RESUMO
BACKGROUND: Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications. However, most current studies predict the risk of esophageal variceal bleeding (EVB) based on image features at a single level, which results in incomplete data. Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis. AIM: To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis. METHODS: In this study, 208 patients with cirrhosis were retrospectively evaluated and randomly split into training (n = 145) and validation (n = 63) cohorts. Three areas were chosen as regions of interest for extraction of multi-organ radiomic features: The whole liver, whole spleen, and lower esophagus-gastric fundus region. In the training cohort, radiomic score (Rad-score) was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method. Independent clinical risk factors were selected using multivariate logistic regression analyses. The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model (RC model). The established models were validated using the validation cohort. RESULTS: The RC model yielded the best predictive performance and accurately predicted the EVB risk of patients with cirrhosis. Ascites, portal vein thrombosis, and plasma prothrombin time were identified as independent clinical risk factors. The area under the receiver operating characteristic curve (AUC) values for the RC model, Rad-score (liver + spleen + esophagus), Rad-score (liver), Rad-score (spleen), Rad-score (esophagus), and clinical model in the training cohort were 0.951, 0.930, 0.801, 0.831, 0.864, and 0.727, respectively. The corresponding AUC values in the validation cohort were 0.930, 0.886, 0.763, 0.792, 0.857, and 0.692. CONCLUSION: In patients with cirrhosis, combined multi-organ radiomics and clinical model can be used to non-invasively predict the probability of the first secondary EVB.
Assuntos
Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Cirrose Hepática , Nomogramas , Humanos , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/epidemiologia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico , Estudos Retrospectivos , Feminino , Fatores de Risco , Idoso , Medição de Risco/métodos , Fígado/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Baço/diagnóstico por imagem , Valor Preditivo dos Testes , Esôfago/diagnóstico por imagem , Esôfago/patologia , Adulto , Curva ROC , RadiômicaRESUMO
BACKGROUND: Spectral imaging of photon-counting detector CT (PCD-CT) scanners allows for generating virtual non-contrast (VNC) reconstruction. By analyzing 12 abdominal organs, we aimed to test the reliability of VNC reconstructions in preserving HU values compared to real unenhanced CT images. METHODS: Our study included 34 patients with pancreatic cystic neoplasm (PCN). The VNC reconstructions were generated from unenhanced, arterial, portal, and venous phase PCD-CT scans using the Liver-VNC algorithm. The observed 11 abdominal organs were segmented by the TotalSegmentator algorithm, the PCNs were segmented manually. Average densities were extracted from unenhanced scans (HUunenhanced), postcontrast (HUpostcontrast) scans, and VNC reconstructions (HUVNC). The error was calculated as HUerror=HUVNC-HUunenhanced. Pearson's or Spearman's correlation was used to assess the association. Reproducibility was evaluated by intraclass correlation coefficients (ICC). RESULTS: Significant differences between HUunenhanced and HUVNC[unenhanced] were found in vertebrae, paraspinal muscles, liver, and spleen. HUVNC[unenhanced] showed a strong correlation with HUunenhanced in all organs except spleen (r = 0.45) and kidneys (r = 0.78 and 0.73). In all postcontrast phases, the HUVNC had strong correlations with HUunenhanced in all organs except the spleen and kidneys. The HUerror had significant correlations with HUunenhanced in the muscles and vertebrae; and with HUpostcontrast in the spleen, vertebrae, and paraspinal muscles in all postcontrast phases. All organs had at least one postcontrast VNC reconstruction that showed good-to-excellent agreement with HUunenhanced during ICC analysis except the vertebrae (ICC: 0.17), paraspinal muscles (ICC: 0.64-0.79), spleen (ICC: 0.21-0.47), and kidneys (ICC: 0.10-0.31). CONCLUSIONS: VNC reconstructions are reliable in at least one postcontrast phase for most organs, but further improvement is needed before VNC can be utilized to examine the spleen, kidneys, and vertebrae.
Assuntos
Tomografia Computadorizada por Raios X , Humanos , Feminino , Masculino , Reprodutibilidade dos Testes , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Idoso , Baço/diagnóstico por imagem , Fígado/diagnóstico por imagem , Algoritmos , Neoplasias Pancreáticas/diagnóstico por imagem , Adulto , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso de 80 Anos ou mais , Músculos Paraespinais/diagnóstico por imagem , Fótons , Coluna Vertebral/diagnóstico por imagemRESUMO
Here, the case of a female patient in her late 60s, who presented to hospital for a scheduled health check relating to a history of myelofibrosis for the previous 9 years, is described. She recently experienced weight loss and abdominal distention. Physical examination revealed no abnormality or tenderness. Laboratory examination showed decreased blood cells, platelets and haemoglobin, and normal renal function. Ultrasound and computed tomography scans revealed a massively enlarged spleen and displaced and compressed left kidney with abnormal features, but normal right kidney. The patient declined surgery and her myelofibrosis was treated with ruxolitinib, with a recommendation of annual follow-up observation. Despite many recorded cases of left renal displacement caused by splenomegaly, it is very rare for the left kidney to be pushed across the midline to the right side by an enlarged spleen. This article explores the causes and management of this uncommon condition and provides a review of previous literature reports with the aim of enhancing the understanding of unusual renal displacement due to massive splenomegaly, and its potential treatment options.
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Rim , Esplenomegalia , Humanos , Esplenomegalia/diagnóstico por imagem , Esplenomegalia/etiologia , Esplenomegalia/diagnóstico , Esplenomegalia/patologia , Feminino , Rim/patologia , Rim/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Mielofibrose Primária/complicações , Mielofibrose Primária/diagnóstico , Mielofibrose Primária/patologia , Pessoa de Meia-Idade , Ultrassonografia , Baço/diagnóstico por imagem , Baço/patologia , Nitrilas/uso terapêutico , Pirazóis/uso terapêutico , Pirimidinas/uso terapêuticoRESUMO
OBJECTIVE: To investigate the accuracy and reproducibility of diaphragmatic excursion (DE) measurements through hepato-renal/spleno-renal section as a novel method for assessing diaphragmatic function. METHODS: Twelve healthy participants were recruited. Each participant underwent DE measurements performed by four operators with varying levels of experience using traditional methods (liver/spleen section) and novel methods (hepato-renal/spleno-renal section), respectively. Among them, two experienced operators were critical care clinicians, and diaphragmatic ultrasound was performed in more than 50 cases. The other two inexperienced operators were respiratory therapists, with less than 10 cases of diaphragmatic ultrasound operations, who received a 2-hour theoretical and operational training before the study. Operators initially used the conventional method with a 1.5-6.0 MHz convex probe in M-mode, placing the sampling line perpendicular to the diaphragm at the point of maximum excursion, and the liver/spleen section DE was determined during normal breathing of participant. Then, they used the novel method with a 1.6-4.5 MHz phased array probe to observe diaphragmatic movement cranio-caudally along the mid-axillary line, employing anatomic M-mode with the sampling line placed perpendicular to the diaphragm at the level of the renal midpoint, and the DE of the hepato-renal/spleno-renal section was measured during normal breathing. The liver and hepato-renal sections were used to assess the right diaphragm, and spleen and spleno-renal sections were used to assess the left diaphragm. Correlation analysis of DE measurements from different sections was conducted using the Deming method, while consistency was assessed using the Bland-Altman method. The consistency of clinical acceptability was defined as the absence of fixed and proportional bias, with a difference of two standard deviations less than 40% of the mean measurement value. Percentage consistency limit = two standard deviations of the differences between measurements/mean measurement value×100%. RESULTS: Four operators performed image scans of DE in all four sections for each of the twelve subjects, with a high DE acquisition rate of 100% (48/48) for hepato-renal and spleno-renal sections, followed by the liver section [91.7% (44/48)] and the spleen section [66.7% (32/48)], particularly for the left diaphragm assessment, where the DE acquisition rate of spleno-renal section was significantly higher than that of traditional spleen section (P < 0.01). The overall measurement results showed that no significant difference was found in DE determined via the hepato-renal and spleno-renal sections using the novel method (cm: 1.64±0.10 vs. 1.55±0.14, P > 0.05), and they were significantly higher than those determined via the conventional liver and spleen sections (cm: hepato-renal section vs. liver section was 1.64±0.10 vs. 1.44±0.09, spleno-renal section vs. spleen section was 1.55±0.14 vs. 1.09±0.14, both P < 0.01). Correlation analysis revealed good correlations of DE between hepato-renal section and spleno-renal section, between liver section and hepato-renal section, between liver section and spleno-renal section (r values were 0.62, 0.59, and 0.42, all P < 0.01). Consistency analysis showed that the consistency in DE between hepato-renal section and spleno-renal section, as well as between liver section and hepato-renal section was good (both % consistency limits < 40%). However, the DE measured in the spleen section were not correlated with the other three sections, and there was no inconsistency (all % consistency limits > 40%). There was no statistically significant difference in DE measured by the four operators in the liver, spleen, hepato-renal, and spleno-renal sections (cm: 1.49±0.34, 1.44±0.37, 1.43±0.30, and 1.40±0.27 in liver section; 1.10±0.36, 1.05±0.18, 1.09±0.22, and 1.06±0.26 in spleen section; 1.67±0.43, 1.57±0.34, 1.63±0.32, and 1.66±0.36 in hepato-renal section; 1.45±0.33, 1.48±0.34, 1.50±0.24, and 1.65±0.26 in spleno-renal section; all P > 0.05). According to the clinically acceptable range of consistency limits, the DE measured by the four operators in all four sections showed good consistency (all % consistency limits < 40%). CONCLUSIONS: The novel method of measuring DE through hepato-renal/spleno-renal sections is accurate, highly reproducible, and has a high acquisition rate, serving as a viable alternative to the conventional method involving the liver/spleen section.
Assuntos
Diafragma , Baço , Ultrassonografia , Humanos , Diafragma/diagnóstico por imagem , Diafragma/fisiologia , Adulto , Masculino , Ultrassonografia/métodos , Feminino , Baço/diagnóstico por imagem , Fígado/diagnóstico por imagem , Adulto Jovem , Rim/diagnóstico por imagem , Reprodutibilidade dos TestesRESUMO
A patient who had sickle cell disease and had spleen uptake on bone scans is described, and additional causes for that finding are discussed.
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Anemia Falciforme , Osso e Ossos , Baço , Anemia Falciforme/diagnóstico por imagem , Anemia Falciforme/complicações , Humanos , Baço/diagnóstico por imagem , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/metabolismo , Transporte Biológico , MasculinoRESUMO
Pulmonary agenesis is a very rare congenital abnormality that can be missed in a routine radiographic examination, which delays diagnosis until adulthood. It can be associated with other congenital malformations, such as valvular heart disease and gastrointestinal organ abnormalities. Computed tomography (CT) is a useful modality for its better delineation of pulmonary and vascular structures. The reported case here is for an adult male who presented with dextroposition of the heart and was found to have a unilobed right lung associated with polysplenia. This has not been previously reported in the literature.
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Pulmão , Baço , Tomografia Computadorizada por Raios X , Humanos , Masculino , Pulmão/anormalidades , Pulmão/diagnóstico por imagem , Baço/anormalidades , Baço/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Anormalidades Múltiplas/diagnóstico por imagem , AdultoRESUMO
Objective. Auto-segmentation in mouse micro-CT enhances the efficiency and consistency of preclinical experiments but often struggles with low-native-contrast and morphologically complex organs, such as the spleen, resulting in poor segmentation performance. While CT contrast agents can improve organ conspicuity, their use complicates experimental protocols and reduces feasibility. We developed a 3D Cycle Generative Adversarial Network (CycleGAN) incorporating anatomy-constrained U-Net models to leverage contrast-enhanced CT (CECT) insights to improve unenhanced native CT (NACT) segmentation.Approach.We employed a standard CycleGAN with an anatomical loss function to synthesize virtual CECT images from unpaired NACT scans at two different resolutions. Prior to training, two U-Nets were trained to automatically segment six major organs in NACT and CECT datasets, respectively. These pretrained 3D U-Nets were integrated during the CycleGAN training, segmenting synthetic images, and comparing them against ground truth annotations. The compound loss within the CycleGAN maintained anatomical fidelity. Full image processing was achieved for low-resolution datasets, while high-resolution datasets employed a patch-based method due to GPU memory constraints. Automated segmentation was applied to original NACT and synthetic CECT scans to evaluate CycleGAN performance using the Dice Similarity Coefficient (DSC) and the 95th percentile Hausdorff Distance (HD95p).Main results.High-resolution scans showed improved auto-segmentation, with an average DSC increase from 0.728 to 0.773 and a reduced HD95p from 1.19 mm to 0.94 mm. Low-resolution scans benefited more from synthetic contrast, showing a DSC increase from 0.586 to 0.682 and an HD95preduction from 3.46 mm to 1.24 mm.Significance.Implementing CycleGAN to synthesize CECT scans substantially improved the visibility of the mouse spleen, leading to more precise auto-segmentation. This approach shows the potential in preclinical imaging studies where contrast agent use is impractical.
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Meios de Contraste , Imageamento Tridimensional , Baço , Microtomografia por Raio-X , Animais , Camundongos , Baço/diagnóstico por imagem , Microtomografia por Raio-X/métodos , Imageamento Tridimensional/métodos , Algoritmos , Processamento de Imagem Assistida por Computador/métodos , Redes Neurais de ComputaçãoRESUMO
BACKGROUND: Liver stiffness (LS) measurement with two-dimensional shear wave elastography (2D-SWE) correlates with the degree of liver fibrosis and thus indirectly reflects liver function reserve. The size of the spleen increases due to tissue proliferation, fibrosis, and portal vein congestion, which can indirectly reflect the situation of liver fibrosis/cirrhosis. It was reported that the size of the spleen was related to posthepatectomy liver failure (PHLF). So far, there has been no study combining 2D-SWE measurements of LS with spleen size to predict PHLF. This prospective study aimed to investigate the utility of 2D-SWE assessing LS and spleen area (SPA) for the prediction of PHLF in hepatocellular carcinoma (HCC) patients and to develop a risk prediction model. AIM: To investigate the utility of 2D-SWE assessing LS and SPA for the prediction of PHLF in HCC patients and to develop a risk prediction model. METHODS: This was a multicenter observational study prospectively analyzing patients who underwent hepatectomy from October 2020 to March 2022. Within 1 wk before partial hepatectomy, ultrasound examination was performed to measure LS and SPA, and blood was drawn to evaluate the patient's liver function and other conditions. Least absolute shrinkage and selection operator logistic regression and multivariate logistic regression analysis was applied to identify independent predictors of PHLF and develop a nomogram. Nomogram performance was validated further. The diagnostic performance of the nomogram was evaluated with receiver operating characteristic curve compared with the conventional models, including the model for end-stage liver disease (MELD) score and the albumin-bilirubin (ALBI) score. RESULTS: A total of 562 HCC patients undergoing hepatectomy (500 in the training cohort and 62 in the validation cohort) were enrolled in this study. The independent predictors of PHLF were LS, SPA, range of resection, blood loss, international normalized ratio, and total bilirubin. Better diagnostic performance of the nomogram was obtained in the training [area under receiver operating characteristic curve (AUC): 0.833; 95% confidence interval (95%CI): 0.792-0.873; sensitivity: 83.1%; specificity: 73.5%] and validation (AUC: 0.802; 95%CI: 0.684-0.920; sensitivity: 95.5%; specificity: 52.5%) cohorts compared with the MELD score and the ALBI score. CONCLUSION: This PHLF nomogram, mainly based on LS by 2D-SWE and SPA, was useful in predicting PHLF in HCC patients and presented better than MELD score and ALBI score.
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Carcinoma Hepatocelular , Técnicas de Imagem por Elasticidade , Hepatectomia , Falência Hepática , Neoplasias Hepáticas , Fígado , Nomogramas , Baço , Humanos , Hepatectomia/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Técnicas de Imagem por Elasticidade/métodos , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Estudos Prospectivos , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Fígado/diagnóstico por imagem , Fígado/cirurgia , Fígado/patologia , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Falência Hepática/etiologia , Idoso , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Medição de Risco/métodos , Valor Preditivo dos Testes , Tamanho do Órgão , Adulto , Curva ROC , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/complicaçõesAssuntos
Tumores Neuroendócrinos , Neoplasias Pancreáticas , Baço , Humanos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Diagnóstico Diferencial , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Baço/diagnóstico por imagem , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Feminino , Pessoa de Meia-Idade , Coristoma/diagnóstico por imagemRESUMO
PURPOSE: For reliable DCE MRI parameter estimation, k-space undersampling is essential to meet resolution, coverage, and signal-to-noise requirements. Pseudo-spiral (PS) sampling achieves this by sampling k-space on a Cartesian grid following a spiral trajectory. The goal was to optimize PS k-space sampling patterns for abdomin al DCE MRI. METHODS: The optimal PS k-space sampling pattern was determined using an anthropomorphic digital phantom. Contrast agent inflow was simulated in the liver, spleen, pancreas, and pancreatic ductal adenocarcinoma (PDAC). A total of 704 variable sampling and reconstruction approaches were created using three algorithms using different parametrizations to control sampling density, halfscan and compressed sensing regularization. The sampling patterns were evaluated based on image quality scores and the accuracy and precision of the DCE pharmacokinetic parameters. The best and worst strategies were assessed in vivo in five healthy volunteers without contrast agent administration. The best strategy was tested in a DCE scan of a PDAC patient. RESULTS: The best PS reconstruction was found to be PS-diffuse based, with quadratic distribution of readouts on a spiral, without random shuffling, halfscan factor of 0.8, and total variation regularization of 0.05 in the spatial and temporal domains. The best scoring strategy showed sharper images with less prominent artifacts in healthy volunteers compared to the worst strategy. Our suggested DCE sampling strategy also showed high quality DCE images in the PDAC patient. CONCLUSION: Using an anthropomorphic digital phantom, we identified an optimal PS sampling strategy for abdominal DCE MRI, and demonstrated feasibility in a PDAC patient.
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Abdome , Algoritmos , Meios de Contraste , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Neoplasias Pancreáticas , Imagens de Fantasmas , Humanos , Imageamento por Ressonância Magnética/métodos , Meios de Contraste/química , Abdome/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Razão Sinal-Ruído , Carcinoma Ductal Pancreático/diagnóstico por imagem , Adulto , Masculino , Baço/diagnóstico por imagem , Voluntários Saudáveis , Feminino , Interpretação de Imagem Assistida por Computador/métodos , Reprodutibilidade dos TestesRESUMO
We present a compelling case of an elderly male with a complex medical history who presented with sepsis secondary to a urinary tract infection. During admission, changes in his abdominal exam prompted imaging studies, which revealed a grade IV splenic laceration with a giant splenic artery pseudoaneurysm containing a suspected arteriovenous fistula component. Multidisciplinary discussion was had regarding patient management which resulted in the decision to perform an emergent splenectomy. Learning points from this case underscore the crucial role of interdisciplinary collaboration in the treatment of this pathology. Additionally, we discuss the decision-making process to support surgical intervention in the absence of clear guidelines in this exceedingly rare condition.
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Falso Aneurisma , Fístula Arteriovenosa , Esplenectomia , Artéria Esplênica , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Falso Aneurisma/etiologia , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Masculino , Artéria Esplênica/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/etiologia , Baço/irrigação sanguínea , Baço/diagnóstico por imagem , Baço/lesões , Idoso , Tomografia Computadorizada por Raios XRESUMO
This study evaluated the use of F-18 fluorodeoxyglucose (FDG) PET/CT imaging to differentiate between scrub typhus and systemic lupus erythematosus (SLE) in patients presenting with lymphadenopathy. We carried out a retrospective analysis of 18 scrub typhus patients and seven SLE patients, using various imaging parameters, including lymph node size, spleen and liver lengths, the distance between the two farthest lesions (Dmax), and assessments of glucose metabolism. On FDG PET images, we measured the maximum standardized uptake value (SUVmax) of the lymph nodes, spleen, and liver and the mean standardized uptake value (SUVmean) of the liver and spleen. The Dmax values of scrub typhus patients were significantly longer than those of SLE patients, indicating that lymphadenopathy is more generalized in the patients with scrub typhus. The SUVmax values for the lymph node, spleen, and liver were also higher in patients with scrub typhus, while the SUVmean of the liver and spleen did not differ between the two groups. This study is the first to compare FDG PET/CT images between these two conditions, suggesting the potential of this imaging modality to provide critical diagnostic distinctions.
Assuntos
Fluordesoxiglucose F18 , Lúpus Eritematoso Sistêmico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tifo por Ácaros , Humanos , Tifo por Ácaros/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Idoso , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Baço/diagnóstico por imagem , Baço/patologia , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/metabolismo , Diagnóstico Diferencial , Compostos Radiofarmacêuticos , Adulto JovemRESUMO
Characteristics of livers and spleens of people with multiple sclerosis (pwMS) could constitute good biomarkers of MS-related characteristics such as the disability status. To test the hypothesis "the gross anatomical features of livers and spleens, are not similar between pwMS with different disease characteristics" a cross-sectional study was conducted on pwMS seen at the Isfahan MS clinic, Iran, from February until December 2023. Definitive, otherwise-healthy, pwMS were enrolled after an initial laboratory evaluation. Presence/absence and grading of non-alcoholic fatty liver disease (NAFLD) and the span of spleen were determined by a radiologist using high-resolution abdominopelvic ultrasonography. 193 pwMS (160 women) were enrolled. Of whom, 143 (74.1%) were receiving first-line disease-modifying therapies (DMTs), 24 (12.4%) fingolimod, and 26 (13.5%) rituximab. The span of spleen was negatively associated with EDSS (adjusted ß [SE] - 4.08 [1.52], p < 0.01), as well as 6 m-CDW (adjusted ß [SE] - 6.94 [3.56], p = 0.05), unlike age, DMTs, and MS duration (all with p > 0.05). Receiver operating characteristic analysis showed, spleen span performs significant but poor in discrimination of EDSS > 1 from EDSS = 1 (area under curve [AUC] 0.62, SE 0.05, p < 0.01), yet, significant and fair in discrimination of presence from absence of 6 m-CDW (AUC 0.72, SE 0.06, p < 0.01). Other findings were unremarkable. Further longitudinal, prospective studies are warranted to confirm whether smaller spleens are predictive of higher disability accrual rate in pwMS. Particularly, findings require further validation in untreated/treatment-naïve pwMS, and ones with higher EDSS scores.
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Esclerose Múltipla , Baço , Ultrassonografia , Humanos , Feminino , Baço/diagnóstico por imagem , Estudos Transversais , Adulto , Masculino , Esclerose Múltipla/diagnóstico por imagem , Ultrassonografia/métodos , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Fígado/diagnóstico por imagem , Fígado/patologia , Irã (Geográfico)RESUMO
177Lu-DOTATATE therapy is an effective treatment for advanced neuroendocrine tumors, despite its dose-limiting hematotoxicity. Herein, the significance of off-target splenic irradiation is unknown. Our study aims to identify predictive markers of peptide receptor radionuclide therapy-induced leukopenia. Methods: We retrospectively analyzed blood counts and imaging data of 88 patients with histologically confirmed, unresectable metastatic neuroendocrine tumors who received 177Lu-DOTATATE treatment at our institution from February 2009 to July 2021. Inclusion criterium was a tumor uptake equivalent to or greater than that in the liver on baseline receptor imaging. We excluded patients with less than 24 mo of follow-up and those patients who received fewer than 4 treatment cycles, additional therapies, or blood transfusions during follow-up. Results: Our study revealed absolute and relative white blood cell counts and relative spleen volume reduction as independent predictors of radiation-induced leukopenia at 24 mo. However, a 30% decline in spleen volume 12 mo after treatment most accurately predicted patients proceeding to leukopenia at 24 mo (receiver operating characteristic area under the curve of 0.91, sensitivity of 0.93, and specificity of 0.90), outperforming all other parameters by far. Conclusion: Automated splenic volume assessments demonstrated superior predictive capabilities for the development of leukopenia in patients undergoing 177Lu-DOTATATE treatment compared with conventional laboratory parameters. The reduction in spleen size proves to be a valuable, routinely available, and quantitative imaging-based biomarker for predicting radiation-induced leukopenia. This suggests potential clinical applications for risk assessment and management.
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Leucopenia , Tumores Neuroendócrinos , Octreotida , Compostos Organometálicos , Receptores de Peptídeos , Baço , Humanos , Feminino , Leucopenia/etiologia , Masculino , Baço/diagnóstico por imagem , Baço/efeitos da radiação , Pessoa de Meia-Idade , Octreotida/análogos & derivados , Octreotida/uso terapêutico , Octreotida/efeitos adversos , Estudos Retrospectivos , Idoso , Tumores Neuroendócrinos/radioterapia , Tumores Neuroendócrinos/diagnóstico por imagem , Receptores de Peptídeos/metabolismo , Compostos Organometálicos/efeitos adversos , Compostos Organometálicos/uso terapêutico , Tamanho do Órgão , Adulto , Biomarcadores , Idoso de 80 Anos ou maisRESUMO
The Bacillus Calmette-Guérin (BCG) vaccine, which has been used for > 100 years to prevent tuberculosis, is well-established for bladder cancer treatment, and under study for neurological and autoimmune diseases. In patients with type 1 diabetes (T1D), BCG vaccinations have been shown in randomized clinical trials to gradually lower blood sugar to near normal levels. This effect appears to be driven by a BCG-induced shift in lymphoid cells' glucose metabolism from oxidative phosphorylation to aerobic glycolysis. The latter is a state of high glucose utilization that draws more glucose from the blood. Apart from blood, it is unknown whether BCG establishes residence in any organs and alters their glucose metabolism. In this two-year-long clinical trial in type 1 diabetics, we use positron emission tomography (PET) and x-ray computed tomography (CT) to map organs that increase their uptake of the glucose analogue 18F-fluorodeoxyglucose (18F-FDG) before versus after BCG vaccinations. We also injected BALB/c mice with BCG to test for the presence of BCG in various organs. Results from both studies point to the spleen as the dominant site for glucose uptake and BCG residence. The human spleen is significant because its 47% increase in 18F-FDG uptake by a large population of lymphocytes and monocytes might help to explain BCG's systemic lowering of blood glucose to near normal levels. Findings suggest that the spleen, triggered by BCG, assumes a critical role in systemic glucose regulation in the absence of a functional pancreas.
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Vacina BCG , Glicemia , Diabetes Mellitus Tipo 1 , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Baço , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/metabolismo , Baço/metabolismo , Baço/diagnóstico por imagem , Vacina BCG/uso terapêutico , Humanos , Animais , Glicemia/metabolismo , Camundongos , Feminino , Masculino , Adulto , Camundongos Endogâmicos BALB C , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaAssuntos
Hemangioma , Microfilárias , Neoplasias Esplênicas , Humanos , Hemangioma/patologia , Hemangioma/diagnóstico por imagem , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/diagnóstico , Microfilárias/isolamento & purificação , Animais , Baço/patologia , Baço/diagnóstico por imagem , Baço/parasitologia , Microscopia , Masculino , Histocitoquímica , Filariose/diagnóstico , Filariose/parasitologiaRESUMO
AIMS: Spleen and liver stiffness, investigated by VCTE (Vibration-Controlled Transient Elastography), have been associated with marrow fibrosis in patients with myeloproliferative neoplasms (MPNs). Tissue stiffness can be assessed by shear wave point (pSWE) and bidimensional elastography (2DSWE). Spleen stiffness (SS) values were higher in Myelofibrosis (MF) and Polycythemia Vera (PV) compared to Essential Thrombocythemia (ET). We aimed to identify SWE differences between MPN patients and healthy volunteers; to evaluate specific SWE features in patients with MF, PV and ET; to establish a correlation with bone marrow fibrosis in patients with myeloproliferative disease. METHODS: Patients with myeloproliferative disease and healthy volunteers performed evaluation of spleen and liver stiffness (LS) by pSWE and 2DSWE. RESULTS: A total of 218 subjects were included: 143 with myeloproliferative disease (64 MF, 29.4%, 33 PV, 15.1% and 46 ET, 21.1%), and 75 (34.4%) healthy volunteers. Compared to volunteers, MF patients had greater spleen (pSWE 40.9 vs. 26.3 kPa, p < 0.001; 2DSWE 34.9 vs. 20.1 kPa, p < 0.001), and liver stiffness (pSWE 7.72 vs. 5.52 kPa, p < 0.001; 2DSWE 6.96 vs. 5.01 kPa, p < 0.001). In low (0-1) (n = 81, 60.4%) versus high-grade bone marrow fibrosis (2-3) (n = 42, 39.6%), is evident a higher median stiffness in patients with higher grades of fibrosis both for liver (pSWE 5.2 vs. 6.65 kPa; 2DSWE 5.1 vs. 6.05 kPa) and spleen (pSWE 27.2 vs. 37.9 kPa, 2DSWE 21.7 vs 30.75 kPa-p < 0.001 in both). CONCLUSION: SWE evaluation distinguishes MF patients from HV and ET/PV and may help in MPN diagnosis. LS and SS values are associated with bone marrow fibrosis grade.
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Técnicas de Imagem por Elasticidade , Fígado , Transtornos Mieloproliferativos , Mielofibrose Primária , Índice de Gravidade de Doença , Baço , Humanos , Técnicas de Imagem por Elasticidade/métodos , Masculino , Baço/diagnóstico por imagem , Baço/patologia , Feminino , Pessoa de Meia-Idade , Mielofibrose Primária/diagnóstico por imagem , Mielofibrose Primária/patologia , Fígado/diagnóstico por imagem , Fígado/patologia , Transtornos Mieloproliferativos/diagnóstico por imagem , Idoso , Adulto , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: The authors aimed to use preoperative computed tomography images to develop a radiomic nomogram to select patients who would benefit from spleen-preserving splenic hilar (No.10) lymphadenectomy (SPSHL). METHODS: A pooled analysis of three distinct prospective studies was performed. The splenic hilar lymph node (SHLN) ratio (sLNR) was established as the quotient of the number of metastatic SHLN to the total number of SHLN. Radiomic features reflecting the phenotypes of the primary tumor (RS1) and SHLN region (RS2) were extracted and used as predictive factors for sLNR. RESULTS: This study included 733 patients: 301 in the D2 group and 432 in the D2+No.10 group. The optimal sLNR cutoff value was set at 0.4, and the D2+No.10 group was divided into three groups: sLNR=0, sLNR ≤0.4, and sLNR >0.4. Patients in the D2+No. 10 group were randomly divided into the training ( n =302) and validation ( n =130) cohorts. The AUCs value of the nomogram, including RS1 and RS2, were 0.952 in the training cohort and 0.888 in the validation cohort. The entire cohort was divided into three groups based on the nomogram scores: low, moderate, and high SHLN metastasis burden groups (LMB, MMB, and HMB, respectively). A similar 5-year OS rate was found between the D2 and D2+No. 10 groups in the LMB and HMB groups. In the MMB group, the 5-year OS of the D2+No. 10 group (73.4%) was significantly higher than that of the D2 group (37.6%) ( P <0.001). CONCLUSIONS: The nomogram showed good predictive ability for distinguishing patients with various SHLN metastasis burdens. It can accurately identify patients who would benefit from SPSHL.
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Excisão de Linfonodo , Nomogramas , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Baço/diagnóstico por imagem , Baço/cirurgia , Baço/patologia , Adulto , Metástase Linfática/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , RadiômicaRESUMO
Miliary tuberculosis is a form of disseminated tuberculosis that can be difficult to detect when the classic pattern is absent on chest radiograph and advanced cross-sectional imaging is not readily available. While the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol for extrapulmonary tuberculosis emphasizes easy-to-teach findings, experienced sonographers may detect additional, subtler signs that can aid in diagnosis. We report a case of a 20-year-old man with miliary tuberculosis diagnosed on computed tomography of the chest. We describe subtle sonographic signs of disseminated tuberculosis including subpleural irregularities and comet-tail artifacts, a bright liver pattern, peritoneal nodules, and a nonspecific sponge spleen pattern. We then discuss important differential diagnoses for each finding. Knowledge of subtle sonographic signs outside of the FASH protocol can aid clinicians in detecting disseminated tuberculosis, including the miliary form, when advanced imaging may not be available.
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Tuberculose Miliar , Ultrassonografia , Humanos , Masculino , Tuberculose Miliar/diagnóstico por imagem , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Adulto Jovem , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Antituberculosos/uso terapêutico , Fígado/diagnóstico por imagem , Fígado/patologia , Baço/diagnóstico por imagem , Baço/patologiaRESUMO
INTRODUCTION: Spontaneous preterm birth complicates â¼7% of pregnancies and causes morbidity and mortality. Although infection is a common etiology, our understanding of the fetal immune system in vivo is limited. This study aimed to utilize T2-weighted imaging and T2* relaxometry (which is a proxy of tissue oxygenation) of the fetal spleen in uncomplicated pregnancies and in fetuses that were subsequently delivered spontaneously prior to 32 weeks. METHODS: Women underwent imaging including T2-weighted fetal body images and multi-eco gradient echo single-shot echo planar sequences on a Phillips Achieva 3T system. Previously described postprocessing techniques were applied to obtain T2- and T2*-weighted imaging of the fetal spleen and T2-weighted fetal body volumes. RESULTS: Among 55 women with uncomplicated pregnancies, an increase in fetal splenic volume, splenic:body volume, and a decrease in splenic T2* signal intensity was demonstrated across gestation. Compared to controls, fetuses who were subsequently delivered prior to 32 weeks' gestation (n = 19) had a larger spleen when controlled for the overall size of the fetus (p = 0.027), but T2* was consistent (p = 0.76). CONCLUSION: These findings provide evidence of a replicable method of studying the fetal immune system and give novel results on the impact of impending preterm birth on the spleen. While T2* decreases prior to preterm birth in other organs, preservation demonstrated here suggests preferential sparing of the spleen.