RESUMEN
We report a subtype of immune-mediated encephalitis associated with COVID-19, which closely mimics acute-onset sporadic Creutzfeldt-Jakob disease. A 64-year-old man presented with confusion, aphasia, myoclonus, and a silent interstitial pneumonia. He tested positive for SARS-CoV-2. Cognition and myoclonus rapidly deteriorated, EEG evolved to generalized periodic discharges and brain MRI showed multiple cortical DWI hyperintensities. CSF analysis was normal, except for a positive 14-3-3 protein. RT-QuIC analysis was negative. High levels of pro-inflammatory cytokines were present in the CSF and serum. Treatment with steroids and intravenous immunoglobulins produced EEG and clinical improvement, with a good neurological outcome at a 6-month follow-up.
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COVID-19/complicaciones , Encefalitis/etiología , Síndrome de Creutzfeldt-Jakob , Encefalitis/patología , Encefalitis/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2RESUMEN
PURPOSE: Hyperdense artery sign is the earliest sign of ischemic stroke on non-enhanced computed tomography and it can be visible long before parenchymal changes. The aim of our study was to compare diagnostic value of model-based iterative reconstruction algorithm (IMR) with that of iterative reconstruction algorithm (iDose4) in identifying hyperdense artery sign. METHODS: We selected 56 consecutive patients suspected for ischemic stroke, who underwent a NCCT and that demonstrated a vessel occlusion at angio-CT or developed ischemic lesion at follow-up CT. Two readers randomly analyzed images of NCCT reconstructed both with iDose4 (4 mm) and IMR (2 mm), reporting presence of hyperdense artery sign (0: no; 1: yes; 2: not sure). They rated image quality on a 4-point scale (1: unacceptable; 4: more than average) and recorded HU values of clot and of normal vessel and measured noise index, CNR and SNR. RESULTS: Mean values of CTDI, DLP, and ED were respectively of 43 mGy, 819.7 mGy cm, and 1.72 mSv. By analyzing the IMR reconstruction, both readers were able to recognize hyperdense vessel sign in 55/56 patients, while only in 12/56 patients were identified with iDose. IMR obtained better rating of image quality (mean score for IMR 3.32 vs 2.53 for iDose), higher clot density (57.2 vs 46.7 HU), lower noise index (5 vs 2), higher CNR and SNR (respectively 4.2 vs 2 and 16.8 vs 8.5). CONCLUSIONS: Model-based approach significantly increases sensitivity in detecting hyperdense artery sign, offering higher SNR and CNR in brain CT images in comparison with standard hybrid reconstruction algorithm.
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Isquemia Encefálica/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Isquemia Encefálica/patología , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Humanos , Dosis de Radiación , Estudios Retrospectivos , Sensibilidad y Especificidad , Relación Señal-Ruido , Accidente Cerebrovascular/patologíaRESUMEN
BACKGROUND: Aim of the study was to determine the value of perfusion computed tomography in the quantitative assessment of tumour-related neoangiogenesis for the diagnosis and treatment of hepatocellular carcinoma lesions. METHODS: Overall, 47 consecutive patients with cirrhotic liver disease, with a high risk of hepatocellular carcinoma, and undergoing standard surveillance (six-month intervals) were eligible for inclusion in this prospective study; based on Barcelona Clinic Liver Cancer guidelines, 27 patients were enrolled. Perfusion computed tomography was performed in 29 biopsy-proven hepatocellular carcinoma lesions before and after treatment with transarterial chemoembolization or radiofrequency ablation. The dynamic study was performed with a 256-slice multidetector-computed tomography scanner; the following parameters were measured: hepatic perfusion, arterial perfusion, blood volume, hepatic perfusion index, and time-to-peak in all patients. RESULTS: Hepatocellular carcinoma lesions had the following median perfusion values: perfusion 46.3mL/min/100g; blood volume 20.4mL/100mg; arterial perfusion 42.9mL/min; hepatic perfusion index 92.5%; time to peak 18.7s. Significantly lower perfusion values were obtained in correctly treated lesions or surrounding parenchyma than in viable hepatocellular carcinoma tissue. CONCLUSIONS: In hepatocellular carcinoma, perfusion computed tomography could contribute to a non-invasive quantification of tumour blood supply related to the formation of new arterial structures, and enable the assessment of therapeutic response.
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Carcinoma Hepatocelular/diagnóstico por imagen , Ablación por Catéter , Quimioembolización Terapéutica , Neoplasias Hepáticas/diagnóstico por imagen , Hígado/irrigación sanguínea , Tomografía Computarizada Multidetector/métodos , Neovascularización Patológica/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients. MATERIALS AND METHODS: Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50mL of non ionic contrast agent (350mg I/mL) at a flow rate of 6mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI). RESULTS: A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2±6.3; AP 10.4±7; BV 4.05±4.8; TTP 38.9±4.2; HPI 9.9±9.2, whereas in partially treated lesions were: HP 43.2±15.1mL/s/100g; AP 38.7±8.8mL/min; BV 20.7±9.5mL/100mg; TTP 24±3.7s; HPI 61.7±7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2±4; AP 12.3±3.4; BV 11.8±2.8; TTP 43.9±2.9; and HPI 17.1±9.8. A significant difference (P<0.001) was found for all parameters between residual viable tumor tissue (P<0.001) compared to successfully treated lesion due to the presence of residual arterial vascular structure in viable portion of treated HCC. CONCLUSION: According to our results, CT-p evaluation is not influenced by TACE or RFA treatments, thus representing a feasible technique that allows a reproducible quantitative evaluation of treatment response in HCC patients.
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Carcinoma Hepatocelular/terapia , Ablación por Catéter/métodos , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Hígado/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/diagnóstico por imagen , Medios de Contraste , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Hígado/cirugía , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neoplasia Residual , Estudios Prospectivos , Intensificación de Imagen Radiográfica/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
PURPOSE: To assess the role of CT perfusion technique in detection of blood flow changes related to the therapeutic effects in HCC lesion treated with RFA. METHODS: 14 cirrhotic patients with known HCC underwent a perfusion study about 4 months (range 1-13 months) after RFA on a 16-slice MDCT scanner (Brilliance, Philips). Dynamic CT was performed acquiring 8 dynamic slice/scan, after injection of 50 mL of contrast media. In treated lesion, surrounding parenchyma and hypervascular tissue suspicious for residual disease/recurrence, the following perfusion parameters were analyzed: perfusion (P, mL/100 g min); arterial perfusion (AP, mL/min); blood volume (BV, mL/100 mg); hepatic perfusion index (HPI, %), and time to peak (TTP, s). Univariate Wilcoxon signed rank test was used for statistical analysis. RESULTS: In patients with residual disease (8/14) values of perfusion parameters measured within tumor were: P, median = 45.2; AP, median = 48.2; BV, median = 18.9; HPI, median = 35.8; and TTP, median = 19.4. The values calculated in ablated area were: P, median = 10.9; AP, median = 9.6; BV, median = 5.5; HPI, median = 14.6; TTP, median = 39.6. The parameters calculated in the surrounding parenchyma were: P, median = 15.8; AP, median = 14.2; BV, median = 12.0; HPI, median = 17.9; TTP, median = 43.2. A significant difference (P < 0.05) was observed in mean values of P, AP, and HPI, calculated between treated lesions with residual tumor and those successfully treated. CONCLUSION: Perfusion CT enables assessment of HCC vascularity after RFA treatment, by adding quantitative information about the presence of residual arterial vessels within the viable residual neoplastic tissue.
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Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/cirugía , Ablación por Catéter , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/patología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Neoplasia Residual , Radiografía IntervencionalRESUMEN
PURPOSE: To assess the additional functional vascular information and the relationship between perfusion measurements and glucose metabolism (SUVmax) obtained by including a perfusion CT study in a whole-body contrast-enhanced PET/CT protocol in primary lung cancer lesions. METHODS: Enrolled in this prospective study were 34 consecutive patients with a biopsy-proven diagnosis of lung cancer who were referred for contrast-enhanced PET/CT staging. This prospective study was approved by our institutional review board, and informed consent was obtained from all patients. Perfusion CT was performed with the following parameters: 80 kV, 200 mAs, 30 scans during intravenous injection of 50 ml contrast agent, flow rate 5 ml/s. Another bolus of contrast medium (3.5 ml/s, 80 ml, 60-s delay) was administered to ensure a full diagnostic contrast-enhanced CT scan for clinical staging. The perfusion CT data were used to calculate a range of tumour vascularity parameters (blood flow, blood volume and mean transit time), and tumour FDG uptake (SUVmax) was used as a metabolic indicator. Quantitative and functional parameters were compared and in relation to location, histology and tumour size. The nonparametric Kruskal-Wallis rank sum test was used for statistical analysis. RESULTS: A cut-off value of 3 cm was used according to the TNM classification to discriminate between T1 and T2 tumours (i.e. T1b vs. T2a). There were significant perfusion differences (lower blood volumes and higher mean transit time) between tumours with diameter >30 mm and tumours with diameter <30 mm (p < 0.05; blood volume 5.6 vs. 7.1 ml/100 g, mean transit time 8.6 vs. 3.9 s, respectively). Also there was a trend for blood flow to be lower in larger lesions (p < 0.053; blood flow 153.1 vs. 98.3 ml/100 g tissue/min). Significant inverse correlations (linear regression) were found between blood volume and SUVmax in tumours with diameter >30 mm in diameter. CONCLUSION: Perfusion CT combined with PET/CT is feasible technique that may provide additional functional information about vascularity and tumour aggressiveness as a result of lower perfusion and higher metabolism shown by larger lesions.
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Fluorodesoxiglucosa F18/farmacología , Neoplasias Pulmonares/patología , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Biopsia , Medios de Contraste/farmacología , Estudios de Factibilidad , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Oncología Médica/métodos , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Perfusión , Estudios ProspectivosRESUMEN
OBJECTIVE: To determine the value of perfusion computed tomography (CT-p) in the quantitative assessment of tumour-related neoangiogenesis processes in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty-two biopsy proven HCC lesions were examined with dynamic CT investigations during injection of 50 mL of contrast agent (350 mgI/mL). A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of a colour scale was employed. The following parameters related to the blood microcirculation and tissue perfusion were calculated: hepatic perfusion (Perf), tissue blood volume (BV), hepatic perfusion index (HPI), arterial perfusion (AP), portal perfusion (PP), and time to peak (TTP). Perfusion parameters were statistically analysed, comparing neoplastic lesions with cirrhotic parenchyma. RESULTS: Perf, BV, HPI and AP values were higher (P < 0.001), whereas PP and TTP were lower (P < 0.001) in HCC relative to the surrounding liver. No significant correlation was found between perfusion parameters and HCC grade. Values of perfusion parameters in the cirrhotic liver of patients with and without HCC were not significantly different. CONCLUSIONS: Our results suggest that CT-p can help in non-invasive quantification of tumour blood supply, related to the formation of new arterial structures (neoangiogenesis), which are essential for tumour growth. KEY POINTS: Perfusion computed tomography (CT) enables depiction of tumour vascular physiology. Perfusion CT is non-invasive and is now quick to perform and analyse. Quantitative measurements of hepatic perfusion provide important information about hepatocellular carcinoma (HCC). Such perfusion CT data may help in the determination of the outcome of HCC. Perfusion CT can act as an in-vivo biomarker of tumour-related angiogenesis.