu resekčních výkonů provádět laparoskopickým přístupem, pořád jsou zatíženy významným rizikem per- a pooperačních komplikací, z nichž nejzávažnější je vznik rektovaginálních píštělí. Identifikace hranic endometriálního uzlu a zachování vitality tkání je u resekčních výkonů z tohoto pohledu kruciální. Endometriotické uzly na základě patogeneze vzniku léze mají různou vaskularitu, a tím pádem i různé perfuzní vzorce, přičemž vzhledem k charakteru tkáně a stupni vaskularizace má většina hluboko infiltrujících uzlů spíše hypoperfuzní vzor. Prostředek, který by umožňoval cílení (vedení) resekce pomocí sledování perfuze tkání, by mohl mít užitečné terapeutické využití. Takovým prostředkem by mohlo být fluorescenční barvivo indocyaninová zeleň. Cílením resekce pomocí fluorescenčního barviva bychom mohli být schopni managementu orientovaného na patogenezi onemocnění, a tím i šetrnější resekce s menší destrukcí tkání, s redukcí per- a pooperačních komplikací a zároveň zlepšení kvality života pacientek, co se týká bolestivosti, rizika recidivy a zachování fertility.
Endometriosis affects approximately 10% of women of fertile age and its deep infiltrating form causes serious consequences for fertility, clinical problems depending on which organs are affected (urinary and digestive tract) and causes serious pain which seriously impairs quality of life. Resection of the affected tissue tend to be complex and often require multidisciplinary approach. Resection in the field of severe deep infiltrating endometriosis is complicated by the difficulty of resection line identification. Although we are able to perform most of the resections laparoscopically, there is still significant risk of intra and postoperative complications, the most serious of which is the formation of rectovaginal fistulas. Identification of boundaries of the endometrial nodule and preservation of tissue vitality is crucial in resection procedures. Endometriotic nodules, based on the pathogenesis of the lesion, have various vascularity and therefore different perfusion patterns. According to nature of tissue and the degree of vascularization, most deep infiltrating nodules have rather hypoperfusion pattern. A substance that would be able to guide the resection by live monitoring of the tissue perfusion, could have useful therapeutic applications. Such substance could be the fluorescent dye indocyanine green. With resection guidance by fluorescence dye, we could be able of pathogenesis oriented management of the disease and therefore perform more gentle tissue preparation, with less collateral damage, reduction of intra and postoperative complications, and thus improvement of the quality of life of patients in terms of pain, risk of recurrence, and preservation of fertility.
- MeSH
- Endometriosis * surgery MeSH
- Fluorescent Dyes MeSH
- Indocyanine Green * administration & dosage therapeutic use MeSH
- Quality of Life MeSH
- Laparoscopy methods MeSH
- Humans MeSH
- Perfusion Imaging methods MeSH
- Rectovaginal Fistula prevention & control MeSH
- Treatment Outcome MeSH
- Fertility Preservation methods MeSH
- Check Tag
- Humans MeSH
Arterial spin labeling (ASL) je neinvazivní metoda MR využívaná k zobrazení mozkové perfuze. S rostoucími obavami týkajícími se používání kontrastních látek obsahujících gadolinium a zároveň významnými technickými pokroky v implementaci ASL se tato metoda stává středem zájmu různých diagnostických aplikací. V přehledovém článku se zaměřujeme na seznámení čtenářů se základy implementace sekvence ASL v neuroradiologii, diskutujeme optimální parametry skenování pro dosažení nejlepší kvality a přesnosti interpretace dat a poskytujeme přehled diagnostických aplikací v oblastech cerebrovaskulárních onemocnění, neuroonkologie, epilepsie a neurodegenerace. Kromě toho představujeme ukázkové radiologické případy a komentujeme potenciální budoucí vývoj neinvazivních ASL metod.
Arterial spin labeling (ASL) is a non-invasive MRI method used to image cerebral perfusion. Given increasing concerns regarding the use of gadolinium-based contrast agents and significant technical advancements in ASL implementation, the method is gaining attention in various diagnostic applications. This review article aims to familiarize readers with the fundamentals of ASL sequence implementation in neuroradiology, discuss optimal scanning parameters for achieving the highest quality and accuracy in data interpretation, and provide an overview of its diagnostic applications in the areas of cerebrovascular diseases, neuro-oncology, epilepsy, and neurodegeneration. Furthermore, we present illustrative radiological cases and explore the potential future developments of non-invasive ASL techniques.
- MeSH
- Cerebral Arteries diagnostic imaging MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Cerebral Angiography MeSH
- Cerebrovascular Circulation MeSH
- Neuroimaging * methods MeSH
- Perfusion Imaging * methods MeSH
- Spin Labels MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Practice Guideline MeSH
Effective burn scar treatment requires objective measurement of burn severity and progression, and 3D scanning technologies could offer a valuable alternative to the current clinical assessments. This article discusses the use of 3D scanning to determine the area and extent of burns. The study involves a comparison of twelve burns in six patients using two CAD software. The article deals with the methodology of scanning burns, and subsequently describes in detail the methodology of determining the area of burns from a 3D scan. Methodologies for burn scanning and determining burn area from 3D scans were detailed, emphasizing the innovation's potential in surpassing traditional assessment methods like the Rule of nine and Palm method estimation. Twelve burns were scanned at least twice, allowing comparison of the burn area before and after a certain period of healing. The study revealed that 3D scanning provides an accurate approach to measuring burn areas, with minimal differences observed between software. Meshmixer software emerged as the preferred tool due to its intuitive features, underscoring the potential of 3D scanning to improve burn assessment and treatment planning. This approach enables the use of 3D scans to determine individual treatment according to the progression of healing, and at the same time opens up the possibilities of using 3D scans to design burn orthoses.
- Keywords
- zátěž, farmakologická zátěž, indikace, viabilita myokardu, infekce cévních náhrad,
- MeSH
- Blood Vessels diagnostic imaging pathology MeSH
- Radiation Dosage MeSH
- Endocarditis diagnostic imaging MeSH
- Image Interpretation, Computer-Assisted MeSH
- Myocardial Ischemia diagnostic imaging MeSH
- Tomography, Emission-Computed, Single-Photon MeSH
- Cardiac Imaging Techniques classification methods instrumentation MeSH
- Cardiology * methods instrumentation MeSH
- Cardiovascular Infections diagnostic imaging MeSH
- Extremities diagnostic imaging pathology MeSH
- Humans MeSH
- Lymphoscintigraphy MeSH
- Neoplasms diagnostic imaging pathology MeSH
- Vascular Diseases diagnostic imaging pathology MeSH
- Heart Diseases diagnostic imaging classification MeSH
- Nuclear Medicine * methods instrumentation MeSH
- Perfusion Imaging methods MeSH
- Lung diagnostic imaging pathology MeSH
- Positron-Emission Tomography methods nursing MeSH
- Prognosis MeSH
- Radiopharmaceuticals classification MeSH
- Radioisotopes pharmacokinetics MeSH
- Risk MeSH
- Gated Blood-Pool Imaging classification MeSH
- Heart diagnostic imaging physiopathology MeSH
- Vasculitis diagnostic imaging MeSH
- Vasodilator Agents classification MeSH
- Ventilation-Perfusion Scan methods MeSH
- Inflammation diagnostic imaging classification pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
PURPOSE: The aim of the study was to compare the assessment of ischemic changes by expert reading and available automated software for non-contrast CT (NCCT) and CT perfusion on baseline multimodal imaging and demonstrate the accuracy for the final infarct prediction. METHODS: Early ischemic changes were measured by ASPECTS on the baseline neuroimaging of consecutive patients with anterior circulation ischemic stroke. The presence of early ischemic changes was assessed a) on NCCT by two experienced raters, b) on NCCT by e-ASPECTS, and c) visually on derived CT perfusion maps (CBF<30%, Tmax>10s). Accuracy was calculated by comparing presence of final ischemic changes on 24-hour follow-up for each ASPECTS region and expressed as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The subanalysis for patients with successful recanalization was conducted. RESULTS: Of 263 patients, 81 fulfilled inclusion criteria. Median baseline ASPECTS was 9 for all tested modalities. Accuracy was 0.76 for e-ASPECTS, 0.79 for consensus, 0.82 for CBF<30%, 0.80 for Tmax>10s. e-ASPECTS, consensus, CBF<30%, and Tmax>10s had sensitivity 0.41, 0.46, 0.49, 0.57, respectively; specificity 0.91, 0.93, 0.95, 0.91, respectively; PPV 0.66, 0.75, 0.82, 0.73, respectively; NPV 0.78, 0.80, 0.82, 0.83, respectively. Results did not differ in patients with and without successful recanalization. CONCLUSION: This study demonstrated high accuracy for the assessment of ischemic changes by different CT modalities with the best accuracy for CBF<30% and Tmax>10s. The use of automated software has a potential to improve the detection of ischemic changes.
- MeSH
- Early Diagnosis MeSH
- Time Factors MeSH
- Stroke diagnostic imaging physiopathology therapy MeSH
- Adult MeSH
- Brain Ischemia diagnostic imaging physiopathology therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Cerebrovascular Circulation * MeSH
- Perfusion Imaging methods MeSH
- Tomography, X-Ray Computed * MeSH
- Predictive Value of Tests MeSH
- Prognosis MeSH
- Radiographic Image Interpretation, Computer-Assisted * MeSH
- Reproducibility of Results MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Software * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Comparative Study MeSH
Cíl: Prezentovat kazuistiku 78leté pacientky, které byla při plicní scintigrafii detekována hiátová hernie, s důrazem na použití SPECT/CT a aerosolu pro ventilaci. Kazuistika: 78letá polymorbidní pacientka byla v roce 2016 vzhledem k polyvalentní alergii odeslaná na naše oddělení k vyloučení embolie do plicnice. Měla úporný dráždivý kašel s nevelkou hemoptýzou. Provedli jsme scintigrafii plicní perfuze a ventilace. Nález prokázal homogenní perfuzi i ventilaci obou plic bez známek embolie do plicnice či chronické obstrukční plicní nemoci. Jako vedlejší nález jsme díky hybridnímu zobrazení a vyšetření plicní ventilace aerosolem detekovali hiátovou hernii. Pacientka k nám byla opět odeslána v únoru 2019 pro podezření na hlubokou žilní trombózu při otoku pravé DK. V anamnéze měla opakované bolesti svíravého a pálivého charakteru za hrudní kostí s propagací do krku, bez dušnosti, někdy s nauzeou a zvracením. Scintigrafie plicní perfuze prokázala homogenní perfuzi obou plicních křídel, scintigrafie plicní ventilace nebyla indikovaná. Na provedeném LDCT byla stále přítomná hiátová hernie, vzhledem k absenci ventilační scintigrafie však snadno přehlédnutelná. Závěr: Naše kazuistika upozorňuje na možnost detekce hiátové hernie jako alternativní diagnózy při plicní scintigrafii, která je snadná díky ventilaci aerosolu a hybridnímu zobrazení. V našem případě může vysvětlit potíže pacientky, které nebyly vysvětleny jinými provedenými metodami.
Aim: To present a case of 78-y-old lady with a hiatal hernia detected during lung scintigraphy with emphasis of using SPECT/CT for imaging and aerosol for ventilation. Case report: 78-y-old polymorbid female patient was sent to our department because of polyvalent allergy to exclude pulmonary embolism. She suffered from a persistent irritating cough with a small hemoptysis. We performed a ventilation and a perfusion lung scan. Both perfusion and ventilation of both lungs were homogenous. Hiatal hernia was detected as an incidental finding thanks to hybrid imaging and a use of aerosol for the ventilation scan. She was sent to our department once more due to a suspicion of a deep venous thrombosis with an edema of right lower extremity in April 2019. There were a repetitive oppressive and a fiery chest pain propagating to the neck, without dyspnea, sometimes with a nausea and a vomiting. Scintigraphy of a lung perfusion demonstrated a homogenous perfusion of both lungs, ventilation scintigraphy was not indicated. Hiatal hernia was still detected on a low dose CT, however, it can be easily overlooked due to an absence of a ventilation scan. Conclusion: Our case report brings attention to a possibility to detect a hiatal hernia as an alternative diagnosis during lung scanning. It was made possible thanks to a hybrid imaging and a use of an aerosol for a ventilation scan. At this case, it can explain patient symptoms which were not explained by other performed procedures.
- MeSH
- Chest Pain diagnostic imaging etiology MeSH
- Hernia, Hiatal * diagnostic imaging MeSH
- Humans MeSH
- Perfusion Imaging methods MeSH
- Aged, 80 and over MeSH
- Single Photon Emission Computed Tomography Computed Tomography * methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: In randomized clinical trials, mechanical thrombectomy (MT) was proved to be a highly effective treatment of acute ischemic stroke which improved clinical outcomes. Some of the trials used automated computed tomography perfusion (CTP) analysis for selection of participants. We present a single-center experience with CTP selection and comparison with CTP trials. METHODS: Data of consecutive MT patients (from January 2016 to December 2017) were retrospectively reviewed. All patients with multiphase CT angiography confirmed the presence of anterior circulation large vessel occlusion/s in the intracranial internal carotid artery and/or middle cerebral artery (M1 or M2) and with admission brain CTP analyzed by RAPID software were included into the analysis. RESULTS: Sixty-two patients fulfilled the inclusion criteria (mean age was 70.1 ± 13.6 years, females 48.5%). At baseline, National Institutes of Health Stroke Scale score was 16 (IQR = 13-20), Alberta Stroke Program Early CT Score (ASPECTS) was 8 (IQR = 7-9), CTP core volume was 20 mL (IQR = 2-36), and CTP penumbra volume was 145.5 mL (IQR = 107-184). Time from stroke onset to imaging was 1 hour 32 minutes, time from stroke onset to reperfusion was 3 hours 50 minutes, and median time from CT to reperfusion was 1 hour 56 minutes. Modified thrombolysis in cerebral infarction 2b/3 was achieved in 42 patients (67.7%). Twenty-three patients (37%) had modified Rankin scale 0-2 at 90 days. CONCLUSIONS: Our analysis of CTP-selected patients for MT supports clinical applicability of automated CTP analysis into everyday clinical practice.
- MeSH
- Stroke diagnostic imaging physiopathology surgery MeSH
- Computed Tomography Angiography methods MeSH
- Brain Ischemia diagnostic imaging physiopathology surgery MeSH
- Clinical Decision-Making * MeSH
- Clinical Trials as Topic methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Cerebrovascular Circulation * MeSH
- Perfusion Imaging methods MeSH
- Disability Evaluation MeSH
- Predictive Value of Tests MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Thrombectomy methods MeSH
- Patient Selection * MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Výpočetní tomografie (CT) mozku představuje nejrozšířenější a nejvíce využívanou zobrazovací metodu v rámci akutní (cévní) neurologie. Nativní CT mozku, CT angiografie mozkových tepen od oblouku aorty a CT perfuzní vyšetření plní v rámci diagnostiky a terapie akutního mozkového infarktu důležitou úlohu komplementární ke klinickému vyšetření a anamnestickým údajům. Cílem tohoto článku je podat souhrnný a stručný přehled o jednotlivých CT zobrazovacích modalitách nezbytných pro běžnou klinickou praxi u pacientů s podezřením na cévní mozkovou příhodu.
Brain computed tomography (CT) is the most widely used and widespread imaging method in acute (vascular) neurology. Non-contrastbrain CT, CT angiography, and CT perfusion represent important imaging tools, complementary to clinical examination andpatients history, helping in diagnosis and decision-making on subsequent therapy. The main aim of this article is to summarizeCT imaging modalities, which are used in routine clinical practise.
- Keywords
- ASPECT skóre,
- MeSH
- Time Factors MeSH
- Stroke * diagnostic imaging diagnosis surgery MeSH
- Computed Tomography Angiography utilization MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Perfusion Imaging methods utilization MeSH
- Tomography, X-Ray Computed * classification utilization MeSH
- Thrombectomy MeSH
- Thrombolytic Therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
The last eight survivors of 80 workers accidentally exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) during production of herbicides based on trichlorophenoxyacetic acid in 1965-1967 in a chemical factory were followed. All were men, mean age 72.4 ± 1.3 years. Their current median TCDD blood level was 112 (46-390) pg/g lipids. Neurological examination revealed central nervous system impairment in all individuals and signs of polyneuropathy in 87.5%, which was confirmed by a nerve conduction study (NCS) in 75%. A Lanthony test demonstrated acquired dyschromatopsia in 87.5% of the patients, with deterioration of mean colour confusion index (CCI) from 1.52 ± 0.39 in 2010 to 1.73 ± 0.41 in 2016. Single-photon emission computer tomography (SPECT) of the brain showed focal reduction of perfusion in various brain locations in all patients and worsening in six patients. Visual-evoked potentials (VEP) was abnormal in 62.6% of individuals. Most patients complained of psychological problems. The neuropsychological test battery showed most positive impairments in the Trail Making Test evaluating processing speed (average level in the range of mild neurocognitive impairment), which correlated with mean CCI (p < 0.05). CONCLUSION: Fifty years after exposure, blood levels of TCDD are still 10 times higher than the general population. NCS, VEP, Lanthony test and SPECT findings deteriorated from examination of these patients in 2004 and in 2010. The total of abnormal tests per patient in 2016 is very high. Minor differences among patients and their reduced count may explain why the number of impairments in 2016 does not correlate with TCDD blood level.
- MeSH
- Time Factors MeSH
- Chemical Industry * MeSH
- Herbicides adverse effects blood chemical synthesis MeSH
- Occupational Health * MeSH
- Tomography, Emission-Computed, Single-Photon MeSH
- Cognition drug effects MeSH
- Humans MeSH
- Brain diagnostic imaging drug effects physiopathology MeSH
- Cerebrovascular Circulation drug effects MeSH
- Neural Conduction drug effects MeSH
- Neurologic Examination MeSH
- Neuropsychological Tests MeSH
- Neurotoxicity Syndromes diagnosis etiology physiopathology psychology MeSH
- Perfusion Imaging methods MeSH
- Polychlorinated Dibenzodioxins adverse effects blood chemical synthesis MeSH
- Polyneuropathies chemically induced diagnosis physiopathology MeSH
- Occupational Exposure adverse effects MeSH
- Accidents, Occupational * MeSH
- Aged MeSH
- Color Vision drug effects MeSH
- Evoked Potentials, Visual drug effects MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Child MeSH
- Cardiovascular Abnormalities diagnostic imaging MeSH
- Humans MeSH
- Lymphoscintigraphy MeSH
- Bone Neoplasms diagnostic imaging MeSH
- Bone Marrow Neoplasms diagnostic imaging MeSH
- Central Nervous System Diseases diagnostic imaging MeSH
- Thyroid Diseases diagnostic imaging MeSH
- Perfusion Imaging methods instrumentation MeSH
- Positron Emission Tomography Computed Tomography methods MeSH
- Lung Diseases diagnostic imaging MeSH
- Positron-Emission Tomography MeSH
- Radiopharmaceuticals administration & dosage pharmacology MeSH
- Radionuclide Imaging * methods instrumentation MeSH
- Splenic Rupture diagnostic imaging MeSH
- Check Tag
- Child MeSH
- Humans MeSH
