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Sample records for reduced-dose expiratory mdct

  1. Vertebral lesion distribution in multiple myeloma - assessed by reduced-dose whole-body MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Bier, Georg; Kloth, Christopher; Schabel, Christoph; Bongers, Malte; Nikolaou, Konstantin; Horger, Marius [Eberhard-Karls-University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2016-01-15

    To observe the distribution and potential distribution patterns of osteolytic and sclerotic vertebral involvement in a representative collective of multiple myeloma patients. A total of 66 consecutive patients with a diagnosis of multiple myeloma at initial diagnosis or during follow-up were examined by multidetector reduced-dose computed tomography to evaluate the distribution of bone lesions along the spine with focus on size, location, and lesion character. Confirmation of diagnosis was performed by comparison to follow-up computed tomography or magnetic resonance tomography. If >50 % of all detected malignant lesions occurred in one spinal segment, the distribution pattern was called cervical, thoracic, lumbar, or sacral, otherwise a ''mixed'' pattern was classified. Of a total number of 933 osseous spine lesions, 632 (67.7 %) were classified as malignant (98.9 % of them osteolytic) and 293 (31.5 %) as benign. The distribution pattern analysis yielded two patients (3.8 %) with a cervical, 26 (50 %) with a thoracic, 4 (7.7 %) with a lumbar, one (1.9 %) with a sacral pattern, and 19 cases (36.6 %) showed a mixed distribution pattern. Segment-wise, the mean lesion size was 6.52 ± 2.76 mm (cervical), 8.97 ± 5.43 mm (thoracic), 11.97 ± 7.11 mm (lumbar), and 17.5 ± 16.465 (sacral), whilst, related to the vertebra size, the lesion/vertebra size ratio is decreasing through the whole spine beginning from the top. Multiple myeloma bone lesions occur preferably and are larger in the thoracic and lumbar spine. Moreover, a specific distribution pattern is present in about 60 %. (orig.)

  2. Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT

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    Matsuura, Yukiko, E-mail: matsuyuki_future@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Kawata, Naoko, E-mail: chumito_03@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Yanagawa, Noriyuki, E-mail: yanagawa@ho.chiba-u.ac.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sugiura, Toshihiko, E-mail: sugiura@js3.so-net.ne.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sakurai, Yoriko, E-mail: yoliri@nifty.com [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sato, Misuzu, E-mail: mis_misuzu@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Iesato, Ken, E-mail: iesato_k@yahoo.co.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Terada, Jiro, E-mail: jirotera@chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Sakao, Seiichiro, E-mail: sakao@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tada, Yuji, E-mail: ytada@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tanabe, Nobuhiro, E-mail: ntanabe@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Suzuki, Yoichi, E-mail: ysuzuki@faculty.chiba-u.jp [Department of public Health, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan); Tatsumi, Koichiro, E-mail: tatsumi@faculty.chiba-u.jp [Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-8670 Japan (Japan)

    2013-10-01

    Objectives: Structural and functional changes in pulmonary vessels are prevalent at the initial stages of chronic obstructive pulmonary disease (COPD). These vascular alterations can be assessed using cross-sectional area (CSA) of small pulmonary vessels. However, neither in non-COPD smokers nor in COPD patients it has been defined whether the structural changes of pulmonary vessels detected by paired inspiratory and expiratory CT scans are associated with emphysematous changes. We quantified the CSA and low attenuation area (LAA) and evaluated the changes in these parameters in the inspiratory and expiratory phases. Materials and methods: Fifty consecutive non-COPD smokers and COPD patients were subjected to multi detector-row CT and the percentage of vessels with a CSA less than 5 mm{sup 2} as well as the percentage LAA for total lung area (%CSA < 5, %LAA, respectively) were calculated. Results: The %CSA < 5 correlated negatively with %LAA. The %CSA < 5 was lower in COPD patients with emphysema as compared with non-COPD smokers and COPD patients with or without mild emphysema. In addition, the %CSA < 5 was lower in the no/mild emphysema subgroup as compared with non-COPD smokers. The respiratory phase change of %CSA < 5 in COPD patients was greater than that in non-COPD smokers. Conclusion: The percentage of small pulmonary vessels decreased as emphysematous changes increase, and this decrease was observed even in patients with no/mild emphysema. Furthermore, respiratory phase changes in CSA were higher in COPD patients than in non-COPD smokers.

  3. MDCT of the abdomen

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    Aschoff, A.J. [Dept. for Diagnostic Radiology, Univ. Hospitals of Ulm (Germany)

    2006-01-10

    Multi-detector row computed tomography (MDCT) enables fast and thin acquisition of the abdominal anatomy. This allows multi-pass multi-planar studies that can be obtained during defined circulatory phases. When bolus timing is adequate, arterial phases with high contrast levels provide 'free lunch' CT angiographies eliminating the need for diagnostic angiographies in most cases. In addition to established clinical indications for abdominal CT such as preoperative MDCT of the liver or pancreas, MDCT of the abdomen is especially gaining ground in the work up for acute abdominal pain and abdominal trauma and is opening new indications for MDCT of the gastrointestinal tract. Indications for gastrointestinal MDCT include tumors, bleeding and ischemia of the small and large bowel as well as diverticulitis. The question of whether to use positive or negative contrast material for bowel distention for MDCT of the gastrointestinal tract is still a controversial issue. In selected cases, modifying the protocol to perform a 'CT enteroclysis' might improve sensitivity and specificity in depicting small bowel tumors or inflammatory changes such as in Crohn's disease. The most common gastrointestinal mesenchymal tumor is the gastrointestinal stromal tumor (GIST). MDCT may show hypervascular submucosal masses. Acute gastrointestinal (GI) bleeding is common with patients presenting with melena, hematemesis or hematochezia. In addition to the established initial work-up MDCT is beginning to establish itself for this indication. It may be especially helpful in the work up of obscure bleeding. Another relatively rare but important cause for acute abdominal pain is mesenteric ischemia. It may be caused by many conditions and may mimic various intestinal diseases. Bowel ischemia severity ranges from transient superficial changes of the intestinal mucosa to life-threatening transmural bowel wall necrosis. CT can demonstrate changes in ischemic bowel segments

  4. MDCT: cardiology indications

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    Kopp, A.F.; Kuettner, A.; Trabold, T.; Heuschmid, M.; Claussen, C.D. [Dept. of Diagnostic Radiology, Eberhard Karls Univ. Tuebingen, Tuebingen (Germany); Schroeder, S. [Div. of Cardiology, Dept. of Internal Medicine, Eberhard Karls Univ. Tuebingen, Tuebingen (Germany)

    2003-12-01

    In the past 2 years mechanical multidetector-row CT (MDCT) systems with simultaneous acquisition of four slices and half-second scanner rotation have become widely available. Data acquisition with these scanners allows for considerably faster coverage of the heart volume compared with single-slice scanning. This increased scan speed can be used for retrospective gating together with 1-mm collimated slice widths and allows coverage of the entire cardiac volume in one breath hold. Initial results from studies in correlation with intracoronary ultrasound suggest that MDTC technology not only offers the possibility to visualize intracoronary stenoses non-invasively but also to differentiate plaque morphology. This is especially the case with the next generation of 16-row multidetector CT. An increased number of simultaneously acquired slices and sub-millimeter collimation for cardiac applications allows true isotropic scanning with high temporal resolution. Contrastenhanced MDTC is a promising non-invasive technique for the detection, visualization, and characterization of stenotic artery disease. It could act as a gate keeper prior to cardiac catherization and finally replace conventional diagnostic modalities. (orig.)

  5. MDCT in blunt intestinal trauma

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    Romano, Stefania [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy)]. E-mail: stefromano@libero.it; Scaglione, Mariano [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Tortora, Giovanni [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Martino, Antonio [Trauma Center, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Di Pietto, Francesco [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Romano, Luigia [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Grassi, Roberto [Department ' Magrassi-Lanzara' , Section of Radiology, Second University of Naples, 80138 Naples (Italy)

    2006-09-15

    Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation.

  6. Image Quality in Reduced-Dose Coronary CT Angiography

    NARCIS (Netherlands)

    Gagarina, Nina V.; Irwan, Roy; Gordina, Galina; Fominykh, Ekaterina; Sijens, Paul E.

    2011-01-01

    Rationale and Objectives: Concerns for patient's risk of radiation-induced cancer have increased demand for reduced-dose coronary computed tomography angiography (CCTA). Previous comparisons of full and reduced-dose CCTA were not conclusive, because results were compared in different groups of patie

  7. Determining gastric cancer resectability by dynamic MDCT

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    Pan, Zilai; Zhang, Huan; Du, Lianjun; Ding, Bei; Song, Qi; Ling, Huawei; Huang, Baisong; Chen, Kemin [Jiaotong University, Department of Radiology, Shanghai (China); Yan, Chao [Jiaotong University, Department of Surgery, Shanghai (China)

    2010-03-15

    Multi-detector row CT (MDCT) has been widely used to detect primary lesions and to evaluate TNM staging. In this study we evaluated the accuracy of dynamic MDCT in the preoperative determination of the resectability of gastric cancer. MDCT was used to image 350 cases of gastric cancer diagnosed by biopsy before surgery. MDCT findings regarding TNM staging and resectability were correlated with surgical and pathological findings. The accuracy of MDCT for staging gastric cancer was high, especially for tumour stage T1 (94.3%), lymph node stage N2 (87.3%), and for predicting distant metastases (>96.6%). When resectability was considered to be the outcome, the total accuracy of MDCT was 87.4%, sensitivity was 89.7% and specificity was 76.7%. Results showed high sensitivity for identifying peritoneal seeding (90.0%) and for predicting liver metastasis (80.0%). Dynamic enhanced MDCT is useful for TNM staging of gastric cancers and for predicting tumour respectability preoperatively. (orig.)

  8. Cardiac Computed Tomography (Multidetector CT, or MDCT)

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Cardiac Computed Tomography (Multidetector CT, or MDCT) Updated:Sep 19, ... The ECG is also needed to help the computer that is connected to the CT scanner create ...

  9. Conventional and reduced radiation dose of 16-MDCT for detection of nephrolithiasis and ureterolithiasis.

    Science.gov (United States)

    Paulson, Erik K; Weaver, Carolyn; Ho, Lisa M; Martin, Lucie; Li, Jianying; Darsie, James; Frush, Donald P

    2008-01-01

    Our purpose was to prospectively compare the reader compatibility and acceptability of a range of reduced-dose 16-MDCT images with standard-dose 16-MDCT images for the detection of nephroureterolithiasis using a dose reduction simulation technique. The study was HIPAA compliant and institutional review board approved. Fifty consecutive patients with suspected nephrolithiasis were recruited to undergo conventional renal stone unenhanced 16-MDCT with at least 160 mA. Noise was then artificially introduced to simulate levels of 70, 100, and 130 mA. Three blinded independent readers interpreted the original and simulated-dose scans for the location and number of renal and ureteral calculi and secondary signs of obstruction using a 5-point confidence scale. Reader acceptability of scans was inversely related to noise. There was no significant reduction in readers' confidence in detection or exclusion of renal collecting system calculi with simulated reduction of mA of 70, 100, and 130 compared with the standard-dose study. However, for ureteral calcifications, there was a decrease in confidence for the detection or exclusion of ureterolithiasis at an mA of 70 (35 mAs). An mA as low as 70 (35 mAs) is acceptable for evaluation of nephrolithiasis. However, the evaluation of ureterolithiasis is compromised with an mA of 70.

  10. The diagnostic role of MDCT enterography in small bowel lesions

    OpenAIRE

    Hasan I. Megally; Hosam eldin Mohamed Elmalah; Gehan S. Seifeldein; Nisreen Adel Abbas; Hussien Ahmed Elamin

    2015-01-01

    Purpose: To evaluate the role of MDCT enterography in the diagnosis of small bowel diseases. Patient and methods: Thirty nine patients suspected to have small bowel diseases were examined with 64 MDCT enterography. Result: MDCT enterography easily diagnosed small intestinal diseases which confirmed with histopathological results, operative data and follow up. Conclusions: MDCT can be used as a front-line imaging and one stop imaging modality for the detection of small bowel diseases....

  11. MDCT features of cardiothoracic sources of stroke

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    Hoey, E.T.D.; Mansoubi, H. [Department of Radiology, Papworth Hospital, Cambridge (United Kingdom); Gopalan, D. [Department of Radiology, Papworth Hospital, Cambridge (United Kingdom)], E-mail: deepa.gopalan2@papworth.nhs.uk; Tasker, A.D.; Screaton, N.J. [Department of Radiology, Papworth Hospital, Cambridge (United Kingdom)

    2009-05-15

    Multidetector computed tomography (MDCT) is widely used in the assessment of cardiothoracic disease and provides high-resolution images of the heart, great vessels, and lungs. A range of cardiothoracic conditions can precipitate stroke, including intracardiac thrombus, right-to-left shunts, and diseases of the thoracic aorta. Many of these conditions may be identified on non-electrocardiogram (ECG)-gated studies, but the advent of high temporal resolution ECG-gated MDCT provides superior anatomical delineation. Radiologists should be familiar with the pathogenesis and CT features of cardiothoracic conditions that can precipitate stroke as their early identification to enables appropriate management and prognostic decisions.

  12. MDCT features of cardiothoracic sources of stroke.

    Science.gov (United States)

    Hoey, E T D; Mansoubi, H; Gopalan, D; Tasker, A D; Screaton, N J

    2009-05-01

    Multidetector computed tomography (MDCT) is widely used in the assessment of cardiothoracic disease and provides high-resolution images of the heart, great vessels, and lungs. A range of cardiothoracic conditions can precipitate stroke, including intracardiac thrombus, right-to-left shunts, and diseases of the thoracic aorta. Many of these conditions may be identified on non-electrocardiogram (ECG)-gated studies, but the advent of high temporal resolution ECG-gated MDCT provides superior anatomical delineation. Radiologists should be familiar with the pathogenesis and CT features of cardiothoracic conditions that can precipitate stroke as their early identification to enables appropriate management and prognostic decisions.

  13. Virtual Coronary Angioscopy - EBCT vs MDCT

    NARCIS (Netherlands)

    van Ooijen, P; Dorgelo, J; Oudkerk, M; Lewis, BS; Halon, DA; Flugelman, MY; Gensini, GF

    2003-01-01

    Introduction of new acquisition techniques like Electron Beam Computed Tomography (EBCT) and Multi Detector Computed Tomography (MDCT) have enabled the visualization of the coronary artery tree using non-invasive methods. Because of the use of these new techniques, new possibilities have emerged in

  14. Multiphasic MDCT in small bowel volvulus

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    Feng Shiting, E-mail: fst1977@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Chan Tao, E-mail: taochan@hku.hk [Department of Diagnostic Radiology, University of Hong Kong, Room 406, Block K, Queen Mary Hospital (Hong Kong); Sun Canhui, E-mail: canhuisun@sina.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Li Ziping, E-mail: liziping163@tom.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Guo Huanyi, E-mail: guohuanyi@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Yang Guangqi, E-mail: shwy03@126.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Peng Zhenpeng, E-mail: ppzhen@21cn.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Meng Quanfei, E-mail: mzycoco@gmail.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China)

    2010-11-15

    Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

  15. Positive expiratory pressure and oscillatory positive expiratory pressure therapies.

    Science.gov (United States)

    Myers, Timothy R

    2007-10-01

    Airway clearance techniques, historically referred to as chest physical therapy, have traditionally consisted of a variety of breathing maneuvers or exercises and manual percussion and postural drainage. The methods and types of airway clearance techniques and devices have rapidly increased in an effort to find a more efficacious strategy that allows for self-therapy, better patient adherence and compliance, and more efficient durations of care. Mechanically applied pressure devices have migrated from European countries over the last several decades to clinical practice in the United States. I conducted a comprehensive MEDLINE search of two such devices: positive expiratory pressure (PEP) and oscillatory positive expiratory pressure (OPEP) and their role in airway clearance strategies. This was followed by a comprehensive search for cross-references in an attempt to identify additional studies. The results of that search are contained and reported in this review. From a methods standpoint, most of the studies of PEP and OPEP for airway clearance are limited by crossover designs and small sample sizes. While PEP and OPEP do not definitively prove superiority to other methods of airway clearance strategies, there is no clear evidence that they are inferior. Ultimately, the correct choice may be an airway clearance strategy that is clinically and cost effective, and is preferred by the patient so that adherence and compliance can be at the very least supported.

  16. Ectopic Varices in Colonic Stoma: MDCT Findings

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    Choi, Jae Woong; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min; Kim, Jin Yong [Guro Hospital of Korea University, Seoul (Korea, Republic of)

    2006-12-15

    We describe the 2D reformatted and 3D volume rendered images by MDCT in a patient with an episode of acute bleeding from the colonic stoma. This case indicates that the 2D reformatted and 3D volume rendered images are useful to detect this rare complication of portal hypertension, and they help to tailor adequate treatment for the patients with bleeding from stomal varices. Ectopic varices are an uncommon cause of gastrointestinal hemorrhage, but they account for up to 5% of all variceal bleedings (1). Bleeding from stomal varices has been reported in up to 20% of the patients suffering with chronic liver failure with permanent stoma (2). However, the diagnosis of stomal varices is difficult because bleeding from stoma may also be associated with lower gastrointestinal bleeding. To the best of our knowledge, the 2D reformatted and 3D volume rendered images by MDCT for visualization of ectopic stomal varices have not been previously reported in the medical literature.

  17. Assessment of vascular invasion in pancreatic carcinoma by MDCT

    Directory of Open Access Journals (Sweden)

    Omar Hassanen

    2014-06-01

    Conclusion: Assessment of vascular invasion is crucial in the evaluation of resectability for pancreatic cancer. MDCT is an accurate diagnostic tool for peripancreatic vascular invasion in cancer pancreas.

  18. Investigation of airways using MDCT for visual and quantitative assessment in COPD patients

    Directory of Open Access Journals (Sweden)

    Pierre-Yves Brillet

    2008-03-01

    Full Text Available Pierre-Yves Brillet1, Catalin I Fetita2, Amaury Saragaglia2, Anne-Laure Brun3, Catherine Beigelman-Aubry3, Françoise Prêteux2, Philippe A Grenier31Department of Radiology, Avicenne Hospital, Assistance Publique–Hôpitaux de Paris, Université Léonard de Vinci–Paris Nord, EA 2361, Bobigny, France; 2ARTEMIS Department, Institut National des Télécommunications, Université Paris V, Evry, France; 3Department of Radiology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, FranceAbstract: Multidetector computed tomography (MDCT acquisition during a single breath hold using thin collimation provides high resolution volumetric data set permitting multiplanar and three dimensional reconstruction of the proximal airways. In chronic obstructive pulmonary disease (COPD patients, this technique provides an accurate assessment of bronchial wall thickening, tracheobronchial deformation, outpouchings reflecting dilatation of the submucous glands, tracheobronchomalacia, and expiratory air trapping. New software developed to segment adequately the lumen and walls of the airways on MDCT scans allows quantitative assessment of the airway dimensions which has shown to be reliable in clinical practice. This technique can become important in longitudinal studies of the pathogenesis of COPD, and in the assessment of therapeutic interventions.Keywords: COPD – tracheobronchial tree, multidetector CT – airway remodeling, tracheobronchomalacia

  19. Chloral hydrate sedation in radiology: retrospective audit of reduced dose

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    Bracken, Jennifer [Children' s University Hospital, Radiology Department, Dublin (Ireland); Royal Children' s Hospital, Department of Medical Imaging, Parkville, Victoria (Australia); Heaslip, Ingrid; Ryan, Stephanie [Children' s University Hospital, Radiology Department, Dublin (Ireland)

    2012-03-15

    Chloral hydrate (CH) is safe and effective for sedation of suitable children. The purpose of this study was to assess whether adequate sedation is achieved with reduced CH doses. We retrospectively recorded outpatient CH sedations over 1 year. We defined standard doses of CH as 50 mg/kg (infants) and 75 mg/kg (children >1 year). A reduced dose was defined as at least 20% lower than the standard dose. In total, 653 children received CH sedation (age, 1 month-3 years 10 months), 42% were given a reduced initial dose. Augmentation dose was required in 10.9% of all children, and in a higher proportion of children >1 year (15.7%) compared to infants (5.7%; P < 0.001). Sedation was successful in 96.7%, and more frequently successful in infants (98.3%) than children >1 year (95.3%; P = 0.03). A reduced initial dose had no negative effect on outcome (P = 0.19) or time to sedation. No significant complications were seen. We advocate sedation with reduced CH doses (40 mg/kg for infants; 60 mg/kg for children >1 year of age) for outpatient imaging procedures when the child is judged to be quiet or sleepy on arrival. (orig.)

  20. The usefulness of MDCT in acute intestinal bleeding

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    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won [College of Medicine, Yeungnam University, Daegu (Korea, Republic of)

    2006-10-15

    We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted.

  1. MDCT findings in sports and recreational accidents

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    Bensch, Frank V; Koivikko, Mika P; Koskinen, Seppo K (Dept. of Radiology, Toeoeloe Hospital, Helsinki (Finland)), email: frank.bensch@hus.fi

    2011-12-15

    Background. Sports and recreational accidents involving critical areas of the body occur commonly in the general population. Reports on their demographics and recommendations for screening procedures are, however, few. Purpose. To assess injuries of the craniofacial area, spine, and torso resulting from sports and recreational accidents with multidetector computed tomography (MDCT) as primary imaging method in a Level I trauma center. Material and Methods. All emergency room CT requests over a time span of 105 months were reviewed retrospectively for trauma mechanism and injury. Patients were identified using an electronic picture archiving and communications system (PACS), and MDCT studies interpreted by two radiologists independently. Results. Of a total of 5898 patients, 492 patients (301 boys/men, 191 girls/women, age range 2-76 years, mean 33.5 years, median 29.5 years) with sports or recreational accidents emerged. A total of 102 traumatic findings were diagnosed, thereof 72 (71%) serious. The three most commonly encountered serious injuries were intracranial injury, fractures of facial bones, and vertebral injuries. The three most common injury mechanisms were bicycling, horseback riding, and team ball sports. Patients from recreational activities were on average significantly younger (29.2 years) than those from sports accidents (36.9 years; P < 0.001). Only age groups <21 years and 41-50 years differed in injury severity from the other age groups (P = 0.004 and P = 0.063, respectively). Of all trauma mechanisms, only bicycling had a significantly increased risk of injury (P < 0.001). Conclusion. Injuries in sports and recreational accidents presented with an overall incidence of 21%, of which 71% are serious. The most common mechanisms of injury were bicycling, horseback riding, and team ball sports. The largest incidence of serious injury involved bicycling. Because of the high probability of a serious injury and the high energies that are often involved

  2. Giant colonic diverticulum: radiographic and MDCT characteristics.

    Science.gov (United States)

    Zeina, Abdel-Rauf; Mahamid, Ahmad; Nachtigal, Alicia; Ashkenazi, Itamar; Shapira-Rootman, Mika

    2015-12-01

    Giant colonic diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare entity that is generally a manifestation of colonic diverticular disease. Because of its rarity and its variable and non-specific presentation, the diagnosis of GCD depends mainly on imaging findings. Knowledge of the spectrum of radiographic and CT features of the GCD is important in making the correct diagnosis and potentially preventing complications. This review focuses on imaging findings characteristic of GCD as well as its complications and radiographic mimics. Teaching points • Giant colonic diverticulum is a rare complication of diverticulosis.• The most common symptom is abdominal pain presenting in approximately 70 % of patients.• Diagnosis is based on imaging findings with plain abdominal radiographs and MDCT.• Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.

  3. MDCT of acute thrombotic and nonthrombotic pulmonary emboli.

    Science.gov (United States)

    Bhalla, Sanjeev; Lopez-Costa, Ignacio

    2007-10-01

    Acute pulmonary embolism (PE) remains a common clinical challenge. MDCT pulmonary angiography has become the first line imaging study in the diagnosis of PE because of its speed, accuracy, low-interobserver variability, and ability to provide alternative diagnoses. This review article highlights the role of MDCT in the evaluation of acute thrombotic PE in the era of PIOPED 2. MDCT findings of acute PE and some potential pitfalls are covered as well as some of the controversies in imaging young and pregnant patients. MDCT findings of acute non-thrombotic PE are also covered. This latter group may be occult on the angiographic portion of the study but may declare themselves through secondary findings. Their findings and potential mimics are included so that the interpreting radiologist can make the most of a CT to rule out PE.

  4. MDCT of acute thrombotic and nonthrombotic pulmonary emboli

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    Bhalla, Sanjeev [Division of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd., St. Louis, MO 63110 (United States)], E-mail: bhallas@mir.wustl.edu; Lopez-Costa, Ignacio [Division of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, 510 South Kingshighway Blvd., St. Louis, MO 63110 (United States)], E-mail: ignacio.lc@mac.com

    2007-10-15

    Acute pulmonary embolism (PE) remains a common clinical challenge. MDCT pulmonary angiography has become the first line imaging study in the diagnosis of PE because of its speed, accuracy, low-interobserver variability, and ability to provide alternative diagnoses. This review article highlights the role of MDCT in the evaluation of acute thrombotic PE in the era of PIOPED 2. MDCT findings of acute PE and some potential pitfalls are covered as well as some of the controversies in imaging young and pregnant patients. MDCT findings of acute non-thrombotic PE are also covered. This latter group may be occult on the angiographic portion of the study but may declare themselves through secondary findings. Their findings and potential mimics are included so that the interpreting radiologist can make the most of a CT to rule out PE.

  5. Detection of metastatic bone lesions in breast cancer patients: Fused {sup 18}F-Fluoride-PET/MDCT has higher accuracy than MDCT. Preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Piccardo, Arnoldo, E-mail: arnoldo.piccardo@galliera.it [Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Altrinetti, Vania, E-mail: vania.altrinetti@galliera.it [Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Bacigalupo, Lorenzo, E-mail: lorenzo.bacigalupo@galliera.it [Department of Radiolog, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Puntoni, Matteo, E-mail: matteo.puntoni@galliera.it [Department of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Biscaldi, Ennio, E-mail: ennio.biscaldi@galliera.it [Department of Radiolog, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Gozza, Alberto, E-mail: alberto.gozza@galliera.it [Department of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Cabria, Manlio, E-mail: manlio.cabria@galliera.it [Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Iacozzi, Massimiliano, E-mail: massimiliano.iacozzi@galliera.it [Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Pasa, Ambra, E-mail: ambra.pasa@galliera.it [Department of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); Morbelli, Silvia, E-mail: silviadaniela.morbelli@hsanmartino.it [Unit of Nuclear Medicine, San Martino Hospital, Largo Rosanna Benzi 10,16132 Genoa (Italy); Villavecchia, Giampiero, E-mail: giampiero.villavecchia@galliera.it [Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy); DeCensi, Andrea, E-mail: andrea.decensi@galliera.it [Department of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa (Italy)

    2012-10-15

    Purpose: So far, no studies comparing {sup 18}F-Fluoride-PET/CT and MDCT for the detection of bone metastases are available. We compared the accuracy of {sup 18}F-Fluoride-PET/CT (MDCT: 3.75 mm thickness-image-reconstruction), whole-body Multi-Detector-CT (MDCT: 1.25 mm thickness-image-reconstruction) and {sup 18}F-Fluoride-PET/MDCT (MDCT: 1.25 mm thickness-image-reconstruction) in identifying bone metastases in breast cancer patients. Methods: We studied 39 breast cancer patients for bone metastases. Imaging was performed on an integrated PET/MDCT-system; CT images were reconstructed at 3.75 mm and 1.25 mm thickness. Two nuclear medicine physicians and one radiologist interpreted blindly {sup 18}F-Fluoride-PET/CT, {sup 18}F-Fluoride-PET/MDCT and MDCT. MDCT at 12 months served as the standard of reference. Results: Overall, 662 bone lesions were detected in our analysis. Of these, 542 were malignant and 120 were benign according to the standard of reference. {sup 18}F-Fluoride-PET/CT detected 491 bone metastases, 114 (23%) of which displayed no clear morphological changes on MDCT, whereas MDCT detected 416 bone metastases, 39 (9.3%) of which showed no {sup 18}F-Fluoride-PET uptake. Overall sensitivity and specificity were: 91% and 91%, respectively, for {sup 18}F-Fluoride-PET/CT, and 77% and 93% for MDCT. The integrated assessment of {sup 18}F-Fluoride-PET/MDCT yielded sensitivity and specificity values of 98% and 93%, respectively. Conclusions: {sup 18}F-Fluoride-PET/MDCT has higher diagnostic accuracy than {sup 18}F-Fluoride-PET/CT and MDCT for the evaluation of bone metastases in breast cancer.

  6. MDCT arthrography of the hip: value of the adaptive statistical iterative reconstruction technique and potential for radiation dose reduction.

    Science.gov (United States)

    Tobalem, Frank; Dugert, Eric; Verdun, Francis R; Dunet, Vincent; Ott, Julien G; Rudiger, Hannes A; Cherix, Stephane; Meuli, Reto; Becce, Fabio

    2014-12-01

    The purpose of this article is to assess the effect of the adaptive statistical iterative reconstruction (ASIR) technique on image quality in hip MDCT arthrography and to evaluate its potential for reducing radiation dose. Thirty-seven patients examined with hip MDCT arthrography were prospectively randomized into three different protocols: one with a regular dose (volume CT dose index [CTDIvol], 38.4 mGy) and two with a reduced dose (CTDIvol, 24.6 or 15.4 mGy). Images were reconstructed using filtered back projection (FBP) and four increasing percentages of ASIR (30%, 50%, 70%, and 90%). Image noise and contrast-to-noise ratio (CNR) were measured. Two musculoskeletal radiologists independently evaluated several anatomic structures and image quality parameters using a 4-point scale. They also jointly assessed acetabular labrum tears and articular cartilage lesions. With decreasing radiation dose level, image noise statistically significantly increased (p=0.0009) and CNR statistically significantly decreased (p=0.001). We also found a statistically significant reduction in noise (p=0.0001) and increase in CNR (p≤0.003) with increasing percentage of ASIR; in addition, we noted statistically significant increases in image quality scores for the labrum and cartilage, subchondral bone, overall diagnostic quality (up to 50% ASIR), and subjective noise (p≤0.04), and statistically significant reductions for the trabecular bone and muscles (p≤0.03). Regardless of the radiation dose level, there were no statistically significant differences in the detection and characterization of labral tears (n=24; p=1) and cartilage lesions (n=40; p≥0.89) depending on the ASIR percentage. The use of up to 50% ASIR in hip MDCT arthrography helps to reduce radiation dose by approximately 35-60%, while maintaining diagnostic image quality comparable to that of a regular-dose protocol using FBP.

  7. Effect of Expiratory Resistive Loading in Expiratory Muscle Strength Training on Orbicularis Oris Muscle Activity

    Science.gov (United States)

    Yanagisawa, Yukio; Matsuo, Yoshimi; Shuntoh, Hisato; Horiuchi, Noriaki

    2014-01-01

    [Purpose] The purpose of this study was to elucidate the effect of expiratory resistive loading on orbicularis oris muscle activity. [Subjects] Subjects were 23 healthy individuals (11 males, mean age 25.5±4.3 years; 12 females, mean age 25.0±3.0 years). [Methods] Surface electromyography was performed to measure the activity of the orbicularis oris muscle during maximum lip closure and resistive loading at different expiratory pressures. Measurement was performed at 10%, 30%, 50%, and 100% of maximum expiratory pressure (MEP) for all subjects. The t-test was used to compare muscle activity between maximum lip closure and 100% MEP, and analysis of variance followed by multiple comparisons was used to compare the muscle activities observed at different expiratory pressures. [Results] No significant difference in muscle activity was observed between maximum lip closure and 100% MEP. Analysis of variance with multiple comparisons revealed significant differences among the different expiratory pressures. [Conclusion] Orbicularis oris muscle activity increased with increasing expiratory resistive loading. PMID:24648644

  8. MDCT imaging of post interventional liver: a pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Stefania [Department of Diagnostic Imaging, Section of General and Emergency Radiology, A.Cardarelli Hospital, Viale Cardarelli, 9, 80131 Naples (Italy)]. E-mail: stefromano@libero.it; Tortora, Giovanni [Department of Diagnostic Imaging, Section of General and Emergency Radiology, A.Cardarelli Hospital, Viale Cardarelli, 9, 80131 Naples (Italy); Scaglione, Mariano [Department of Diagnostic Imaging, Section of General and Emergency Radiology, A.Cardarelli Hospital, Viale Cardarelli, 9, 80131 Naples (Italy); Lassandro, Francesco [Department of Diagnostic Imaging, Section of General and Emergency Radiology, A.Cardarelli Hospital, Viale Cardarelli, 9, 80131 Naples (Italy); Guidi, Guido [Department of Diagnostic Imaging, Section of General and Emergency Radiology, A.Cardarelli Hospital, Viale Cardarelli, 9, 80131 Naples (Italy); Grassi, Roberto [Institute of Radiology, Department ' Magrassi-Lanzara' , Second University of Naples, Naples 80138 (Italy); Romano, Luigia [Department of Diagnostic Imaging, Section of General and Emergency Radiology, A.Cardarelli Hospital, Viale Cardarelli, 9, 80131 Naples (Italy)

    2005-03-01

    In this pictorial essay, we consider the post operative MDCT findings after liver resection, transplantation, surgical managed major trauma and radiofrequency ablation of focal lesions. Common complications such as fluid collections, hemorrhage, biloma, vascular disease, hematoma, abscesses will be also considered.

  9. Renal sympathetic denervation: MDCT evaluation of the renal arteries.

    LENUS (Irish Health Repository)

    Hutchinson, Barry D

    2013-08-01

    Percutaneous transluminal renal sympathetic denervation is a new treatment of refractory systemic hypertension. The purpose of this study was to assess the clinical utility of MDCT to evaluate the anatomic configuration of the renal arteries in the context of renal sympathetic denervation.

  10. Expiratory high-resolution CT in diffuse lung disease

    Energy Technology Data Exchange (ETDEWEB)

    Arakawa, Hiroaki [St. Marianna Univ. School of Medicine, Kawasaki, Kanagawa (Japan)

    2000-08-01

    Expiratory high-resolution computed tomography (HRCT) is a powerful adjunct to inspiratory HRCT in the diagnosis of diffuse lung disease (DLD), revealing air-trapping even when the inspiratory scan is normal. Expiratory scans are also useful in the differentiation of inhomogeneous lung opacity, which is not uncommon in various types of DLD. The history and technique of expiratory HRCT are described as well as the basic understanding of lung attenuation and the diagnostic value of expiratory scans DLD. The clinical significance of the presence of expiratory air-trapping in the absence of inspiratory scan abnormality is also presented. (author)

  11. Effect of Expiratory Resistive Loading in Expiratory Muscle Strength Training on Orbicularis Oris Muscle Activity

    OpenAIRE

    2014-01-01

    [Purpose] The purpose of this study was to elucidate the effect of expiratory resistive loading on orbicularis oris muscle activity. [Subjects] Subjects were 23 healthy individuals (11 males, mean age 25.5±4.3 years; 12 females, mean age 25.0±3.0 years). [Methods] Surface electromyography was performed to measure the activity of the orbicularis oris muscle during maximum lip closure and resistive loading at different expiratory pressures. Measurement was performed at 10%, 30%, 50%, and 100% o...

  12. Circulatory effects of expiratory flow-limited exercise, dynamic hyperinflation and expiratory muscle pressure

    Directory of Open Access Journals (Sweden)

    P. T. Macklem

    2006-12-01

    Full Text Available This article reviews recent research in normal subjects exercising with and without expiratory flow limitation at 1 L·s–1 imposed by a Starling resistor in the expiratory line, and in patients with chronic obstructive pulmonary disease (COPD, using optoelectronic plethysmography to measure respiratory kinematics, combined with mouth, pleural and abdominal pressure measurements, to assess work of breathing and respiratory muscle performance. In normal subjects, flow-limited exercise resulted in the following: 1 Impaired exercise performance due to intolerable dyspnoea; 2 hypercapnia; 3 excessive respiratory muscle recruitment; 4 blood shifts from trunk to extremities; 5 a 10% reduction in cardiac output and a 5% reduction in arterial oxygen saturation, decreasing energy supplies to working respiratory and locomotor muscles. In both normal subjects and in COPD patients, dynamic hyperinflation did not always occur. Those patients that hyperinflated had worse lung function and less work of breathing, but better exercise performance than the others, in whom expiratory muscle recruitment prevented dynamic hyperinflation at the cost of increased work of breathing and excessive oxygen cost of breathing. This established an early competition between respiratory and locomotor muscles for available energy supplies. Dynamic hyperinflation is a better exercise strategy in chronic obstructive pulmonary disease than expiratory muscle recruitment, but the benefit it confers is small.

  13. Acquired tracheomalacia: detection by expiratory CT scan.

    Science.gov (United States)

    Aquino, S L; Shepard, J A; Ginns, L C; Moore, R H; Halpern, E; Grillo, H C; McLoud, T C

    2001-01-01

    The purpose of this work was to determine whether cross-sectional area and coronal and sagittal diameter measurements of the trachea between inspiration and end-expiration on CT are significantly different between patients with acquired tracheomalacia and those without this condition. Inspiratory and end-expiratory CT scans of the trachea of 23 normal patients and 10 patients with acquired tracheomalacia were analyzed. Percent changes in cross-sectional area, coronal, and sagittal diameters were calculated. For patients with tracheomalacia, mean percent changes in the upper and middle trachea between inspiration and expiration were 49 and 44%; mean changes in the coronal and sagittal diameters in the upper and middle tracheal were 4 and 10% and 39 and 54%, respectively. Control group mean percent changes in the upper and middle tracheal area were 12 and 14%, respectively, and mean changes in the coronal and sagittal diameters in the upper and middle trachea were 4 and 4% and 11 and 13%, respectively. Significant differences were calculated for changes in cross-sectional area and sagittal diameter between groups (p 18% change in the upper trachea and 28% change in the midtrachea between inspiration and expiration were observed; the probability of tracheomalacia was 89-100%. The probability of tracheomalacia was > 89%, especially if the change in sagittal diameter was > 28%. By measuring changes in tracheal cross-sectional area and sagittal diameters between inspiratory and end-expiratory CT, a significant difference can be identified between normal patients and those with acquired tracheomalacia.

  14. Perfusion measurement in acute pancreatitis using dynamic perfusion MDCT.

    Science.gov (United States)

    Bize, Pierre E; Platon, Alexandra; Becker, Christoph D; Poletti, Pierre-Alexandre

    2006-01-01

    Our objective was to determine whether MDCT with perfusion imaging could help in assessing the severity of acute pancreatitis in the initial phase of the disease. One hundred six patients with abdominal pain were prospectively enrolled in this study. Patients were separated into two groups: P1 (severe) and P2 (mild) acute pancreatitis. Mean perfusion value was 24.8 mL/100 mL/min in the P1 group and 50.5 mL/100 mL/min in the P2 group (p = 0.0016, significant). Our preliminary data suggest that pancreatic perfusion measurement using MDCT with perfusion imaging could help in assessing the severity of acute pancreatitis.

  15. Fulminant hepatic failure in children: Etiology, histopathology and MDCT findings

    Energy Technology Data Exchange (ETDEWEB)

    Cakir, Banu [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: banutopcu@yahoo.com; Kirbas, Ismail [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: drismailk@yahoo.com; Demirhan, Beyhan [Baskent University Faculty of Medicine Department of Pathology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: beyhand@baskent-ank.edu.tr; Tarhan, Nefise Cagla [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: caglat@gmail.com; Bozkurt, Alper [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: abozkurt78@hotmail.com; Ozcay, Figen [Baskent University Faculty of Medicine Department of Pediatric Gastroenterology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: fozcay@baskent.edu.tr; Coskun, Mehmet [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: mcoskun@baskent-ank.edu.tr

    2009-11-15

    Introduction: The purpose of this study is to determine the etiologies, histopathology and MDCT findings of children with fulminant hepatic failure admitted to our institution. Materials and methods: Between June 2004 and November 2006, 15 children with fulminant hepatic failure who underwent MDCT were included retrospectively in this study. Twelve patients had liver biopsies. The patients were divided into three groups as hyperacute (Group I), acute (Group II) and subacute (Group III) depending on onset of hepatic encephalopathy. Results: Hepatitis A in 4 patients, non-A, non-E hepatitis in 4; mushroom poisoning in 3; fulminant Wilson's disease in 2; autoimmune hepatitis in 1; and both hepatitis B and toxic hepatitis (with leflunomide treatment) in 1 patient were detected. MDCT of all three groups revealed diffuse reduction in hepatic attenuation in 11 patients; ascites in 9; periportal edema in 6; edema of gallbladder wall in 6; splenomegaly in 6; heterogeneous hepatic parenchyma in 6; hepatomegaly in 3; irregular contours of liver in 2; multiple micronodules in 1 and necrotic areas and regeneration in liver parenchyma in 2 patients. Histopathologic evaluation of liver biopsies showed massive hepatic necrosis, inflammatory cell infiltration and ductular proliferation in 8 patients, periportal edema in 6, edema of gallbladder wall in 5, regenerating nodules and fibrous septa consistent with cirrhotic pattern in 2, and regenerating nodules and necrotic areas in 2 patients. Conclusion: The most common MDCT findings in fulminant hepatic failure were diffuse reduction in hepatic attenuation and ascites. Massive hepatic necrosis was the most common histopathologic finding.

  16. Vascular involvement in periampullary tumors: MDCT, EUS, and CDU.

    Science.gov (United States)

    Gusmini, S; Nicoletti, R; Martinenghi, C; Del Maschio, A

    2009-07-01

    In patients affected by periampullary tumors, surgical resection represents the only treatment with curative intent. Preoperative evaluation of vascular involvement is necessary to avoid surgical treatments unable of curative intent resection. The aim of our update article is to assess the performance of multidetector computed tomography (MDCT), endoscopic ultrasonography (EUS), and color Doppler ultrasonography (CDU) in the evaluation of vascular involvement of major peripancreatic vessels, in periampullary tumors, analyzing the current and past literature.

  17. MDCT arthrography of the wrist: Diagnostic accuracy and indications

    Energy Technology Data Exchange (ETDEWEB)

    De Filippo, Massimo [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy)], E-mail: massimo.defilippo@unipr.it; Pogliacomi, Francesco [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Bertellini, Annalisa [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Araoz, Philip A. [Department of Radiology, Division of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (United States); Averna, Raffaele; Sverzellati, Nicola; Ingegnoli, Anna [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Corradi, Maurizio; Costantino, Cosimo [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Zompatori, Maurizio [Department of Radiological and Histopathological Sciences, Policlinic S.Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna (Italy)

    2010-04-15

    Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k = 0.96) and statistically significant (p < 0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.

  18. Expiratory muscle control during vomiting - Role of brain stem expiratory neurons

    Science.gov (United States)

    Miller, A. D.; Tan, L. K.

    1987-01-01

    The neural mechanisms controlling the muscles involved during vomiting were examined using decerebrated cats. In one experiment, the activity of the ventral respiratory group (VRG) expiratory (E) neurons was recorded during induced 'fictive vomiting' (i.e., a series of bursts of coactivation of abdominal and phrenic nerves that would be expected to produce expulsion in unparalyzed animals) and vomiting. In a second, abdominal muscle electromyographic and nerve activity were compared before and after sectioning the axons of descending VRG E neurons as they cross the midline between C1 and the obex (the procedure that is known to abolish expiratory modulation of internal intercostal muscle activity). The results of the study indicate that the abdominal muscles are controlled differently during respiration and vomiting.

  19. Reduced-dose CT protocol for the assessment of cerebral vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Bricout, N.; Estrade, L.; Boustia, F.; Kalsoum, E.; Pruvo, J.P.; Leclerc, X. [Hopital Roger Salengro, CHRU de Lille, Department of Neuroradiology, Universite Lille Nord de France, Lille cedex (France)

    2015-12-15

    Despite the increased radiation dose, multimodal CT including noncontrast CT (NCT), CT angiography (CTA), and perfusion CT (PCT) remains a useful tool for the diagnosis of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to assess the radiation dose and the image quality between a standard-dose and a reduced-dose multimodal CT protocol. The study group consisted of 26 aSAH patients with a suspicion of DCI on clinical examination and transcranial doppler. Two different CT protocols were used: a standard-dose protocol (NCT 120 kV, 350 mAs; CTA 100 kV, 250 mAs; PCT 80 kV, 200 mAs) from August 2011 to October 2013 (n = 13) and a reduced-dose protocol (NCT 100 kV, 400 mAs; CTA 100 kV, 220 mAs; PCT 80 kV, 180 mAs) from November 2013 to May 2014 (n = 13). Dose-length product (DLP), effective dose, volume CT dose index (CTDI), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and overall image quality were determined for each examination. The overall image quality was judged as good or excellent in all cases. The reduced-dose protocol allowed a 15 % decrease in both the median total DLP (2438 vs 2898 mGy cm, p < 0.0001) and the effective dose as well as a significant decrease in median CTDI of 23, 31, and 10 % for NCT, CTA, and CTP, respectively. This dose reduction did not result in significant alteration of SNR (except for NCT) or CNR between groups. The present study showed that the reduced-dose multimodal CT protocol enabled a significant reduction of radiation dose without image quality impairment. (orig.)

  20. Modeling of the expiratory flow pattern of spontaneously breathing cats

    NARCIS (Netherlands)

    Walraven, D; van der Grinten, CPM; Bogaard, JM; van der Ent, CK; Luijendijk, SCM

    2003-01-01

    A mathematical model was developed describing the entire expiratory flow pattern during spontaneous, tidal breathing in the absence of expiratory muscle activity. It provides estimates for the time constants of the respiratory System (tauRS(model)) and of the decay of continuing inspiratory muscle a

  1. Utility of 64-row MDCT in assessment of neonates with congenital EA and distal TEF

    Directory of Open Access Journals (Sweden)

    Hosam El-Deen Galal Mohamed El-Malah

    2015-12-01

    Conclusion: Preoperative MDCT scan with MPVR, 3D TL-VR of 64-row MDCT which is a noninvasive technique could provide more accurate information about the assessment of the origin of the fistula, the distal esophageal pouches and inter-pouch distance in neonates with EA and distal TEF.

  2. Valsalva maneuver: shortest optimal expiratory strain duration

    Directory of Open Access Journals (Sweden)

    Ramesh K. Khurana, Md

    2011-07-01

    Full Text Available Purpose : To quantitate the level of difficulty and determine consistency of hemodynamic responses with various expiratory strain (ES durations. Methods : Thirty-four healthy subjects performed the Valsalva maneuver (VM with an ES duration of 10, 12, and 15 seconds in random order. Level of difficulty after each trial was rated 1 to 10, with 10 being the most difficult. Blood pressure and heart rate (HR were recorded continuously and non-invasively. Parameters studied were Valsalva ratio (VR, early phase II (IIE, late phase II (IIL, tachycardia latency (TL, bradycardia latency (BL, and overshoot latency (OV-L. Consistency of responses was calculated. Results : Difficulty increased significantly with increased ES duration: 5.1±0.1 (mean±SEM at 10 seconds, 5.9±0.1 at 12 seconds, and 6.8±0.1 at 15 seconds (p<0.001. Phase IIE, TL, BL, OV-L, and VR response did not differ statistically with increasing ES durations, and there were no differences in variability. Phase IIL response increased significantly with increasing ES duration. Phase IIL was poorly delineated in 14 of 102 trials with 10 seconds ES duration. Conclusions : ES duration of 10 seconds created a low level of difficulty in healthy individuals. This strain duration produced consistent hemodynamic response for all parameters tested except IIL phase. The absence of IIL phase with 10 seconds ES should not be interpreted as an indicator of sympathetic vasoconstrictor failure.

  3. MDCT Diagnosis of Isolated Colonic Hernia Through the Esophageal Hiatus

    Directory of Open Access Journals (Sweden)

    Naime Altınkaya

    2011-03-01

    Full Text Available Colonic herniation through the esophageal hiatus is an unusual condition. Isolated trans-hiatal herniation of the transverse colon is very rare and only five cases have been reported. All these reported patients were symptomatic, and had dysphagia, epigastralgia, vomiting, dyspnea, cough, or palpitations. Hiatal hernia is an important clinical problem. Because of the severe complications of hiatal hernia, including bleeding, strangulation, and perforation, early diagnosis and treatment are important. A 75-year-old man who had prostate carcinoma was evaluated with multidetector computed tomography (MDCT. In this case, CT findings and clinical emphasis of the incidentally discovered isolated transverse colonic hiatal herniation was reviewed.

  4. Coronary lesion complexity assessed by SYNTAX score in 256-slice dual-source MDCT angiography

    Science.gov (United States)

    Yüceler, Zeyneb; Kantarcı, Mecit; Tanboğa, İbrahim Halil; Sade, Recep; Kızrak, Yeşim; Pirimoğlu, Berhan; Bayraktutan, Ümmügülsüm; Oğul, Hayri; Aksakal, Enbiya

    2016-01-01

    PURPOSE The SYNTAX Score (SS) has an important role in grading the complexity of coronary artery disease (CAD) in patients undergoing revascularization. Noninvasive determination of SS prior to invasive coronary angiography (ICA) might optimize patient management. We aimed to evaluate the agreement between ICA and multidetector computed tomography (MDCT) while testing the diagnostic effectiveness of SS-MDCT. METHODS Our study included 108 consecutive patients who underwent both MDCT angiography with a 256-slice dual-source MDCT system and ICA within 14±3 days. SS was calculated for both ICA and MDCT coronary angiography. Spearman’s rank correlation coefficient was used to evaluate the association of SS-MDCT with SS-ICA, and Bland-Altman analysis was performed. RESULTS The degree of agreement between SS-ICA and SS-MDCT was moderate. The mean SS-MDCT was 14.5, whereas the mean SS-ICA was 15.9. After dividing SS into three groups (high [≥33], intermediate [23–32], and low [≤22] subgroups), agreement analysis was repeated. There was a significant correlation between SS-MDCT and SS-ICA in the low SS group (r=0.63, P = 0.043) but no significant correlation in the high SS group (r=0.036, P = 0.677). The inter-test agreement analysis showed at least moderate agreement, whereas thrombotic lesions and the type of bifurcation lesion showed fair agreement. CONCLUSION The calculation of SS-MDCT by adapting SS-ICA parameters achieved nearly the same degree of precision as SS-ICA and was better than SS-ICA, especially in the low SS group. PMID:27328718

  5. Effects of expiratory resistive loading on the sensation of dyspnea.

    Science.gov (United States)

    Chonan, T; Altose, M D; Cherniack, N S

    1990-07-01

    To determine whether an increase in expiratory motor output accentuates the sensation of dyspnea (difficulty in breathing), the following experiments were undertaken. Ten normal subjects, in a series of 2-min trials, breathed freely (level I) or maintained a target tidal volume equal to (level II) or twice the control (level III) at a breathing frequency of 15/min (similar to the control frequency) with an inspiratory load, an expiratory load, and without loads under hyperoxic normocapnia. In tests at levels II and III, end-expiratory lung volume was maintained at functional residual capacity. A linear resistance of 25 cmH2O.1(-1).s was used for both inspiratory and expiratory loading; peak mouth pressure (Pm) was measured, and the intensity of dyspnea (psi) was assessed with a visual analog scale. The sensation of dyspnea increased significantly with the magnitude of expiratory Pm during expiratory loading (level II: Pm = 9.4 +/- 1.5 (SE) cmH2O, psi = 1.26 +/- 0.35; level III: Pm = 20.3 +/- 2.8 cmH2O, psi = 2.22 +/- 0.48) and with inspiratory Pm during inspiratory loading (level II: Pm = 9.7 +/- 1.2 cmH2O, psi = 1.35 +/- 0.38; level III: Pm = 23.9 +/- 3.0 cmH2O, psi = 2.69 +/- 0.60). However, at each level of breathing, neither the intensity of dyspnea nor the magnitude of peak Pm during loading was different between inspiratory and expiratory loading. The augmentation of dyspnea during expiratory loading was not explained simply by increases in inspiratory activity. The results indicate that heightened expiratory as well as inspiratory motor output causes comparable increases in the sensation of difficulty in breathing.

  6. Effect of expiratory load on neural inspiratory drive

    Institute of Scientific and Technical Information of China (English)

    XIAO Si-chang; LU Yi-rong; GUO Hong-xi; QIU Zhi-hui; LUO Yuan-ming

    2012-01-01

    Background Neural respiratory drive is usually measured during inspiration,even in patients with chronic obstructive pulmonary disease (COPD) in whom the primary physiological deficit is expiratory flow limitation.The purpose of the study was to test the hypothesis that inspiratory muscle neural respiratory drive could be used to assess expiratory load.Methods Ten healthy young men,(26±4) years old,were asked to expire through a tube immersed in water where an expiratory load was required.The load was judged by the depth of the tube in water and the different loads (0 cmH2O,10 cmH2O,20 cmH2O and 30 cmH2O) were randomly introduced.Each expiratory load lasted for 3-5 minutes and inspiration was unimpeded throughout.Diaphragm electromyogram (EMG) and transdiaphragmatic pressure were recorded by a catheter with 10 metal coils and two balloons.Incremental cycle exercise with and without an expiratory load at 30 cmH2O was also performed.Results Neural drive during expiratory loaded breathing was larger than during unloaded breathing but neural drive did not increase proportionally with increasing expiratory load; neural drive during expiratory loading at 0,10,20 and 30 cmH2O was (10.1±3.1) μV,(16.7±7.3) μV,(18.4±10.7) μV and (22.9±13.2) μV,respectively.Neural drive as a percentage of maximum at the end of exercise with or without load was similar ((57.4±11.0)% max vs.(62.7±16.4)% max,P >0.05).Conclusion Neural respiratory drive measured at inspiration does not accurately quantify expiratory load either at rest or during exercise.

  7. MDCT imaging of the stomach: advances and applications.

    Science.gov (United States)

    Nagpal, Prashant; Prakash, Anjali; Pradhan, Gaurav; Vidholia, Aditi; Nagpal, Nishant; Saboo, Sachin S; Kuehn, David M; Khandelwal, Ashish

    2017-01-01

    The stomach may be involved by a myriad of pathologies ranging from benign aetiologies like inflammation to malignant aetiologies like carcinoma or lymphoma. Multidetector CT (MDCT) of the stomach is the first-line imaging for patients with suspected gastric pathologies. Conventionally, CT imaging had the advantage of simultaneous detection of the mural and extramural disease extent, but advances in MDCT have allowed mucosal assessment by virtual endoscopy (VE). Also, better three-dimensional (3D) post-processing techniques have enabled more robust and accurate pre-operative planning in patients undergoing gastrectomy and even predict the response to surgery for patients undergoing laparoscopic sleeve gastrectomy for weight loss. The ability of CT to obtain stomach volume (for bariatric surgery patients) and 3D VE images depends on various patient and protocol factors that are important for a radiologist to understand. We review the appropriate CT imaging protocol in the patients with suspected gastric pathologies and highlight the imaging pearls of various gastric pathologies on CT and VE.

  8. Mixed-radix Algorithm for the Computation of Forward and Inverse MDCT.

    Science.gov (United States)

    Wu, Jiasong; Shu, Huazhong; Senhadji, Lotfi; Luo, Limin

    2008-08-12

    The modified discrete cosine transform (MDCT) and inverse MDCT (IMDCT) are two of the most computational intensive operations in MPEG audio coding standards. A new mixed-radix algorithm for efficient computing the MDCT/IMDCT is presented. The proposed mixed-radix MDCT algorithm is composed of two recursive algorithms. The first algorithm, called the radix-2 decimation in frequency (DIF) algorithm, is obtained by decomposing an N-point MDCT into two MDCTs with the length N/2. The second algorithm, called the radix-3 decimation in time (DIT) algorithm, is obtained by decomposing an N-point MDCT into three MDCTs with the length N/3. Since the proposed MDCT algorithm is also expressed in the form of a simple sparse matrix factorization, the corresponding IMDCT algorithm can be easily derived by simply transposing the matrix factorization. Comparison of the proposed algorithm with some existing ones shows that our proposed algorithm is more suitable for parallel implementation and especially suitable for the layer III of MPEG-1 and MPEG-2 audio encoding and decoding. Moreover, the proposed algorithm can be easily extended to the multidimensional case by using the vector-radix method.

  9. Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation

    Directory of Open Access Journals (Sweden)

    Hyeyoung Kim

    2014-09-01

    Full Text Available Background/AimsThe dose of mycophenolate mofetil (MMF has been reduced in Asia due to side effects associated with the conventional fixed dose of 2-3 g/day. We aimed to determine the pharmacokinetics of a reduced dose of MMF and to validate its feasibility in combination with tacrolimus in living-donor liver transplantation (LDLT.MethodsTwo sequential studies were performed in adult LDLT between October 2009 and 2011. First, we performed a prospective pharmacokinetic study in 15 recipients. We measured the area under the curve from 0 to 12 hours (AUC0-12 for mycophenolic acid at postoperative days 7 and 14, and we performed a protocol biopsy before discharge. Second, among 215 recipients, we reviewed 74 patients who were initially administered a reduced dose of MMF (1.0 g/day with tacrolimus (trough, 8-12 ng/mL during the first month, and 5-8 ng/mL thereafter, with a 1-year follow-up. We performed protocol biopsies at 2 weeks and 1 year post-LDLT.ResultsIn the first part of study, AUC0-12 was less than 30 mgh/L in 93.3% of cases. In the second, validating study, 41.9% of the recipients needed dose reduction or cessation due to side effects within the first year after LDLT. At 12 months post-LDLT, 17.6% of the recipients were administered a lower dose of MMF (0.5 g/day, and 16.2% needed permanent cessation due to side effects. The 1- and 12-month rejection-free survival rates were 98.6% and 97.3%, respectively.ConclusionsA reduced dose of MMF was associated with low blood levels compared to the existing recommended therapeutic range. However, reducing the dose of MMF combined with a low level of tacrolimus was feasible clinically, with an excellent short-term outcome in LDLT.

  10. Hepatosplenic volumetric assessment at MDCT for staging liver fibrosis.

    Science.gov (United States)

    Pickhardt, Perry J; Malecki, Kyle; Hunt, Oliver F; Beaumont, Claire; Kloke, John; Ziemlewicz, Timothy J; Lubner, Meghan G

    2017-07-01

    To investigate hepatosplenic volumetry at MDCT for non-invasive prediction of hepatic fibrosis. Hepatosplenic volume analysis in 624 patients (mean age, 48.8 years; 311 M/313 F) at MDCT was performed using dedicated software and compared against pathological fibrosis stage (F0 = 374; F1 = 48; F2 = 40; F3 = 65; F4 = 97). The liver segmental volume ratio (LSVR) was defined by Couinaud segments I-III over segments IV-VIII. All pre-cirrhotic fibrosis stages (METAVIR F1-F3) were based on liver biopsy within 1 year of MDCT. LSVR and total splenic volumes increased with stage of fibrosis, with mean(±SD) values of: F0: 0.26 ± 0.06 and 215.1 ± 88.5 mm(3); F1: 0.25 ± 0.08 and 294.8 ± 153.4 mm(3); F2: 0.331 ± 0.12 and 291.6 ± 197.1 mm(3); F3: 0.39 ± 0.15 and 509.6 ± 402.6 mm(3); F4: 0.56 ± 0.30 and 790.7 ± 450.3 mm(3), respectively. Total hepatic volumes showed poor discrimination (F0: 1674 ± 320 mm(3); F4: 1631 ± 691 mm(3)). For discriminating advanced fibrosis (≥F3), the ROC AUC values for LSVR, total liver volume, splenic volume and LSVR/spleen combined were 0.863, 0.506, 0.890 and 0.947, respectively. Relative changes in segmental liver volumes and total splenic volume allow for non-invasive staging of hepatic fibrosis, whereas total liver volume is a poor predictor. Unlike liver biopsy or elastography, these CT volumetric biomarkers can be obtained retrospectively on routine scans obtained for other indications. • Regional changes in hepatic volume (LSVR) correlate well with degree of fibrosis. • Total liver volume is a very poor predictor of underlying fibrosis. • Total splenic volume is associated with the degree of hepatic fibrosis. • Hepatosplenic volume assessment is comparable to elastography for staging fibrosis. • Unlike elastography, volumetric analysis can be performed retrospectively.

  11. Superoxide dismutase levels and peak expiratory flow in asthmatic children

    Directory of Open Access Journals (Sweden)

    Arie Kurniasih

    2015-09-01

    Full Text Available Background Asthma is a chronic inflammatory process which involve variety of cells such as inflammatory mediators, reactive oxygen species (ROS, and cytokines. The inflammatory process would be exacerbated in the presence of oxidative stress. Superoxide dismutase (SOD is the first important enzyme to protect the respiratory tract against oxidative stress. The decreased of SOD has a correlation with increased of airway obstruction and bronchospasm. Objective To assess for a correlation between superoxide dismutase (SOD levels and peak expiratory flow, as well as to determine the impact of SOD levels for predicting asthma attacks. Methods We conducted a prospective cohort study at Dr. Sardjito Hospital, Yogyakarta, between February and April 2011 involving asthmatic children aged 5-18 years. Subjects’ serum SOD levels and peak expiratory flow were measured at the same time point. We then performed a prospective study following up on the same subjects to find out if they had a recurrent asthma attack within one month of the tests. We also reassessed their peak expiratory flow one month after blood specimens were obtained. Results Thirty-nine patients were enrolled in this study. There was no significant correlation between SOD level and peak expiratory flow [r=0.289; 95%CI -0.025 to 0.47; P=0.074]. However, older age was significantly associated with higher peak expiratory flow (=0.5; 95%CI 3.10 to 11.57; P=0.01. Lower levels of SOD increased the risk of asthma attacks in a month following the initial measurements (RR=5.5; 95%CI 1.6 to 18.9; P=0.009. Conclusion Superoxide dismutase (SOD level is not significantly associated with peak expiratory flow. However, we find a relationship between older age and higher peak expiratory flow and a relationship between lower SOD levels and risk of asthma attacks within one month following the tests.

  12. Radiological profile of anemia on unenhanced MDCT of the thorax

    Energy Technology Data Exchange (ETDEWEB)

    Kamel, Ehab M.; Rizzo, Elena; Duran, Rafael; Goncalves-Matoso, Vasco; Schnyder, Pierre [Centre Hospitalier Universitaire Vaudois (CHUV), Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Duchosal, Michel A. [Centre Hospitalier Universitaire Vaudois (CHUV), Service of Hematology, Lausanne (Switzerland); Qanadli, Salah D. [Centre Hospitalier Universitaire Vaudois (CHUV), Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); University of Lausanne-CHUV, Diagnostic and Interventional Radiology, Lausanne (Switzerland)

    2008-09-15

    Our aim was to investigate the diagnostic value of unenhanced MDCT in anemic patients. Fifty consecutive patients with proven anemia and 50 nonanemic matched group for age, sex and body mass index were evaluated. In either group, hemoglobin levels were assessed no more than 24 h from an unenhanced CT of the thorax. For each patient, the presence of a hyperattenuating aortic wall (aortic ring sign) and/or dense interventricular septum (subjective parameters) were identified by two radiologists who were blinded to the laboratory findings. Furthermore, the aortic CT attenuation values (objective parameter) were also obtained and correlated with the hemoglobin levels. The sensitivity and specificity in detecting anemia were calculated for each variable, and ROC analysis was generated for subjective and objective parameters. Subjective image analysis revealed that the aortic ring sign was more sensitive than the interventricular septum sign for anemia detection (84% vs. 72%), whereas this latter sign was more specific (100% vs. 92%). A good correlation (r=0.60) was observed between the aortic CT attenuation values and the hemoglobin levels in the whole study population. Using a threshold of {<=}35 HU for anemia diagnosis, the sensitivity and specificity of aortic CT attenuation value were 84% and 94%, respectively, with the largest area under the curve (0.89) among all diagnostic criteria. However, the best trade-off between sensitivity (80%) and specificity (100%) was obtained from combining both subjective and objective analysis. Interpreting anemia upon unnenhanced MDCT of the thorax is quite feasible. A diagnostic approach that considers both subjective and objective analysis offers the best trade-off between sensitivity and specificity. (orig.)

  13. Empirical description of bronchial and nonbronchial arteries with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Yu Hong, E-mail: yuhong.2002@hotmail.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Liu Shiyuan, E-mail: cjr.liushiyuan@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Li Huimin, E-mail: yuhongphd@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Xiao Xiangsheng, E-mail: cjr.xxsh@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Dong Weihua, E-mail: dongweihua2000@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China)

    2010-08-15

    Purpose: We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders. Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries. Results: We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat. Conclusions: The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.

  14. MDCT assessment of HCC patient after radiofrequency ablation among Egyptian population: Preliminary experience

    Directory of Open Access Journals (Sweden)

    Nadia F. El Ameen

    2014-06-01

    Conclusion: RF ablation is an internationally approved treatment for HCC. MDCT should be the corner stone method for follow to achieve better results and improve the survival rate via early detection and immediate interference with any new or recurrent lesions.

  15. Multidetector computed tomography (MDCT angiography of thoracic aortic coarctation in pediatric patients: Pre-operative evaluation

    Directory of Open Access Journals (Sweden)

    Mohamad Zakaryia Al-Azzazy

    2014-03-01

    Conclusion: We concluded that MDCT angiography with multiplanar and three dimensional techniques can be considered the modality of choice for pre-operative assessment of coarctation of the thoracic aorta in pediatric patients.

  16. How accurate is unenhanced multidetector-row CT (MDCT) for localization of renal calculi?

    Energy Technology Data Exchange (ETDEWEB)

    Goetschi, Stefan, E-mail: goetschi@gmx.net [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Umbehr, Martin, E-mail: martin.umbehr@triemli.ch [Urology Clinic, Department of Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Ullrich, Stephan, E-mail: stephan.ullrich@triemli.ch [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Glenck, Michael, E-mail: michael.glenck@triemli.ch [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Suter, Stefan, E-mail: stefan.suter@triemli.ch [Urology Clinic, Department of Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland); Weishaupt, Dominik, E-mail: dominik.weishaupt@triemli.ch [Institute of Radiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zuerich (Switzerland)

    2012-11-15

    Purpose: To investigate the correlation between unenhanced MDCT and intraoperative findings with regard to the exact anatomical location of renal calculi. Design, setting, and participants: Fifty-nine patients who underwent unenhanced MDCT for suspected urinary stone disease, and who underwent subsequent flexible ureterorenoscopy (URS) as treatment of nephrolithiasis were included in this retrospective study. All MDCT data sets were independently reviewed by three observers with different degrees of experience in reading CT. Each observer was asked to indicate presence and exact anatomical location of any calcification within pyelocaliceal system, renal papilla or renal cortex. Results were compared to intraoperative findings which have been defined as standard of reference. Calculi not described at surgery, but present on MDCT data were counted as renal cortex calcifications. Results: Overall 166 calculi in 59 kidneys have been detected on MDCT, 100 (60.2%) were located in the pyelocaliceal system and 66 (39.8%) in the renal parenchyma. Of the 100 pyelocaliceal calculi, 84 (84%) were correctly located on CT data sets by observer 1, 62 (62%) by observer 2, and 71 (71%) by observer 3. Sensitivity/specificity was 90-94% and 50-100% if only pyelocaliceal calculi measuring >4 mm in size were considered. For pyelocaliceal calculi {<=}4 mm in size diagnostic performance of MDCT was inferior. Conclusion: Compared to flexible URS, unenhanced MDCT is accurate for distinction between pyelocaliceal calculi and renal parenchyma calcifications if renal calculi are >4 mm in size. For smaller renal calculi, unenhanced MDCT is less accurate and distinction between a pyelocaliceal calculus and renal parenchyma calcification is difficult.

  17. Trabecular bone structure analysis of the spine using clinical MDCT: can it predict vertebral bone strength?

    Science.gov (United States)

    Baum, Thomas; Gräbeldinger, Martin; Räth, Christoph; Garcia, Eduardo Grande; Burgkart, Rainer; Patsch, Janina M; Rummeny, Ernst J; Link, Thomas M; Bauer, Jan S

    2014-01-01

    Recent technical improvements have made it possible to determine trabecular bone structure parameters of the spine using clinical multi-detector computed tomography (MDCT). Therefore, the purpose of this study was to analyze trabecular bone structure parameters obtained from clinical MDCT in relation to high resolution peripheral quantitative computed tomography (HR-pQCT) as a standard of reference and to investigate whether clinical MDCT can predict vertebral bone strength. Fourteen functional spinal segment units between T7 and L3 were harvested from 14 formalin-fixed human cadavers (11 women and 3 men; age 84 ± 10 years). All functional spinal segment units were examined using HR-pQCT (isotropic voxel size of 41 μm(3)) and a clinical whole-body MDCT (interpolated voxel size of 146 × 146 × 300 μm(3)). Trabecular bone structure analyses (histomorphometric and texture measures) were performed in the HR-pQCT as well as MDCT images. Vertebral failure load (FL) of the functional spinal segment units was determined in an uniaxial biomechanical test. The HR-pQCT and MDCT derived trabecular bone structure parameters showed correlations ranging from r = 0.60 to r = 0.90 (p parameters and FL amounted up to r = 0.86 (p parameters obtained with HR-pQCT and MDCT were not significantly different (p > 0.05). In this cadaver model, the spatial resolution of clinically available whole-body MDCT scanners was suitable for trabecular bone structure analysis of the spine and to predict vertebral bone strength.

  18. Abdominal Wall Hernias: Various Imaging Features Correlated with the Anatomy of Abdominal Wall at MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Shin Young; Shin, Hyeong Cheol; Kim, Sang Won; Kim, Il Young; Kim, Young Tong [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2009-07-15

    Abdominal wall hernias are a common condition. However, they may develop acute complications and require surgical correction in most cases. Hence, the correct radiological examination is requisite for an accurate diagnosis. A multi-detector row CT (MDCT) provides an accurate identification of the anatomy of the abdominal wall, precise hernia type, and helps in the detection of early signs of complication. We report various imaging features of abdominal wall hernias via a MDCT.

  19. MDCT of acute subaxial cervical spine trauma: a mechanism-based approach

    OpenAIRE

    Raniga, Sameer B.; Menon, Venugopal; Al Muzahmi, Khamis S.; Butt, Sajid

    2014-01-01

    Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3–C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of...

  20. Physiological techniques for detecting expiratory flow limitation during tidal breathing

    Directory of Open Access Journals (Sweden)

    N.G. Koulouris

    2011-09-01

    Full Text Available Patients with severe chronic obstructive pulmonary disease (COPD often exhale along the same flow–volume curve during quiet breathing as they do during the forced expiratory vital capacity manoeuvre, and this has been taken as an indicator of expiratory flow limitation at rest (EFLT. Therefore, EFLT, namely attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFLT leads to small airway injury and promotes dynamic pulmonary hyperinflation, with concurrent dyspnoea and exercise limitation. In fact, EFLT occurs commonly in COPD patients (mainly in Global Initiative for Chronic Obstructive Lung Disease III and IV stage, in whom the latter symptoms are common, but is not exclusive to COPD, since it can also be detected in other pulmonary and nonpulmonary diseases like asthma, acute respiratory distress syndrome, heart failure and obesity, etc. The existing up to date physiological techniques of assessing EFLT are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, noninvasive, practical and accurate new technique.

  1. Assessment of microembolization associated with revascularization in acute myocardial infarction: MDCT cardiac perfusion and function study.

    Science.gov (United States)

    Saeed, Maythem; Hetts, Steven W; Do, Loi; Wilson, Mark W

    2013-12-01

    To use multi-detector computed tomography (MDCT) for assessing the effects of coronary microemboli on pre-existing acute myocardial infarct (AMI) and to compare this pathology to LAD microembolization and occlusion/reperfusion. An angioplasty balloon catheter was placed in the LAD coronary artery of pigs under X-ray guidance. Four animals served as controls without intervention (group A) and an additional 24 animals (8/group) were subjected to microembolization (group B), occlusion/reperfusion (group C) or combination of the two insults (group D). MDCT was used to assess perfusion, LV function and viability. At postmortem, the LV sections were stained with hematoxylin/eosin and triphenyltetrazolium chloride (TTC). Dynamic perfusion and helical cine MDCT demonstrated decline in regional LV perfusion and function, respectively, after all interventions. MDCT showed significant differences in ejection fraction between groups: A = 57.5 ± 4.7%, B = 40.3 ± 0.5% P 0.7). Microscopic examination confirmed the presence of patchy and contiguous necrosis, MVO, edema and calcium deposits. Dynamic and helical cine MDCT imaging can grade LV dysfunction and perfusion deficit, respectively. DE-MDCT demonstrated a large and persistent MVO zone after microembolization of pre-existing AMI. Furthermore, it has the potential to visualize patchy microinfarct, detect perfusion deficits and dysfunction at the border zone after microembolization of pre-existing AMI.

  2. Evaluation of Coronary Artery Bypass Grafts in the Early Postoperative Period Using 64-Slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Yu Mi; Kim, Jeong Ho; Park, Chul Hyun; Park, Kook Yang; Byun, Sung Su; Hwang, Hee Young; Park, Chul Hi; Kim, Hyung Sik [Gachon University Hospital, Incheon (Korea, Republic of)

    2009-05-15

    The aim of this study was to evaluate the accuracy of 64-slice multidetector row CT (MDCT), as compared with conventional coronary angiography (CCA), for assessing coronary artery bypass grafts (CABG) in the early (< 1 month) postoperative period. Twenty-four patients underwent both 64-slice MDCT (0.6 mm collimation, 0.37s gantry rotation) and CCA within 15 days after CABG. Sixty-five bypass grafts (20 venous grafts and 45 arterial grafts) and 67 distal runoff arteries in 24 patients were included in the analysis. The bypass grafts and distal runoffs were evaluated for the presence of significant stenosis, including obstruction. The CT findings were compared with the CCA findings. CCA confirmed that 62 of the 65 grafts were patent and that 3 had significant stenosis or obstruction. Sixty of the 62 patent grafts were correctly identified by MDCT. One of the three grafts that had significant stenosis was misinterpreted on the MDCT images. The sensitivity, specificity and positive and negative predictive values for detecting stenosis were 67%, 97%, 50% and 98%, respectively, with an overall diagnostic accuracy of 95%. MDCT also correctly detected all the stenotic distal runoff arteries (4 of 67). 64-slice MDCT is a promising alternative diagnostic modality for evaluating a CABG in the early postoperative period.

  3. Suspected pulmonary embolism and deep venous thrombosis: A comprehensive MDCT diagnosis in the acute clinical setting

    Energy Technology Data Exchange (ETDEWEB)

    Salvolini, Luca [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)], E-mail: lucasalvolini@alice.it; Scaglione, Mariano [Emergency and Trauma CT Section, Department of Radiology, Cardarelli Hospital, Via G. Merliani 31, 80127 Naples (Italy); Giuseppetti, Gian Marco; Giovagnoni, Andrea [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)

    2008-03-15

    Both pulmonary arterial and peripheral venous sides of venous thromboembolism (VTE) can now be efficiently and safely investigated by multi-detector CT (MDCT) at the same time by a combined CT angiography/CT venography protocol. In the emergency setting, the use of such a single test for patients suspected of suffering from VTE on a clinical grounds may considerably shorten and simplify diagnostic algorithms. The selection of patients to be submitted to MDCT must follow well-established clinical prediction rules in order to avoid generalized referral to CT on a generic clinical suspicion basis and excessive population exposure to increased ionizing radiation dose, especially in young patients. Clinical and anatomical wide-panoramic capabilities of MDCT allow identification of underlying disease that may explain patients' symptoms in a large number of cases in which VTE is not manifest. The analysis of MDCT additional findings on cardiopulmonary status and total thrombus burden can lead to better prognostic stratification of patients and influence therapeutic options. Some controversial points such as optimal examination parameters, clinical significance of subsegmentary emboli, CT pitfalls and/or possible falsely positive diagnoses, and outcome of untreated patients in which VTE has been excluded by MDCT without additional testing, must of course be taken into careful consideration before the definite role of comprehensive MDCT VTE 'one-stop-shop' diagnosis in everyday clinical practice can be ascertained.

  4. [Comparision of forced expiratory time, recorded by two spirometers with flow sensors of various types, and acoustic duration of tracheal forced expiratory noises].

    Science.gov (United States)

    Malaeva, V V; Pochekutova, I A; Korenbaum, V I

    2015-01-01

    In the sample of 44 volunteers forced expiratory time values obtained in spirometers, equipped with flow sensor of Lilly type and turbine flow sensor, and acoustic duration of tracheal forced expiratory noises are compared. It is shown that spirometric forced expiratory time is dependent on flow sensor type. Therefore it can't be used in diagnostic aims.

  5. Lung function in North American Indian children: reference standards for spirometry, maximal expiratory flow volume curves, and peak expiratory flow.

    Science.gov (United States)

    Wall, M A; Olson, D; Bonn, B A; Creelman, T; Buist, A S

    1982-02-01

    Reference standards of lung function was determined in 176 healthy North American Indian children (94 girls, 82 boys) 7 to 18 yr of age. Spirometry, maximal expiratory flow volume curves, and peak expiratory flow rate were measured using techniques and equipment recommended by the American Thoracic Society. Standing height was found to be an accurate predictor of lung function, and prediction equations for each lung function variable are presented using standing height as the independent variable. Lung volumes and expiratory flow rates in North American Indian children were similar to those previously reported for white and Mexican-American children but were greater than those in black children. In both boys and girls, lung function increased in a curvilinear fashion. Volume-adjusted maximal expiratory flow rates after expiring 50 or 75% of FVC tended to decrease in both sexes as age and height increased. Our maximal expiratory flow volume curve data suggest that as North American Indian children grow, lung volume increases at a slightly faster rate than airway size does.

  6. Reduced-dose abdominopelvic CT using hybrid iterative reconstruction in suspected left-sided colonic diverticulitis

    Energy Technology Data Exchange (ETDEWEB)

    Laqmani, Azien; Dulz, Simon; Behzadi, Cyrus; Schmidt-Holtz, Jakob; Wassenberg, Felicia; Adam, Gerhard; Regier, Marc [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Veldhoen, Simon [University Medical Center Wuerzburg, Department of Diagnostic and Interventional Radiology, Wuerzburg (Germany); Derlin, Thorsten [Hannover Medical School, Department of Nuclear Medicine, Hannover (Germany); Sehner, Susanne [University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg (Germany); Nagel, Hans-Dieter [Scientific and Application-oriented Studies and Consulting in Radiology (SASCRAD), Buchholz (Germany)

    2016-01-15

    To assess the effect of hybrid iterative reconstruction (HIR) and filtered back projection (FBP) on abdominopelvic CT with reduced-dose (RD-APCT) in the evaluation of acute left-sided colonic diverticulitis (ALCD). Twenty-five consecutive patients with suspected ALCD who underwent RD-APCT (mean CTDIvol 11.2 ± 4.2 mGy) were enrolled in this study. Raw data were reconstructed using FBP and two increasing HIR levels, L4 and L6. Two radiologists assessed image quality, image noise and reviewer confidence in interpreting findings of ALCD, including wall thickening, pericolic fat inflammation, pericolic abscess, and contained or free extraluminal air. Objective image noise (OIN) was measured. OIN was reduced up to 54 % with HIR compared to FBP. Subjective image quality of HIR images was superior to FBP; subjective image noise was reduced. The detection rate of extraluminal air was higher with HIR L6. Reviewer confidence in interpreting CT findings of ALCD significantly improved with application of HIR. RD-APCT with HIR offers superior image quality and lower image noise compared to FBP, allowing a high level of reviewer confidence in interpreting CT findings in ALCD. HIR facilitates detection of ALCD findings that may be missed with the FBP algorithm. (orig.)

  7. Maximal expiratory flow volume curve in quarry workers.

    Science.gov (United States)

    Subhashini, Arcot Sadagopa; Satchidhanandam, Natesa

    2002-01-01

    Maximal Expiratory Flow Volume (MEFV) curves were recorded with a computerized Spirometer (Med Spiror). Forced Vital Capacity (FVC), Forced Expiratory Volumes (FEV), mean and maximal flow rates were obtained in 25 quarry workers who were free from respiratory disorders and 20 healthy control subjects. All the functional values are lower in quarry workers than in the control subject, the largest reduction in quarry workers with a work duration of over 15 years, especially for FEF75. The effects are probably due to smoking rather than dust exposure.

  8. Application of adaptive non-linear 2D and 3D postprocessing filters for reduced dose abdominal CT.

    Science.gov (United States)

    Borgen, Lars; Kalra, Mannudeep K; Laerum, Frode; Hachette, Isabelle W; Fredriksson, Carina H; Sandborg, Michael; Smedby, Orjan

    2012-04-01

    Abdominal computed tomography (CT) is a frequently performed imaging procedure, resulting in considerable radiation doses to the patient population. Postprocessing filters are one of several dose reduction measures that might help to reduce radiation doses without loss of image quality. To assess and compare the effect of two- and three-dimensional (2D, 3D) non-linear adaptive filters on reduced dose abdominal CT images. Two baseline abdominal CT image series with a volume computer tomography dose index (CTDI (vol)) of 12 mGy and 6 mGy were acquired for 12 patients. Reduced dose images were postprocessed with 2D and 3D filters. Six radiologists performed blinded randomized, side-by-side image quality assessments. Objective noise was measured. Data were analyzed using visual grading regression and mixed linear models. All image quality criteria were rated as superior for 3D filtered images compared to reduced dose baseline and 2D filtered images (P 0.05). There were no significant variations of objective noise between standard dose and 2D or 3D filtered images. The quality of 3D filtered reduced dose abdominal CT images is superior compared to reduced dose unfiltered and 2D filtered images. For patients with BMI < 30 kg/m(2), 3D filtered images are comparable to standard dose images.

  9. MAXILLOFACIAL AND ORBITAL INJURIES EVALUATION BY THREE DIMENSIONAL MDCT

    Directory of Open Access Journals (Sweden)

    Shrishail

    2015-09-01

    Full Text Available There has been considerable increase in maxillofacial and orbital injuries due to road traffic accidents, falls and assaults. There is need for accurate detection of these maxillofacial bony fractures. MDCT is the method of choice in the evaluation of maxillofacial traumas, as it allows accurate determination of the presence, location and extent of fractures especially in cases of communited fractures, rotational deformities and multiple bone fractures also having advantage to diagnose even in patients with facial edema, lacerations and altered sensorium. PURPOSE: The objective of the study is to compare axial, coronal and 3D reformatted CT images for the study of maxillofacial and orbital fractures. MATERIALS AND METHODS: Multislice CT scan was done for 131 patients attending BTGH Gulbarga with history of maxillofacial and orbital trauma during the period of December 2012 to September 2014 using Philips Brilliance 6 slice CT scanner. RESULTS : Majority of the patients were males (85.5% belonged to age group of 21 - 30 years (42%. Most common cause of maxillofacial trauma was road traffic accident (78.6%. Fractures of nasal bones were most common followed by walls of maxillary sinuses and least common fractured bone was cribriform plate. Most common type of complex fracture was naso - ethmoido - orbital complex fracture followed by zygomaticomaxillary complex. Lateral wall of the orbit was most commonly fractured followed by medial wall and floor. DISCUSSION : Axial CT was better in diagnosing anterior maxillary wall, zygomatic arch fractures. Coronal CT was better in detecting orbital floor, O rbital roof, P terygoid plate fractures, C lassification of Le Fort fractures and orbital floor blow out fractures. 3D CT was slightly better to 2D CT in evaluating anterior maxillary wall fractures and frontal bone fractures. 2D and 3D CT were almost similar in evaluating fractures of nasal bone, zygomatic bone and zygomatic arch fractures. 3D CT was

  10. Application of adaptive non-linear 2D and 3D postprocessing filters for reduced dose abdominal CT

    Energy Technology Data Exchange (ETDEWEB)

    Borgen, Lars (Dept. of Radiology, Drammen Hospital, Drammen and Buskerud Univ. College, Drammen (Norway)), Email: lars.borgen@vestreviken.no; Kalra, Mannudeep K. (Massachusetts General Hospital Imaging, Harvard Medical School, Massachusetts General Hospital, Boston (United States)); Laerum, Frode (Dept. of Radiology, Akershus Univ. Hospital, Loerenskog (Norway)); Hachette, Isabelle W.; Fredriksson, Carina H. (ContextVision AB, Linkoeping (Sweden)); Sandborg, Michael (Dept. of Medical Physics, IMH, Faculty of Health Sciences, Linkoeping Univ., County Council of Oestergoetland, Linkoeping (Sweden); Center for Medical Image Science and Visualization, Linkoeping (Sweden)); Smedby, Oerjan (Center for Medical Image Science and Visualization, Linkoeping (Sweden); Dept. of Radiology, Linkoeping Univ., Linkoeping (Sweden))

    2012-04-15

    Background: Abdominal computed tomography (CT) is a frequently performed imaging procedure, resulting in considerable radiation doses to the patient population. Postprocessing filters are one of several dose reduction measures that might help to reduce radiation doses without loss of image quality. Purpose: To assess and compare the effect of two- and three-dimensional (2D, 3D) non-linear adaptive filters on reduced dose abdominal CT images. Material and Methods: Two baseline abdominal CT image series with a volume computer tomography dose index (CTDI{sub vol}) of 12 mGy and 6 mGy were acquired for 12 patients. Reduced dose images were postprocessed with 2D and 3D filters. Six radiologists performed blinded randomized, side-by-side image quality assessments. Objective noise was measured. Data were analyzed using visual grading regression and mixed linear models. Results: All image quality criteria were rated as superior for 3D filtered images compared to reduced dose baseline and 2D filtered images (P < 0.01). Standard dose images had better image quality than reduced dose 3D filtered images (P < 0.01), but similar image noise. For patients with body mass index (BMI) < 30 kg/m2 however, 3D filtered images were rated significantly better than normal dose images for two image criteria (P < 0.05), while no significant difference was found for the remaining three image criteria (P > 0.05). There were no significant variations of objective noise between standard dose and 2D or 3D filtered images. Conclusion: The quality of 3D filtered reduced dose abdominal CT images is superior compared to reduced dose unfiltered and 2D filtered images. For patients with BMI < 30 kg/m2, 3D filtered images are comparable to standard dose images

  11. Ovarian and endocrine responses in tropical sheep treated with reduced doses of cloprostenol.

    Science.gov (United States)

    Contreras-Solis, Ignacio; Vasquez, B; Diaz, T; Letelier, C; Lopez-Sebastian, A; Gonzalez-Bulnes, A

    2009-09-01

    The present study aimed to assess the efficacy of reduced doses of cloprostenol for synchronizing estrus and ovulation in hair sheep. With the aim to evaluate the luteolytic activity of reduced cloprostenol doses, a first experiment was performed using a relatively large (group H: 126 microg; n=8), medium (group M: 68.25 microg; n=6) and small (group L: 38.5 microg; n=6) cloprostenol dose. Luteolysis was assessed at Days 3 and 6 after injection (Day 0) by progesterone concentrations (P(4)) and transrectal ultrasonography (US). In Experiment 2, sheep were randomly assigned to the same three doses to evaluate a protocol for estrous synchronization using two injections administered 9 days apart. A third trial was performed with ewes treated (9 days apart) with the large dose (H=126 microg; n=12) and with a small dose adjusted for facilitating volume management (LA=43.75 microg; n=12). Presence of estrous cycling was determined in all the ewes by US and P(4) assay, at Days -9, -6, -2, 0 (Day of second cloprostenol injection), 8 and 11. Bleeding and US were done every 4h from 16 h of the beginning of the estrus during the third trial to assess the preovulatory LH surge and timing of ovulation. Additionally, blood samples were drawn at Days 0, 1, 2 and 3 to assess estradiol (Experiments 2 and 3) and P(4) (Experiment 2) concentrations during the ovarian follicular phase. In all experiments, percentage of animals showing luteolysis, preovulatory follicular dynamics and function and percentage of ewes showing behavioral estrus in response to treatment was similar among groups. Timing of estrus for group H was earlier than group L (28.6+/-1.8h compared with 37.1+/-2.4h; Psheep, with the additional advantage of reducing treatment costs.

  12. Detection of cutaneous invasion by malignant head and neck tumors with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Nemec, Stefan Franz [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)], E-mail: stefan.nemec@meduniwien.ac.at; Linecker, Alexander [Department of Craniomaxillofacial and Oral Surgery, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Czerny, Christian; Imhof, Herwig; Krestan, Christian Robert [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

    2008-11-15

    Objective: Cutaneous invasion by direct infiltration and metastasis, in malignant head and neck tumors, has a distinct impact on therapeutic options, especially surgical procedures, curative intent, and overall prognosis. Therefore, the purpose of this study was to determine the diagnostic accuracy of MDCT in detecting cutaneous invasion by malignant head and neck tumors. Materials and methods: Nineteen patients with malignant head and neck tumors and clinical suspicion of cutaneous invasion routinely underwent contrast-enhanced 16-row MDCT (Philips MDCT MX 8000) of the region of interest in the axial plane before surgical intervention. The following parameters were used: 16 mm x 0.75 mm detector collimation; 3 mm reconstructed slice thickness; 1.5 mm increment; 0.75 s rotation speed; 120 kV, 200 mAs; and 100 ml non-ionic contrast agent, i.v., with a flow of 2.0 ml/s and a scan delay of 50 s. The studies were reconstructed with a soft tissue algorithm (W400, L100 HU), and coronal and sagittal planes were also reconstructed. The axial images were retrospectively reviewed in consensus by two radiologists for the evidence of cutaneous invasion blinded to the histological results. The MDCT results were correlated with histology that was obtained by punch biopsy or surgery. Results: MDCT correctly revealed 11 of 11 cases with cutaneous invasion, and correctly excluded 4 of 8 cases without cutaneous invasion. The diagnostic accuracy of MDCT in detecting cutaneous invasion showed a sensitivity of 100%, a specificity of 50%, and an overall accuracy of 79%. Conclusion: MDCT reconstructed with a soft tissue algorithm has a good sensitivity and moderate overall accuracy in detecting cutaneous invasion by malignant head and neck tumors.

  13. Consideration of Adverse Reaction to MDCT Contrast Media

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Won Seok; Shin, Seong Gyu [Dept. of Radiology, Dong A University Medical Center, Busan (Korea, Republic of)

    2012-03-15

    In this experiment, we investigated 82 patients who suffered adverse reactions due to contrast medium. We selected the subjects out of 21,178 people who had an intravenous injection of contrast medium to undergo MDCT examination at one university hospital in Busan in 2007. As a result, the largest groups of the patients were as follows. 52.4% of the patients were male when classify by gender; 28.0% of the patients were 50's by age; 45% of the patients got when it was spring(April and March); 75.6% of the patients had a side effects when the speed of injection is 2.5 mL/sec; 58.5% of the patients were suffered when the volume of injected contrast medium is over 130 mL. Urticaria was the main symptom of side effect as 26.8%. And the main treatment for the effect was alleviating the symptoms before making patients to return home. Thus, practical preventive measures are needed as follows: use the OCS system to observe warning signs at risky patients, secure warming spaces for patients to cope with season changing, prepare enough emergency kits for the patients in danger, and establish CPR call systems, explain the risk of contrast medium and get agree about using contrast medium.

  14. Analysis of the influential factors of maximal-effort expiratory capacity of elderly women.

    Science.gov (United States)

    Lee, Bomjin; Park, Soyun; Han, Dongwook

    2016-10-01

    [Purpose] The purpose of this study was to find the influential factors of maximal-effort expiratory capacity of elderly women. [Subjects and Methods] The subjects of this study were 83 healthy elderly women. The study's methods and purpose were explained and these women agreed to participate. The maximal-effort expiratory capacity was measured using spirometry (Pony FX, COSMED Inc., Italy). We measured forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity, maximal expiratory flow 75%, maximal expiratory flow 50%, and maximal expiratory flow 25%. [Results] Regarding forced vital capacity and forced expiratory volume in 1 second, it was found that height and age were influential factors. Regarding forced expiratory volume in 1 second/forced vital capacity %, maximal expiratory flow 75%, maximal expiratory flow 50%, and maximal expiratory flow 25%, it was found that only age was an influential factor. [Conclusion] This study demonstrated that the most influential factors of maximal-effort expiratory capacity of elderly women were age, and the second influential factor was height. We noticed that weight was the least influential factor among them.

  15. The value of MDCT in diagnosis of hyaline-vascular Castleman's disease

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Xiaoli [Department of Radiology, Beijing Shijitan Hospital affiliated to Capital University of Medical Sciences, Yangfangdian Tieyiyuan, Road No. 10, Haidian District, Beijing, 100038 China (China); Liu, Cheng [CT Department, Shandong Medical Imaging Research Institute (China); Wang, Rengui, E-mail: 490150302@qq.com [Department of Radiology, Beijing Shijitan Hospital affiliated to Capital University of Medical Sciences, Yangfangdian Tieyiyuan, Road No. 10, Haidian District, Beijing, 100038 China (China); Zhu, Xuejun [Dermatology Department, Beijing University First Hospital (China); Gao, Li [Department of Radiology, Beijing University First Hospital (China); Chen, Jiuhong [Healthcare, Siemens Ltd. (China)

    2012-09-15

    Purpose: Castleman's disease (CD) is an uncommon entity characterized by a massive growth of lymphoid tissue. There are two types: the hyaline-vascular (HV) type and the plasma cell (PC) type. The purpose of this study was to evaluate the clinical value of multiple detector computed tomography (MDCT) in the diagnosis and planning of treatment for hyaline-vascular CD. Materials and methods: Fifty-two cases of confirmed hyaline-vascular CD were retrospectively reviewed. Unenhanced and contrast-enhanced MDCT scans had been performed in all patients, followed by surgery and pathological analysis of the lesion. Original MDCT transverse and reconstructed images were used for image interpretation. Features of the lesion and its adjacent structures were identified. Results: The lesion was present in the thorax of 24 patients and the abdomen in 28. Obvious features of hyaline-vascular CD (especially feeding vessels and draining veins) and its adjacent structures were demonstrated on 52 patients. Conclusion: On MDCT imaging, original MDCT transverse and reconstructed images provide an excellent tool for diagnosis of hyaline-vascular CD and have high value in the determination of a treatment plan.

  16. Role of multidetector computed tomography (MDCT in patients with ovarian masses

    Directory of Open Access Journals (Sweden)

    Mubarak F, Alam MS

    2011-04-01

    Full Text Available Fatima Mubarak, Muhammad Shahbaz Alam, Waseem Akhtar, Saima Hafeez, Noureen NizamuddinRadiology Department, Aga Khan University Hospital, Karachi, PakistanObjective: To evaluate the diagnostic accuracy of multidetector 64-slice computed tomography (MDCT in the diagnosis and differentiation of benign and malignant ovarian masses using histopathology and surgical findings as the gold standard.Material and methods: This study was conducted in Aga Khan University Hospital, Karachi, Pakistan. Data was reviewed retrospectively from 1 November 2008 to 12 December 2009. One hundred patients found to have ovarian masses on CT scan were included in the study. CT scan was performed in all these patients after administration of oral and IV contrast. Ovarian masses were classified as benign and malignant on scan findings. Imaging findings were compared with histopathologic results and surgical findings. Sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV, and diagnostic accuracy of MDCT were calculated.Results: MDCT was found to have 97% sensitivity, 91% specificity, and an accuracy of 96% in the differentiation of benign and malignant ovarian masses, while PPV and NPV were 97% and 91%, respectively.Conclusion: MDCT imaging offers a safe, accurate and noninvasive modality to differentiate between benign and malignant ovarian masses.Keywords: ovarian masses, surgery, MDCT

  17. Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts

    Energy Technology Data Exchange (ETDEWEB)

    Cansu, Aysegul, E-mail: drcansu@gmail.com [Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey); Soyturk, Mehmet; Ozturk, Mehmet Halil; Kul, Sibel [Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey); Pulathan, Zerrin [Department of Cardiovascular Surgery, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey); Dinc, Hasan [Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon (Turkey)

    2013-09-15

    Purpose: The purpose of the study was to compare the diagnostic value of color Doppler ultrasonography (CDUS) and multidetector computed tomography (MDCT) angiography against that of digital subtraction angiography (DSA) or surgery in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs). Materials and methods: CDUS and MDCT angiography were performed with 41 patients (24 men, 17 women; mean age 55.8) with dysfunctional hemodialysis fistulas. The presence of stenosis, thrombosis, aneurysm, pseudoaneurysm and seroma were recorded. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of CDUS and MDCT angiography were calculated both individually and in combination for the detection of vascular segments with significant stenosis, thrombosis, aneurysms, pseudoaneurysms, perivascular complications and stenosis subgroups. Results: Sixty-four segmental lesions were diagnosed by DSA or surgery. Sensitivity, specificity, PPV, NPV and accuracy of CDUS for all vascular tree lesions were 85.9%, 99.2%, 96.4%, 96.7% and 94.5%, respectively. For MDCT angiography the figures were 96.8%, 99.6%, 98.4%, 99.2% and 98.5%, respectively. When both tests were used in combination, sensitivity, specificity, PPV, NPV and accuracy for all vascular tree lesions rose to 100%. Conclusion: Combined use of MDCT and CDUS for diagnosis of AVF dysfunctions is of equivalent value to surgery or DSA, a gold standard technique.

  18. Virtual multislice computed tomography cystoscopy for evaluation of urinary bladder lesions; Virtuelle MDCT-Zystoskopie bei der Detektion von Blasenlaesionen

    Energy Technology Data Exchange (ETDEWEB)

    Heinz-Peer, G.; Happel, B.; Memarsadeghi, M.; Mang, T. [Medizinische Universitaet Wien (Austria). Klinik fuer Radiodiagnostik

    2005-10-01

    The introduction of multislice computed tomography (MDCT) with the possibility of acquiring isotropic datasets has been an ideal prerequisite for development of virtual MDCT cystoscopy. Remarkable technical progress regarding post-processing of high-resolution 3D datasets as well as a considerable reduction of the time required for post-processing made it possible to introduce virtual MDCT cystoscopy into the clinical routine. 3D post-processing that often required 7-8 h when virtual endoscopy techniques were first developed can now be performed in less than 5 min after transfer of data to the 3D workstation. With the limitations and contraindications of conventional cystoscopy in mind, virtual MDCT cystoscopy may be seen as a valuable alternative to conventional cystoscopy for evaluation of hematuria. (orig.) [German] Mit der Einfuehrung der Multidetektorcomputertomographie (MDCT) und der damit verbundenen Moeglichkeit, isotrope Datensaetze zu akquirieren, ergaben sich ideale Voraussetzungen zur Entwicklung der virtuellen MDCT-Zystoskopie. Beachtliche technische Fortschritte bei der Nachbearbeitung der hochaufloesenden 3D-Datensaetze sowie eine deutliche Reduktion der Nachbearbeitungszeit haben den Einsatz der virtuellen MDCT-Zystoskopie in der klinischen Routine ermoeglicht. Waren zu Beginn der Entwicklung virtueller Endoskopietechniken 3D-Nachbearbeitungszeiten von 7-8 h keine Seltenheit, kann diese heute nach dem Datentransfer auf die Workstation in weniger als 5 min erfolgen. Unter Betrachtung der Limitationen und Kontraindikationen der konventionellen Zystoskopie kann die virtuelle MDCT-Zystoskopie als wertvolle Alternative bei der Haematurieabklaerung gesehen werden. (orig.)

  19. Robust extraction of the aorta and pulmonary artery from 3D MDCT image data

    Science.gov (United States)

    Taeprasartsit, Pinyo; Higgins, William E.

    2010-03-01

    Accurate definition of the aorta and pulmonary artery from three-dimensional (3D) multi-detector CT (MDCT) images is important for pulmonary applications. This work presents robust methods for defining the aorta and pulmonary artery in the central chest. The methods work on both contrast enhanced and no-contrast 3D MDCT image data. The automatic methods use a common approach employing model fitting and selection and adaptive refinement. During the occasional event that more precise vascular extraction is desired or the method fails, we also have an alternate semi-automatic fail-safe method. The semi-automatic method extracts the vasculature by extending the medial axes into a user-guided direction. A ground-truth study over a series of 40 human 3D MDCT images demonstrates the efficacy, accuracy, robustness, and efficiency of the methods.

  20. Segmentation of the central-chest lymph nodes in 3D MDCT images.

    Science.gov (United States)

    Lu, Kongkuo; Higgins, William E

    2011-09-01

    Central-chest lymph nodes play a vital role in lung-cancer staging. The definition of lymph nodes from three-dimensional (3D) multidetector computed-tomography (MDCT) images, however, remains an open problem. We propose two methods for computer-based segmentation of the central-chest lymph nodes from a 3D MDCT scan: the single-section live wire and the single-click live wire. For the single-section live wire, the user first applies the standard live wire to a single two-dimensional (2D) section after which automated analysis completes the segmentation process. The single-click live wire is similar but is almost completely automatic. Ground-truth studies involving human 3D MDCT scans demonstrate the robustness, efficiency, and intra-observer and inter-observer reproducibility of the methods.

  1. Radiation dose reduction to the male gonads during MDCT: the effectiveness of a lead shield.

    Science.gov (United States)

    Hohl, Christian; Mahnken, Andreas H; Klotz, Ernst; Das, Marco; Stargardt, Achim; Mühlenbruch, Georg; Schmidt, Thorsten; Günther, Rolf W; Wildberger, Joachim E

    2005-01-01

    Our study was designed to quantify the effect of a standard gonad shield on the testicular radiation exposure due to scatter during routine abdominopelvic MDCT. Routine abdominopelvic MDCT was performed in 34 patients with gonadal lead shielding and 32 patients without this shielding; the testes were not exposed to the direct beam during the examination. We estimated the testicular dose administered with thermoluminescent dosimetry, taking into account each patient's body weight and body mass index (BMI). With a 1-mm lead shield, the mean testicular dose was reduced from 2.40 to 0.32 mSv, a reduction of 87%. The difference was found to be statistically significant (p Shielding the male gonads reduces the testicular radiation dose during abdominopelvic MDCT significantly and can be recommended for routine use.

  2. Measurement of response of pulmonal tumors in 64-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Sohns, Christian; Sossalla, Samuel (Dept. of Cardiology and Pneumology/Heart Center, Georg-August-Univ., Goettingen (Germany)), e-mail: christian.sohns@gmx.de; Mangelsdorf, Johanna; Obenauer, Silvia (Dept. of Radiology, Georg-August-Univ., Goettingen (Germany)); Konietschke, Frank (Dept. of Medical Statistics, Georg-August-Univ., Goettingen (Germany))

    2010-06-15

    Background: Advances in CT technology from single to multi-detector row CT (MDCT) permit a high resolution and volumetric presentation of pulmonary lesions. This implicates emerging measurement techniques that need to be contrasted with established methods. Purpose: To compare bidimensional, unidimensional, and volumetric methods for evaluation of treatment response in patients with lung lesions. Material and Methods: This study comprised 68 patients with pulmonary lesions who underwent a total of 276 64-MDCTs of chest at baseline and follow-up. RECIST and WHO criteria were used for unidimensional and bidimensional methods and region growing (RG) for volumetry. Patients were classified into four response categories. Respectively, two measurement techniques were contrasted and the kappa index was calculated. For intra-observer reproducibility the relative measurement error (RME) and kappa index with regard to agreement of response categories were evaluated. Results: Comparison of WHO und RECIST criteria achieves high correlation with kappa indices of 0.76 and 0.82. In particular, lesions with moderate increase of size in the range of 25-44% for bidimensional and 12-29% for unidimensional measurement result in different response categories when applying WHO and RECIST criteria. WHO criteria delivered PD more often than RECIST. kappa indices of 0.79 and 0.87 were attained in comparison of RECIST and RG, and 0.83 and 0.84 for WHO and RG. RME was 2.82% for RECIST, 7.53% for WHO, and 8.97% for RG. Intra-observer reproducibility was 95% for RECIST, 95% for WHO, and 96% for RG. Conclusion: The comparison of all methods resulted in no statistically significant differences. WHO criteria seemed to diverge the most, they declared several lesions prematurely as progression, and showed no benefit in comparison to RECIST. RG showed the best reproducibility, considered irregular lesions, was slightly superior to RECIST, and could be applied uniformly. Unidimensional measurement

  3. Simple shielding reduces dose to the contralateral breast during prone breast cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Goyal, Uma, E-mail: uma.goyal@gmail.com; Locke, Angela; Smith-Raymond, Lexie; Georgiev, Georgi N.

    2016-07-01

    shielded dose means were 12.68 and 1.54 cGy, respectively. When comparing medial and lateral portions of the contralateral bolus-based doses without and with Pb, the shield significantly reduced dose to both sides of the contralateral breast (medial p = 2.64 × 10{sup −14}, lateral p = 4.91 × 10{sup −6}). The prone 0.2-cm Pb shield significantly reduced scatter dose to the contralateral breast on the order of 2 to 3 times. Reductions may be clinically relevant for women younger than 45 years by decreasing the risk of contralateral radiation-induced breast cancer in patients receiving radiation therapy for breast cancer. This shield is simple as it would be a part of the prone breast board during treatments, but future studies are warranted for safety and efficacy clinically.

  4. In the workup of patients with obscure gastrointestinal bleed, does 64-slice MDCT have a role?

    Directory of Open Access Journals (Sweden)

    Chinmay Kulkarni

    2012-01-01

    Full Text Available Purpose: The purpose was to prospectively determine the sensitivity of 64-slice MDCT in detecting and diagnosing the cause of obscure gastrointestinal bleed (OGIB. Materials and Methods: Our study included 50 patients (male 30, female 20 in the age range of 3-82 years (average age: 58.52 years who were referred to our radiology department as part of their workup for clinically evident gastrointestinal (GI bleed or as part of workup for anemia (with and without positive fecal occult blood test. All patients underwent conventional upper endoscopy and colonoscopy before undergoing CT scan. Following a noncontrast scan, all patients underwent triple-phase contrast CT scan using a 64-slice CT scan system. The diagnostic performance of 64-slice MDCT was compared to the results of capsule endoscopy, 99m-technetium-labeled red blood cell scintigraphy (99mTc-RBC scintigraphy, digital subtraction angiography, and surgery whenever available. Results: CT scan showed positive findings in 32 of 50 patients. The sensitivity, specificity, positive predictive value, and negative predictive values of MDCT for detection of bleed were 72.2%, 42.8%, 81.2%, and 44.4%, respectively. Capsule endoscopy was done in 15 patients and was positive in 10 patients; it had a sensitivity of 71.4%. Eleven patients had undergone 99mTc-RBC scintigraphy prior to CT scan, and the result was positive in seven patients (sensitivity 70%. Digital subtraction angiography was performed in only eight patients and among them all except one patient showed findings consistent with the lesions detected on MDCT. Conclusion: MDCT is a sensitive and noninvasive tool that allows rapid detection and localization of OGIB. It can be used as the first-line investigation in patients with negative endoscopy and colonoscopy studies. MDCT and capsule endoscopy have complementary roles in the evaluation of OGIB.

  5. Sixty-four MDCT achieves higher contrast in pancreas with optimization of scan time delay

    Science.gov (United States)

    Stuber, Tina; Brambs, Hans-Jürgen; Freund, Wolfgang; Juchems, Markus S

    2012-01-01

    AIM: To compare different multidetector computed tomography (MDCT) protocols to optimize pancreatic contrast enhancement. METHODS: Forty consecutive patients underwent contrast-enhanced biphasic MDCT (arterial and portal-venous phase) using a 64-slice MDCT. In 20 patients, the scan protocol was adapted from a previously used 40-channel MDCT scanner with arterial phase scanning initiated 11.1 s after a threshold of 150 HU was reached in the descending aorta, using automatic bolus tracking (Protocol 1). The 11.1-s delay was changed to 15 s in the other 20 patients to reflect the shorter scanning times on the 64-channel MDCT compared to the previous 40-channel system (Protocol 2). HU values were measured in the head and tail of the pancreas in the arterial and portal-venous phase. RESULTS: Using an 11.1-s delay, 74.2 HU (head) were measured on average in the arterial phase and 111.2 HU (head) were measured using a 15-s delay (P < 0.0001). For the pancreatic tail, the average attenuation level was 76.73 HU (11.1 s) and 99.89 HU (15 s) respectively (P = 0.0002). HU values were also significantly higher in the portal-venous phase [pancreatic head: 70.5 HU (11.1 s) vs 84.0 HU (15 s) (P = 0.0014); pancreatic tail: 67.45 HU (11.1 s) and 77.18 HU (15 s) using Protocol 2 (P = 0.0071)]. CONCLUSION: Sixty-four MDCT may yield a higher contrast in pancreatic study with (appropriate) optimization of scan delay time. PMID:22900134

  6. Expiratory Flow Limitation Definition, Mechanisms, Methods, and Significance

    Directory of Open Access Journals (Sweden)

    Claudio Tantucci

    2013-01-01

    Full Text Available When expiratory flow is maximal during tidal breathing and cannot be increased unless operative lung volumes move towards total lung capacity, tidal expiratory flow limitation (EFL is said to occur. EFL represents a severe mechanical constraint caused by different mechanisms and observed in different conditions, but it is more relevant in terms of prevalence and negative consequences in obstructive lung diseases and particularly in chronic obstructive pulmonary disease (COPD. Although in COPD patients EFL more commonly develops during exercise, in more advanced disorder it can be present at rest, before in supine position, and then in seated-sitting position. In any circumstances EFL predisposes to pulmonary dynamic hyperinflation and its unfavorable effects such as increased elastic work of breathing, inspiratory muscles dysfunction, and progressive neuroventilatory dissociation, leading to reduced exercise tolerance, marked breathlessness during effort, and severe chronic dyspnea.

  7. Superoxide dismutase levels and peak expiratory flow in asthmatic children

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    Arie Kurniasih

    2016-11-01

    Full Text Available involvevariety of cells such as inflammatory mediators, reactive oxygenspecies (ROS, and cytokines. The inflammatory process would beexacerbated in the presence of oxidative stress. Superoxide dismutase(SOD is the first important enzyme to protect the respiratory tractagainst oxidative stress. The decreased of SOD has a correlation withincreased of airway obstruction and bronchospasm.Objective To assess for a correlation between superoxide dismutase(SOD levels and peak expiratory flow, as well as to determinethe impact of SOD levels for predicting asthma attacks.Methods We conducted a prospective cohort study at Dr. SardjitoHospital, Yogyakarta, between February and April 2011 involvingasthmatic children aged 5-18 years. Subjects’ serum SOD levelsand peak expiratory flow were measured at the same time point.We then performed a prospective study following up on the samesubjects to find out if they had a recurrent asthma attack withinone month of the tests. We also reassessed their peak expiratoryflow one month after blood specimens were obtained.Results Thirty-nine patients were enrolled in this study. Therewas no significant correlation between SOD level and peakexpiratory flow [r=0.289; 95%CI -0.025 to 0.47; P=0.074].However, older age was significantly associated with higher peakexpiratory flow (=0.5; 95%CI 3.10 to 11.57; P=0.01. Lowerlevels of SOD increased the risk of asthma attacks in a monthfollowing the initial measurements (RR=5.5; 95%CI 1.6 to 18.9;P=0.009.Conclusion Superoxide dismutase (SOD level is not significantlyassociated with peak expiratory flow. However, we find arelationship between older age and higher peak expiratory flowand a relationship between lower SOD levels and risk of asthmaattacks within one month following the tests. [

  8. US and MDCT findings in a caudal blind ending bifid ureter with calculi

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    Caglar Uzun

    2011-09-01

    Full Text Available Herein we present a rare ureteric duplication anomaly; blind ending bifid ureter with calculi which is asymptomatic unless complicated by infection, reflux, calculi or malignancy. The diagnosis is often missed at intravenous urography (IVU and US because the ipsilateral ureter and kidney are grossly normal. In this case the diagnosis was established with ultrasound (US and mainly with multidetector computerized tomography (MDCT imaging using multiplanar reformats and 3-D reconstructions which were unique to this case. MDCT scans not only revealed the exact diagnosis and anatomic relationships but also ruled out other pathologies included in the differential diagnosis as well, such as ureter and bladder diverticula.

  9. US and MDCT findings in a caudal blind ending bifid ureter with calculi

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    Evren Ustuner

    2011-11-01

    Full Text Available Herein we present a rare ureteric duplication anomaly; blind ending bifid ureter with calculi which is asymptomatic unless complicated by infection, reflux, calculi or malignancy. The diagnosis is often missed at intravenous urography (IVU and US because the ipsilateral ureter and kidney are grossly normal. In this case the diagnosis was established with ultrasound (US and mainly with multidetector computerized tomography (MDCT imaging using multiplanar reformats and 3-D reconstructions which were unique to this case. MDCT scans not only revealed the exact diagnosis and anatomic relationships but also ruled out other pathologies included in the differential diagnosis as well, such as ureter and bladder diverticula.

  10. Forced expiratory technique, directed cough, and autogenic drainage.

    Science.gov (United States)

    Fink, James B

    2007-09-01

    In health, secretions produced in the respiratory tract are cleared by mucociliary transport, cephalad airflow bias, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce secretion clearance, leading to increased risk of infection. In obstructive lung disease these conditions are further complicated by early collapse of airways, due to airway compression, which traps both gas and secretions. Techniques have been developed to optimize expiratory flow and promote airway clearance. Directed cough, forced expiratory technique, active cycle of breathing, and autogenic drainage are all more effective than placebo and comparable in therapeutic effects to postural drainage; they require no special equipment or care-provider assistance for routine use. Researchers have suggested that standard chest physical therapy with active cycle of breathing and forced expiratory technique is more effective than chest physical therapy alone. Evidence-based reviews have suggested that, though successful adoption of techniques such as autogenic drainage may require greater control and training, patients with long-term secretion management problems should be taught as many of these techniques as they can master for adoption in their therapeutic routines.

  11. Abdominal expiratory muscle activity in anesthetized vagotomized neonatal rats.

    Science.gov (United States)

    Iizuka, Makito

    2009-05-01

    The pattern of respiratory activity in abdominal muscles was studied in anesthetized, spontaneously breathing, vagotomized neonatal rats at postnatal days 0-3. Anesthesia (2.0% isoflurane, 50% O(2)) depressed breathing and resulted in hypercapnia. Under this condition, abdominal muscles showed discharge late in the expiratory phase (E2 activity) in most rats. As the depth of anesthesia decreased, the amplitude of discharges in the diaphragm and abdominal muscles increased. A small additional burst frequently occurred in abdominal muscles just after the termination of diaphragmatic inspiratory activity (E1 or postinspiratory activity). Since this E1 activity is not often observed in adult rats, the abdominal respiratory pattern likely changes during postnatal development. Anoxia-induced gasping after periodic expiratory activity without inspiratory activity, and in most rats, abdominal expiratory activity disappeared before terminal apnea. These results suggest that a biphasic abdominal motor pattern (a combination of E2 and E1 activity) is a characteristic of vagotomized neonatal rats during normal respiration.

  12. Diagnostic methods to assess inspiratory and expiratory muscle strength.

    Science.gov (United States)

    Caruso, Pedro; Albuquerque, André Luis Pereira de; Santana, Pauliane Vieira; Cardenas, Leticia Zumpano; Ferreira, Jeferson George; Prina, Elena; Trevizan, Patrícia Fernandes; Pereira, Mayra Caleffi; Iamonti, Vinicius; Pletsch, Renata; Macchione, Marcelo Ceneviva; Carvalho, Carlos Roberto Ribeiro

    2015-01-01

    Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength.

  13. Forced expiratory flows' contribution to lung function interpretation in schoolchildren.

    Science.gov (United States)

    Boutin, Bernard; Koskas, Marc; Guillo, Houda; Maingot, Lucia; La Rocca, Marie-Claude; Boulé, Michèle; Just, Jocelyne; Momas, Isabelle; Corinne, Alberti; Beydon, Nicole

    2015-01-01

    Forced expiratory flow (FEF) at low lung volumes are supposed to be better at detecting lung-function impairment in asthmatic children than a forced volume. The aim of this study was to examine whether FEF results could modify the interpretation of baseline and post-bronchodilator spirometry in asthmatic schoolchildren in whom forced expiratory volumes are within the normal range. Spirometry, with post-bronchodilator vital capacity within 10% of that of baseline in healthy and asthmatic children, was recorded prospectively. We defined abnormal baseline values expressed as z-scores 12%, FEF reversibility as an increase larger than the 2.5th percentile of post-bronchodilator changes in healthy children. Among 66 healthy and 50 asthmatic schoolchildren, only two (1.7%) children with normal vital capacity and no airways obstruction had abnormal baseline forced expiratory flow at 25-75% of forced vital capacity (FEF25-75%). After bronchodilation, among the 45 asthmatic children without FEV1 reversibility, 5 (11.1%) had an FEF25-75% increase that exceeded the reference interval. Isolated abnormal baseline values or significant post-bronchodilator changes in FEF are rare situations in asthmatic schoolchildren with good spirometry quality.

  14. Protection against brucellosis in goats, five years after vaccination with reduced-dose Brucella melitensis Rev 1 vaccine.

    Science.gov (United States)

    Díaz-Aparicio, E; Hernández, L; Suárez-Güemes, F

    2004-02-01

    The protection conferred by the reduced-dose Rev 1 Brucella melitensis vaccine in goats that had been immunized 5 years previously was evaluated. Sixteen goats vaccinated 5 years before with Rev 1 (1 x 10(5) cfu) and 5 non-vaccinated goats were challenged with B. melitensis 16M (4 x 10(5) cfu) using the conjunctival route. After giving birth or aborting, the goats were sacrificed and tissue samples were taken for bacteriological study. The challenge strain was recovered in 12%, of the animals from the vaccinated group, and in (80% of the control group. It is concluded, therefore that the use of reduced-dose Rev 1 protects goats vaccinated in endemic areas for at least 5 years after immunization.

  15. Stability Study of Iriba Brucellosis Full-dose and Reduced-dose Vaccine Produced by Razi Institute in Iran

    Directory of Open Access Journals (Sweden)

    Hasannia, E.

    2015-04-01

    Full Text Available Stability study of biological products plays an important role for determination of product changes in maintenance period and ensuring of safety and efficacy of vaccines. In this research, accelerated and long-term stability study performed for six batches of full and reduced-dose cattle Iriba strain brucellosis vaccine that manufactured by Razi vaccine and serum research institute as a new vaccine. After sampling, the vaccines were tested for accelerated stability, after four days storage at 22 0C and tested intervals in three months until 24 months for long-term stability after storage at 2-8 0C. The result indicated all batches of vaccines in accelerated stability met the specification recommended by OIE 2012 and the mean loss of activity for full-dose was 16.68, 18.87 and 17.79 % and for reduced-dose was 38.85, 36.06 and 34.98 %. In long term stability, the quality control tests including colony forming unit, purity, dissociation and physicochemical tests in all samples until 24 months, met the specification recommended by OIE 2012. The full-dose vaccines showed a mean loss of activity of 30.73, 25.53 and 32.45 % and the reduced-dose vaccines showed 63.51, 58.60 and 60.83 %. The mean increasing of moisture content was, 187.85, 214.13 and 160.77 % for full-dose and 142.35, 110.23 and 164.47 % for reduced-dose. So, the results of this research indicated in spite of moisture content increasing in second year, the brucellosis vaccines with this strain are stable at least 24months if the cold chain considered properly but the best expiry date for the vaccine is one year.

  16. Impact of iterative reconstruction on the diagnosis of acute pulmonary embolism (PE) on reduced-dose chest CT angiograms

    Energy Technology Data Exchange (ETDEWEB)

    Pontana, Francois; Henry, Simon; Faivre, Jean-Baptiste; Tacelli, Nunzia; Pagniez, Julien; Remy, Jacques; Remy-Jardin, Martine [CHRU et Universite de Lille 2 Nord de France, Department of Thoracic Imaging, Hospital Calmette (EA 2694), Lille (France); Duhamel, Alain [CHRU et Universite de Lille 2 Nord de France, Department of Biostatistics (EA 2694), Lille (France)

    2015-04-01

    To evaluate the impact of iterative reconstruction on the detectability of clots. Fifty-three patients were enrolled in a study comparing reduced-dose and full-dose images, available from the same dual-source data set. From each acquisition, three series of images were generated: (1) full-dose images (from both tubes), reconstructed with filtered back projection (FBP) (group 1; standard of reference), (2) reduced-dose images (from tube A only; 60 % dose reduction) reconstructed with FBP (group 2) and iterative reconstruction (SAFIRE) (group 3). In group 1 (mean DLP: 264.6 mGy.cm), (1) PE was diagnosed in 8 patients (15 %) with 82 clots in the central (n = 5), segmental (n = 39) and subsegmental (n = 38) arteries and (2) mean level of noise was 30.56 ± 5.07. In group 2 (mean DLP: 105.8 mGy.cm), a significant increase in noise (44.56 ± 6.24; p < 0.0001) (1) hampered detection of PE in one patient and (2) altered detection of peripheral clots (12 false-negative and 2 false-positive results). In group 3, image noise was not significantly different from that in group 1 (p = 0.1525; effect size: 0.2683), with a similar detection of PE compared to group 1 (p = 1). Reconstruction of reduced-dose images (60 % dose reduction) with SAFIRE provided image quality and diagnostic value comparable to those of full-dose FBP images. (orig.)

  17. The effect of sulfur dioxide on the response of rabbits to expiratory loads.

    Science.gov (United States)

    Davenport, P W; Freed, A N; Rex, K A

    1984-06-01

    The role of slowly adapting pulmonary stretch receptors (PSR) in the reflex control of expiratory duration was investigated in anesthetized, spontaneously breathing rabbits. Graded resistive and elastic loads were applied for single expirations to produce expiratory volume-time curves. The PSR were selectively blocked by administration of 200-400 ppm sulfur dioxide (SO2) to the inspired air of the rabbits. Volume-time curves were generated for pre-treatment, SO2 exposure, recovery and post-bilateral cervical vagotomy. SO2 exposure significantly reduced the volume-dependent modulation of expiratory duration from the pre-treatment levels. The response to the expiratory loads returned when the SO2 gas was removed. Vagotomy completely abolished any volume-dependent modulation of expiratory duration with expiratory loading. These results demonstrate that the response of rabbits to expiratory loads is vagally dependent. The hypothesis that PSR are the vagal afferents mediating this response is supported by these results.

  18. MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy

    Energy Technology Data Exchange (ETDEWEB)

    Marano, Riccardo; Savino, Giancarlo; Merlino, Biagio; Pirro, Federica; Rutigliano, Claudia; Santangelo, Carolina; Minoiu, Aurelian Costin; Natale, Luigi; Bonomo, Lorenzo [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Radiological Sciences - Institute of Radiology, Rome (Italy); Pitocco, Dario [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Internal Medicine, Rome (Italy); Di Stasio, Enrico [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Clinical Biochemistry, Rome (Italy); Trani, Carlo [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Cardiovascular Medicine - Institute of Cardiology, Rome (Italy)

    2016-03-15

    To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87 %. These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. (orig.)

  19. MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy.

    Science.gov (United States)

    Marano, Riccardo; Pitocco, Dario; Di Stasio, Enrico; Savino, Giancarlo; Merlino, Biagio; Trani, Carlo; Pirro, Federica; Rutigliano, Claudia; Santangelo, Carolina; Minoiu, Aurelian Costin; Natale, Luigi; Bonomo, Lorenzo

    2016-03-01

    To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. CN patients showed higher rates of significant CAD in comparison with DN subjects [p CAD of 87%. These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. Type 2-diabetic-patients with CN result having more severe coronary artery plaque-burden. MDCT-CA may stratify the CV risk in type 2-diabetic-patients with CN. Adequate diagnostic is mandatory for optimal management of type 2-diabetic-patients with CN.

  20. Our Incidence of Diaphragmatic Hernia Detected with MDCT in the Past Two Years

    Directory of Open Access Journals (Sweden)

    Nesrin Atcı

    2015-11-01

    Full Text Available Aim: Diaphragmatic hernia develops as a result of extension of the intraabdominal organs to the thorax from a diaphragmatic defect which may be either a congenital fusion defect or subsequently formed defect(iatrojenic or traumatic. The diagnosis of symptomatic or asymptomatic diaphragmatic hernia can be easily done with the cross-sectional imaging, multidetector computed tomography (MDCT devices our aim in this study is to investigate diaphragmatic hernia incidence diagnosed by MDCT retrospectively. Methods: An experienced radiologist retrospectively evaluated MDCT results of 1000 patients to whom thorax and abdominal computed tomography was done due to chest and abdominal discomfort or trauma during the last 2 years. Results: According to our results, out of 1000 patients, 77 (7.7% patients had different types of diaphragmatic hernia the most common herniation was hiatal hernia which was seen in 54 patients. Congenital diaphragmatic hernia (n=21 and traumatic diaphragmatic hernia (n=2 were observed also. Conclusion: Diaphragmatic hernia diagnosis could be made easily with extensive use of MDCT in which multi-planar imaging can be taken.

  1. Novel technique for addressing streak artifact in gated dual-source MDCT angiography utilizing ECG-editing

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Laura T.; Boll, Daniel T. [Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC (United States)

    2008-11-15

    Streak artifact is an important source of image degradation in computed tomographic imaging. In coronary MDCT angiography, streak artifact from pacemaker leads in the SVC can render segments of the right coronary artery uninterpretable. With current technology in clinical practice, there is no effective way to eliminate streak artifact in coronary MDCT angiography entirely. We propose a technique to minimize the impact of streak artifact in retrospectively gated coronary MDCT angiography by utilizing small shifts in the reconstruction window. In our experience, previously degraded portions of the coronary vasculature were able to be well evaluated using this technique. (orig.)

  2. Automatic detection of osteoporotic vertebral fractures in routine thoracic and abdominal MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Baum, Thomas; Dobritz, Martin; Rummeny, Ernst J.; Noel, Peter B. [Technische Universitaet Muenchen, Institut fuer Radiologie, Klinikum rechts der Isar, Muenchen (Germany); Bauer, Jan S. [Technische Universitaet Muenchen, Abteilung fuer Neuroradiologie, Klinikum rechts der Isar, Muenchen (Germany); Klinder, Tobias; Lorenz, Cristian [Philips Research Laboratories, Hamburg (Germany)

    2014-04-15

    To develop a prototype algorithm for automatic spine segmentation in MDCT images and use it to automatically detect osteoporotic vertebral fractures. Cross-sectional routine thoracic and abdominal MDCT images of 71 patients including 8 males and 9 females with 25 osteoporotic vertebral fractures and longitudinal MDCT images of 9 patients with 18 incidental fractures in the follow-up MDCT were retrospectively selected. The spine segmentation algorithm localised and identified the vertebrae T5-L5. Each vertebra was automatically segmented by using corresponding vertebra surface shape models that were adapted to the original images. Anterior, middle, and posterior height of each vertebra was automatically determined; the anterior-posterior ratio (APR) and middle-posterior ratio (MPR) were computed. As the gold standard, radiologists graded vertebral fractures from T5 to L5 according to the Genant classification in consensus. Using ROC analysis to differentiate vertebrae without versus with prevalent fracture, AUC values of 0.84 and 0.83 were obtained for APR and MPR, respectively (p < 0.001). Longitudinal changes in APR and MPR were significantly different between vertebrae without versus with incidental fracture (ΔAPR: -8.5 % ± 8.6 % versus -1.6 % ± 4.2 %, p = 0.002; ΔMPR: -11.4 % ± 7.7 % versus -1.2 % ± 1.6 %, p < 0.001). This prototype algorithm may support radiologists in reporting currently underdiagnosed osteoporotic vertebral fractures so that appropriate therapy can be initiated. circle This spine segmentation algorithm automatically localised, identified, and segmented the vertebrae in MDCT images. (orig.)

  3. Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices

    Energy Technology Data Exchange (ETDEWEB)

    Kodama, Hideaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Aikata, Hiroshi, E-mail: aikata@hiroshima-u.ac.jp [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Takaki, Shintaro; Azakami, Takahiro; Katamura, Yoshio; Kawaoka, Tomokazu; Hiramatsu, Akira; Waki, Koji; Imamura, Michio; Kawakami, Yoshiiku; Takahashi, Shoichi [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Toyota, Naoyuki; Ito, Katsuhide [Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan); Chayama, Kazuaki [Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551 (Japan)

    2010-11-15

    Objective: To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment. Methods: Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n = 24) and no-change (n = 25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates. Results: The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P = 0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P = 0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P = 0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P = 0.435). Conclusion: Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.

  4. Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies.

    LENUS (Irish Health Repository)

    Killeen, Ronan P

    2012-02-01

    OBJECTIVE: To determine whether cardiac computed tomography (MDCT) can differentiate between functional and valvular aetiologies of chronic mitral regurgitation (MR) compared with echocardiography (TTE). METHODS: Twenty-seven patients with functional or valvular MR diagnosed by TTE and 19 controls prospectively underwent cardiac MDCT. The morphological appearance of the mitral valve (MV) leaflets, MV geometry, MV leaflet angle, left ventricular (LV) sphericity and global\\/regional wall motion were analysed. The coronary arteries were evaluated for obstructive atherosclerosis. RESULTS: All control and MR cases were correctly identified by MDCT. Significant differences were detected between valvular and control groups for anterior leaflet length (30 +\\/- 7 mm vs. 22 +\\/- 4 mm, P < 0.02) and thickness (3.0 +\\/- 1 mm vs. 2.2 +\\/- 1 mm, P < 0.01). High-grade coronary stenosis was detected in all patients with functional MR compared with no controls (P < 0.001). Significant differences in those with\\/without MV prolapse were detected in MV tent area (-1.0 +\\/- 0.6 mm vs. 1.3 +\\/- 0.9 mm, P < 0.0001) and MV tent height (-0.7 +\\/- 0.3 mm vs. 0.8 +\\/- 0.8 mm, P < 0.0001). Posterior leaflet angle was significantly greater for functional MR (37.9 +\\/- 19.1 degrees vs. 22.9 +\\/- 14 degrees , P < 0.018) and less for valvular MR (0.6 +\\/- 35.5 degrees vs. 22.9 +\\/- 14 degrees, P < 0.017). Sensitivity, specificity, and positive and negative predictive values of MDCT were 100%, 95%, 96% and 100%. CONCLUSION: Cardiac MDCT allows the differentiation between functional and valvular causes of MR.

  5. Detection of occult vertebral fractures by quantitative assessment of bone marrow attenuation values at MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Henes, Frank Oliver, E-mail: f.henes@uke.de [Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg (Germany); Groth, Michael [Department of Diagnostic and Interventional Neuroradiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg (Germany); Kramer, Harald [Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377 Munich (Germany); Department of Radiology, University of Wisconsin – Madison, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792 (United States); Schaefer, Christian [Department of Trauma-, Hand- and Reconstructive Surgery, Spine Center, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Regier, Marc; Derlin, Thorsten; Adam, Gerhard; Bannas, Peter [Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg (Germany)

    2014-01-15

    Objectives: To determine a cut-off value of Hounsfield attenuation units (HU) at multidetector computed tomography (MDCT) for valid and reliable detection of bone marrow oedema (BME) related to occult vertebral fractures. Methods: 36 patients underwent both MDCT and Magnetic Resonance Imaging (MRI) for evaluation of vertebral fractures of the thoracolumbar spine and were included in this retrospective study. Two readers independently assessed HU values at MDCT in a total of 196 vertebrae. Reliability was assessed by intraclass correlation coefficient and Bland–Altman analysis. For each patient we determined the vertebra with the lowest HU value and calculated the HU-difference to each other vertebral body. HU-differences were subjected to receiver operating characteristic (ROC) curve analysis to determine the diagnostic accuracy for detection of BME as determined by MRI, which served as the reference standard. Results of HU-measurements were compared with standard visual evaluation of MDCT. Results: HU measurements demonstrated a high interrater reliability (ICC = 0.984). ROC curve analysis (AUC = 0.978) exhibited an ideal cut-off value of 29.6 HU for detection of BME associated with vertebral fractures with an accuracy of 97.4% as compared to 93.4% accuracy of visual evaluation. Particularly, HU-measurements increased the sensitivity for detection of vertebral fractures from 78.0% to 92.7% due to the detection of 7 of 9 occult fractures that were missed by visual evaluation alone. Conclusions: Assessing bone marrow density by HU measurements using the cut-off of 29.6 HU is a valid and reliable tool for detection of BME related to occult vertebral fractures in MDCT. The introduced technique may allow more accurate treatment decisions and may make further diagnostic work-up with MRI unnecessary.

  6. Realistic simulation of reduced-dose CT with noise modeling and sinogram synthesis using DICOM CT images

    Energy Technology Data Exchange (ETDEWEB)

    Won Kim, Chang [Interdisciplinary Program of Bioengineering Major Seoul National University College of Engineering, San 56-1, Silim-dong, Gwanak-gu, Seoul 152-742, South Korea and Institute of Radiation Medicine, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744 (Korea, Republic of); Kim, Jong Hyo, E-mail: kimjhyo@snu.ac.kr [Department of Radiology, Institute of Radiation Medicine, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744 (Korea, Republic of); Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Gyeonggi-do, 443-270 (Korea, Republic of); Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Gyeonggi-do, 443-270 (Korea, Republic of)

    2014-01-15

    Purpose: Reducing the patient dose while maintaining the diagnostic image quality during CT exams is the subject of a growing number of studies, in which simulations of reduced-dose CT with patient data have been used as an effective technique when exploring the potential of various dose reduction techniques. Difficulties in accessing raw sinogram data, however, have restricted the use of this technique to a limited number of institutions. Here, we present a novel reduced-dose CT simulation technique which provides realistic low-dose images without the requirement of raw sinogram data. Methods: Two key characteristics of CT systems, the noise equivalent quanta (NEQ) and the algorithmic modulation transfer function (MTF), were measured for various combinations of object attenuation and tube currents by analyzing the noise power spectrum (NPS) of CT images obtained with a set of phantoms. Those measurements were used to develop a comprehensive CT noise model covering the reduced x-ray photon flux, object attenuation, system noise, and bow-tie filter, which was then employed to generate a simulated noise sinogram for the reduced-dose condition with the use of a synthetic sinogram generated from a reference CT image. The simulated noise sinogram was filtered with the algorithmic MTF and back-projected to create a noise CT image, which was then added to the reference CT image, finally providing a simulated reduced-dose CT image. The simulation performance was evaluated in terms of the degree of NPS similarity, the noise magnitude, the bow-tie filter effect, and the streak noise pattern at photon starvation sites with the set of phantom images. Results: The simulation results showed good agreement with actual low-dose CT images in terms of their visual appearance and in a quantitative evaluation test. The magnitude and shape of the NPS curves of the simulated low-dose images agreed well with those of real low-dose images, showing discrepancies of less than +/−3.2% in

  7. FCT (functional computed tomography) evaluation of the lung volumes at different PEEP (positive-end expiratory pressure) ventilation pattern, in mechanical ventilated patients

    Energy Technology Data Exchange (ETDEWEB)

    Papi, M.G.; Di Segni, R.; Mazzetti, G.; Staffa, F. [Dept. of Radiology, S. Giovanni HS, Rome (Italy); Conforto, F.; Calimici, R.; Salvi, A. [Dept. of Anesthesiology, S. Giovanni HS, Rome (Italy); Matteucci, G. [Dept. of Pneumology, S. Giovanni HS, Rome (Italy)

    2007-06-15

    Purpose To evaluate with FCT (functional computed tomography) total lung volume and fractional lung volumes at different PEEP (positive end expiratory pressure) values in acute mechanically ventilated patients. Methods Nine ICU (intensive care unity) patients (1 lung pneumonia, 2 polytrauma, 2 sepsis, 3 brain surgery, 1 pulmonary embolism); mean age 48 {+-} 15 years, 6 male, 3 female; GE 16 MDCT scan was performed with acquisition from apex to diaphragma in seven seca at different PEEP values. Raw CT data were analysed by an advantage workstation to obtain volume density masks and histograms of both lungs and each lung and these density ranges were applied: - 1000 - 950 = hyper-ventilated lung, -900 - 650 well aerated lung, -950 - 500 all aerated lung, -500 + 200 lung tissue. Total and fractional lung volumes, Hounsfield unit (HU) were calculated and compared at different PEEP values (0, 5, 10, 15 cm H{sub 2}O). In four patients lung volumes were compared between the more and the less involved lung at increased PEEP. Statistic analysis: comparison means-medians tests. Results Data calculated at five PEEP showed unexpected decrease of total lung volume and increase of lung density (HU); proportionally no significant improvement of oxigenation. (orig.)

  8. Methods for Assessing Expiratory Flow Limitation during Tidal Breathing in COPD Patients

    Directory of Open Access Journals (Sweden)

    Nickolaos G. Koulouris

    2012-01-01

    Full Text Available Patients with severe COPD often exhale along the same flow-volume curve during quite breathing as during forced expiratory vital capacity manoeuvre, and this has been taken as indicating expiratory flow limitation at rest (EFLT. Therefore, EFLT, namely, attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFLT leads to small airway injury and promotes dynamic pulmonary hyperinflation with concurrent dyspnoea and exercise limitation. In fact, EFLT occurs commonly in COPD patients (mainly in GOLD III and IV stage in whom the latter symptoms are common. The existing up-to-date physiological methods for assessing expiratory flow limitation (EFLT are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure (NEP has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, non invasive, most practical, and accurate new technique.

  9. Comparison between MDCT and Grayscale IVUS in a Quantitative Analysis of Coronary Lumen in Segments with or without Atherosclerotic Plaques

    Directory of Open Access Journals (Sweden)

    João L. A. A. Falcão

    2015-04-01

    Full Text Available Background: The diagnostic accuracy of 64-slice MDCT in comparison with IVUS has been poorly described and is mainly restricted to reports analyzing segments with documented atherosclerotic plaques. Objectives: We compared 64-slice multidetector computed tomography (MDCT with gray scale intravascular ultrasound (IVUS for the evaluation of coronary lumen dimensions in the context of a comprehensive analysis, including segments with absent or mild disease. Methods: The 64-slice MDCT was performed within 72 h before the IVUS imaging, which was obtained for at least one coronary, regardless of the presence of luminal stenosis at angiography. A total of 21 patients were included, with 70 imaged vessels (total length 114.6 ± 38.3 mm per patient. A coronary plaque was diagnosed in segments with plaque burden > 40%. Results: At patient, vessel, and segment levels, average lumen area, minimal lumen area, and minimal lumen diameter were highly correlated between IVUS and 64-slice MDCT (p < 0.01. However, 64-slice MDCT tended to underestimate the lumen size with a relatively wide dispersion of the differences. The comparison between 64-slice MDCT and IVUS lumen measurements was not substantially affected by the presence or absence of an underlying plaque. In addition, 64-slice MDCT showed good global accuracy for the detection of IVUS parameters associated with flow-limiting lesions. Conclusions: In a comprehensive, multi-territory, and whole-artery analysis, the assessment of coronary lumen by 64-slice MDCT compared with coronary IVUS showed a good overall diagnostic ability, regardless of the presence or absence of underlying atherosclerotic plaques.

  10. Ectopia cordis with tetralogy of Fallot in an infant with pentalogy of Cantrell: high-pitch MDCT exam.

    Science.gov (United States)

    Santiago-Herrera, Rogerio; Ramirez-Carmona, Rocio; Criales-Vera, Sergio; Calderon-Colmenero, Juan; Kimura-Hayama, Eric

    2011-07-01

    We report the MDCT findings of a 17-month-old girl with Cantrell's pentalogy, a rare congenital disease characterized by several defects in the ventral thoracoabdominal wall including ectopia cordis, and, in this patient, associated with tetralogy of Fallot. This case provides an example of the utility of a wide volume in coverage and high-pitch MDCT scan in the evaluation of complex cardiovascular anatomy in infants with congenital heart disease without the need of an ECG-gating acquisition.

  11. BMD measurements of the spine derived from sagittal reformations of contrast-enhanced MDCT without dedicated software

    Energy Technology Data Exchange (ETDEWEB)

    Baum, Thomas, E-mail: thbaum@gmx.de [Institut fuer Roentgendiagnostik, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675 Muenchen (Germany); Mueller, Dirk, E-mail: dirk.mueller@roe.med.tum.de [Institut fuer Roentgendiagnostik, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675 Muenchen (Germany); Dobritz, Martin, E-mail: dobritz@roe.med.tum.de [Institut fuer Roentgendiagnostik, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675 Muenchen (Germany); Rummeny, Ernst J., E-mail: institut@roe.med.tum.de [Institut fuer Roentgendiagnostik, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675 Muenchen (Germany); Link, Thomas M., E-mail: thomas.link@radiology.ucsf.edu [Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107 (United States); Bauer, Jan S., E-mail: jsb@roe.med.tum.de [Institut fuer Roentgendiagnostik, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675 Muenchen (Germany)

    2011-11-15

    Purpose: To assess QCT equivalent BMD of the lumbar spine in sagittal reformations of routine abdominal contrast-enhanced MDCT with simple PACS measurement tools and to apply this method to MDCT datasets for differentiating patients with and without osteoporotic vertebral fractures. Materials and methods: Eight postmenopausal women (65 {+-} 5years) underwent standard QCT to assess BMD of L1-L3. Afterwards routine abdominal contrast-enhanced MDCT images of these women were obtained and apparent BMD of L1-L3 was measured using the sagittal reformations. The MDCT-to-QCT conversion equation for BMD was calculated with linear regression analysis. The conversion equation was applied to vertebral BMD datasets (L1-L3) of 75 postmenopausal women (66 {+-} 4years). Seventeen of the 75 patients had osteoporotic vertebral fractures. Results: BMD values of contrast-enhanced MDCT were on average 56 mg/ml higher than those of standard QCT. A correlation coefficient of r = 0.94 (p < 0.05) was calculated for the BMD values of MDCT and standard QCT with the conversion equation BMD{sub QCT} = 0.69 x BMD{sub MDCT} - 11 mg/ml. Accordingly converted BMD values of patients with vertebral fractures were significantly lower than those of patients without vertebral fractures (69 mg/ml vs. 85 mg/ml; p < 0.05). Using ROC analysis to differentiate patients with and without vertebral fractures, AUC = 0.72 was obtained for converted BMD values (p < 0.05). Short- and long-term reproducibility errors for BMD measurements in the sagittal reformations amounted 2.09% and 7.70%, respectively. Conclusion: BMD measurements of the spine could be computed in sagittal reformations of routine abdominal contrast-enhanced MDCT with minimal technical and time effort. Using the conversion equation, the acquired BMD data could differentiate patients with and without osteoporotic vertebral fractures.

  12. Comparison between MDCT and Grayscale IVUS in a Quantitative Analysis of Coronary Lumen in Segments with or without Atherosclerotic Plaques

    Energy Technology Data Exchange (ETDEWEB)

    Falcão, João L. A. A.; Falcão, Breno A. A. [Heart Institute (InCor), University of São Paulo Medical School (USP), São Paulo, SP (Brazil); Gurudevan, Swaminatha V. [Cedars-Sinai Heart Institute, Los Angeles, California, USA (United States); Campos, Carlos M.; Silva, Expedito R.; Kalil-Filho, Roberto; Rochitte, Carlos E.; Shiozaki, Afonso A.; Coelho-Filho, Otavio R.; Lemos, Pedro A. [Heart Institute (InCor), University of São Paulo Medical School (USP), São Paulo, SP (Brazil)

    2015-04-15

    The diagnostic accuracy of 64-slice MDCT in comparison with IVUS has been poorly described and is mainly restricted to reports analyzing segments with documented atherosclerotic plaques. We compared 64-slice multidetector computed tomography (MDCT) with gray scale intravascular ultrasound (IVUS) for the evaluation of coronary lumen dimensions in the context of a comprehensive analysis, including segments with absent or mild disease. The 64-slice MDCT was performed within 72 h before the IVUS imaging, which was obtained for at least one coronary, regardless of the presence of luminal stenosis at angiography. A total of 21 patients were included, with 70 imaged vessels (total length 114.6 ± 38.3 mm per patient). A coronary plaque was diagnosed in segments with plaque burden > 40%. At patient, vessel, and segment levels, average lumen area, minimal lumen area, and minimal lumen diameter were highly correlated between IVUS and 64-slice MDCT (p < 0.01). However, 64-slice MDCT tended to underestimate the lumen size with a relatively wide dispersion of the differences. The comparison between 64-slice MDCT and IVUS lumen measurements was not substantially affected by the presence or absence of an underlying plaque. In addition, 64-slice MDCT showed good global accuracy for the detection of IVUS parameters associated with flow-limiting lesions. In a comprehensive, multi-territory, and whole-artery analysis, the assessment of coronary lumen by 64-slice MDCT compared with coronary IVUS showed a good overall diagnostic ability, regardless of the presence or absence of underlying atherosclerotic plaques.

  13. Reduced dose of foscarnet as preemptive therapy for cytomegalovirus infection following reduced-intensity cord blood transplantation.

    Science.gov (United States)

    Narimatsu, H; Kami, M; Kato, D; Matsumura, T; Murashige, N; Kusumi, E; Yuji, K; Hori, A; Shibata, T; Masuoka, K; Wake, A; Miyakoshi, S; Morinaga, S; Taniguchi, S

    2007-03-01

    Although foscarnet is a promising alternative for the treatment of cytomegalovirus (CMV) infection, its toxicity can be significant in patients with advanced age. We retrospectively reviewed medical records of 123 patients (median age of 55; range, 17-79) who received reduced-intensity cord blood transplantation (RI-CBT). Patients preemptively received reduced-dose foscarnet 30 mg/kg twice daily when CMV antigenemia exceeded 10/50,000. Sixty-three patients developed CMV antigenemia on a median of day 34, and 29 received foscarnet preemptively. The median level of CMV antigenemia at the initiation of foscarnet was 30. Median duration of foscarnet administration was 24 days. Adverse effects included electrolyte abnormalities (n=19), renal impairment (n=13), and skin eruption requiring discontinuation of foscarnet (n=1). Preemptive therapy of foscarnet was completed in 18 patients. Seven patients died during foscarnet use without developing CMV disease. The remaining 3 developed CMV enterocolitis 5, 14, and 17 days after initiation of foscarnet. All of them were successfully treated with ganciclovir or foscarnet. Reduced dose of foscarnet is beneficial to control CMV reactivation following RI-CBT; however, it has considerable toxicities in RI-CBT recipients with advanced age. Further studies are warranted to minimize toxicities and identify optimal dosages.

  14. A comparative study of reduced dose alemtuzumab in matched unrelated donor and related donor reduced intensity transplants.

    Science.gov (United States)

    Jardine, Laura; Publicover, Amy; Bigley, Venetia; Hale, Geoff; Pearce, Kim; Dickinson, Anne; Jackson, Graham; Collin, Matthew

    2015-03-01

    In vivo T cell depletion with 100 mg alemtuzumab prevents graft-versus-host disease (GVHD) in reduced intensity conditioned transplants but is associated with delayed immune reconstitution, a higher risk of infection and relapse. De-escalation studies have shown that a reduced dose of 30 mg is as effective as 100 mg in preventing GVHD in matched related donor (MRD) transplants. Dose reduction in matched unrelated donor (MUD) transplants is feasible but the comparative efficacy of alemtuzumab in this setting is not known and opinions vary widely concerning the optimal level of GVHD prophylaxis that should be achieved. Through retrospective analysis we made an objective comparison of MUD transplants receiving an empirically reduced dose of 60 mg, with MRD transplants receiving a 30 mg dose. We observed proportionate levels of alemtuzumab according to dose but an inverse relationship with body surface area particularly in MRD transplants. MUD transplants experienced more acute and chronic GVHD, higher T cell chimerism, more sustained use of ciclosporin and less need for donor lymphocyte infusion than MRD transplants. Thus, doubling the dose of alemtuzumab to 60 mg did not provide equivalent prevention of GVHD after MUD transplant although there was no difference in non-relapse mortality or survival compared with MRD transplants.

  15. Resolution of Mild Ganciclovir-Resistant Cytomegalovirus Disease with Reduced-Dose Cidofovir and CMV-Hyperimmune Globulin

    Directory of Open Access Journals (Sweden)

    Samir J. Patel

    2014-01-01

    Full Text Available Ganciclovir-resistant cytomegalovirus (CMV is associated with significant morbidity in solid organ transplant recipients. Management of ganciclovir-resistant CMV may be complicated by nephrotoxicity which is commonly observed with recommended therapies and/or rejection induced by “indirect” viral effects or reduction of immunosuppression. Herein, we report a series of four high serologic risk (donor CMV positive/recipient CMV negative kidney transplant patients diagnosed with ganciclovir-resistant CMV disease. All patients initially developed “breakthrough” viremia while still receiving valganciclovir prophylaxis after transplant and were later confirmed to exhibit UL97 mutations after failing to eradicate virus on adequate dosages of valganciclovir. The patients were subsequently and successfully treated with reduced-dose (1-2 mg/kg cidofovir and CMV-hyperimmune globulin, given in 2-week intervals. In addition, all patients exhibited stable renal function after completion of therapy, and none experienced acute rejection. The combination of reduced-dose cidofovir and CMV-hyperimmune globulin appeared to be a safe and effective regimen in patients with mild disease due to ganciclovir-resistant CMV.

  16. Safety and efficacy of reduced doses of Brucella melitensis strain Rev. 1 vaccine in pregnant Iranian fat-tailed ewes.

    Science.gov (United States)

    Ebrahimi, Mohammad; Nejad, Ramin Bagheri; Alamian, Saeed; Mokhberalsafa, Ladan; Abedini, Fatemeh; Ghaderi, Rainak; Jalali, Hamid Reza

    2012-01-01

    Brucellosis is one of the most important zoonotic diseases and is a significant cause of abortion in animals. Brucella melitensis strain Rev. 1 is recommended as the most effective vaccine for small ruminants but the application of full doses in adult animals is restricted. This study was conducted to determine a proper reduced dose of vaccine which confers protection but which is not abortifacient in Iranian fat-tailed sheep. A total of 51 non-vaccinated pregnant ewes were divided into three main groups and several subgroups. Ewes in different groups were vaccinated at different stages of pregnancy and various subgroups were subcutaneously immunised with different quantities of the micro-organism (7.5 × 10(6), 10(6), 5 × 10(5)). Ewes again became pregnant a year later and were challenged with the wild-type strain to evaluate the protection conferred. Results revealed that the proportion of vaccination-induced abortions was significantly higher in ewes immunised with 7.5 × 10(6) Rev. 1 organisms than in those which received 10(6) or 5 × 10(5) bacteria. While 80% of non-vaccinated ewes aborted after challenge, none of the vaccinated ewes aborted post-challenge. This study indicated that a reduced dose of Rev. 1 vaccine containing 10(6) or 5 × 10(5) live cells could be safely used to induce protection in Iranian fat-tailed sheep at various stages of pregnancy.

  17. Chickpea (Cicer arietinum L. responds to inoculation with Azotobacter vineladii and Burkholderia cepacia at reduced dose of nitrogen fertilizer

    Directory of Open Access Journals (Sweden)

    Juan Manuel Sánchez-Yáñez

    2014-09-01

    Full Text Available Chickpea (Cicer arietinum L. crop demands nitrogen fertilizer (NF applied in excess caused lost soil fertility and environmental pollution. An alternative for solving this problem are: to reduce and to optimize NF in chickpea using inoculants based on plant growth promoting bacteria (PGPB genus. Thus, the aim of this study was to analyze the response of chickpea to inoculation with Azotobacter vinelandii and Burkholderia cepacia at 50% reduced dose of NF. These PGPB were inoculated chickpea under an experimental design of randomized blocks. The response variables to measure the effect of PGPB on the legume were: the percent of germination, shoot and root phenotyping: plant height, root length and biomass: fresh and dry weight of shoot and root. Experimental data were analyzed by ANOVA and Tukey test. Results showed that a positive respond of chickpea to both PGPB on its germination as well as at seeding and flowering where chickpea had 0.82g total dry weight (TDW of this value was statistically different and significant compared to chickpea treated by NF 100% not inoculated used as relative control (RC with 0.71g TDW. This data suggests that chickpea optimized NF reduced dose by synergistic interaction of both genera PGPB in its root system. Which could to avoid in part soil lost fertility and environmental pollution for applying NF in excess.

  18. Safety and efficacy of reduced doses of Brucella melitensis strain Rev. 1 vaccine in pregnant Iranian fat-tailed ewes

    Directory of Open Access Journals (Sweden)

    Mohammad Ebrahimi

    2012-12-01

    Full Text Available Brucellosis is one of the most important zoonotic diseases and is a significant cause of abortion in animals. Brucella melitensis strain Rev. 1 is recommended as the most effective vaccine for small ruminants but the application of full doses in adult animals is restricted. This study was conducted to determine a proper reduced dose of vaccine which confers protection but which is not abortifacient in Iranian fat-tailed sheep. A total of 51 non-vaccinated pregnant ewes were divided into three main groups and several subgroups. Ewes in different groups were vaccinated at different stages of pregnancy and various subgroups were subcutaneously immunised with different quantities of the micro-organism (7.5 × 106, 106, 5 × 105. Ewes again became pregnant a year later and were challenged with the wild-type strain to evaluate the protection conferred. Results revealed that the proportion of vaccination-induced abortions was significantly higher in ewes immunised with 7.5 × 106 Rev. 1 organisms than in those which received 106 or 5 × 105 bacteria. While 80% of non-vaccinated ewes aborted after challenge, none of the vaccinated ewes aborted post-challenge. This study indicated that a reduced dose of Rev. 1 vaccine containing 106 or 5 × 105 live cells could be safely used to induce protection in Iranian fat-tailed sheep at various stages of pregnancy.

  19. Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes

    Energy Technology Data Exchange (ETDEWEB)

    Sucha, Dominika; Mali, Willem P.T.M.; Habets, Jesse [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Chamuleau, Steven A.J. [University Medical Center Utrecht, Department of Cardiology, Utrecht (Netherlands); Symersky, Petr [VU Medical Center, Department of Cardiothoracic Surgery, Amsterdam (Netherlands); Meijs, Matthijs F.L. [Thoraxcentrum Twente, Medisch Spectrum Twente, Department of Cardiology, Enschede (Netherlands); Brink, Renee B.A. van den [Academic Medical Center, Department of Cardiology, Amsterdam (Netherlands); Mol, Bas A.J.M. de [Academic Medical Center, Department of Cardiothoracic Surgery, Amsterdam (Netherlands); Herwerden, Lex A. van [University Medical Center Utrecht, Department of Cardiothoracic Surgery, Utrecht (Netherlands); Budde, Ricardo P.J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands)

    2016-04-15

    Recent studies have proposed additional multidetector-row CT (MDCT) for prosthetic heart valve (PHV) dysfunction. References to discriminate physiological from pathological conditions early after implantation are lacking. We present baseline MDCT findings of PHVs 6 weeks post implantation. Patients were prospectively enrolled and TTE was performed according to clinical guidelines. 256-MDCT images were systematically assessed for leaflet excursions, image quality, valve-related artefacts, and pathological and additional findings. Forty-six patients were included comprising 33 mechanical and 16 biological PHVs. Overall, MDCT image quality was good and relevant regions remained reliably assessable despite mild-moderate PHV-artefacts. MDCT detected three unexpected valve-related pathology cases: (1) prominent subprosthetic tissue, (2) pseudoaneurysm and (3) extensive pseudoaneurysms and valve dehiscence. The latter patient required valve surgery to be redone. TTE only showed trace periprosthetic regurgitation, and no abnormalities in the other cases. Additional findings were: tilted aortic PHV position (n = 3), pericardial haematoma (n = 3) and pericardial effusion (n = 3). Periaortic induration was present in 33/40 (83 %) aortic valve patients. MDCT allowed evaluation of relevant PHV regions in all valves, revealed baseline postsurgical findings and, despite normal TTE findings, detected three cases of unexpected, clinically relevant pathology. (orig.)

  20. Time-effectiveness, observer-dependence, and accuracy of measurements of left ventricular ejection fraction using 4-channel MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Boehm, T.; Willmann, J.K.; Desbiolles, L.M.; Marincek, B.; Wildermuth, S. [Dept. of Radiology, Kantonsspital, Chur (Switzerland); Alkadhi, H. [Dept. Medical Radiology, Inst. of Diagnostic Radiology, Univ. Hospital, Zurich (Switzerland); Roffi, M. [Dept. of Cardiology, Univ. Hospital, Zurich (Switzerland)

    2004-04-01

    Purpose: To evaluate the time-effectiveness, inter-observer variance, and accuracy of left ventricular ejection fraction (EF) measurements using retrospectively ECG-gated four-channel multi-detector row CT (MDCT) angiography in comparison with biplane cine-ventriculography. Materials and Methods: Twenty consecutive patients underwent retrospectively ECG-gated MDCT angiography and conventional coronary angiography with biplane ventriculography. Raw MDCT data were reconstructed at 0%-90% of the cardiac cycle in increments of 10%. Ten geometrically identical multiplanar reformations parallel to the short axis of the heart were reconstructed in each patient. Three blinded readers segmented the left ventricle in the end-systolic and end-diastolic phase using standardized window settings in order to determine the EF. The EF was measured with biplane cine-ventriculography by two blinded readers and was compared with MDCT. The time needed for post-processing was recorded and the inter-observer agreement for both imaging techniques was assessed. Results: Mean post-processing time was 63{+-}3 min per patient for MDCT and 5.5{+-}1.2 min for ventriculography. MDCT and ventriculography showed a good correlation (r=0.83, p<0.0001) for measurement of the EF. Mean errors of EF measurements for the three MDCT readers compared with the mean of the ventriculography were -6.3{+-}6.6%, -4.7{+-}7.1% and -4.6{+-}5.7%, respectively. The mean differences between the three readers assessing MDCT were -1.6{+-}3.2% (reader 1 versus 2, r=0.96), -1.6{+-}5.6% (1 versus 3, r=0.95) and -0.011{+-}2.9% (2 versus 3, r=0.97, p<0.0001). The mean differences between the two readers assessing ventriculography was 0.32{+-}5.1% (r=0.88, p<0.0001). (orig.) [German] Ziel: Beurteilung der Nachverarbeitungszeit, Messgenauigkeit und Untersucherabhaengigkeit bei der Bestimmung der linksventrikulaeren Ejektionsfraktion (EF) mit der retrospektiv EKG-synchronisierten Multidetektor-CT-(MDCT-)Angiographie im

  1. [Positive end-expiratory pressure : adjustment in acute lung injury].

    Science.gov (United States)

    Bruells, C S; Dembinski, R

    2012-04-01

    Treatment of patients suffering from acute lung injury is a challenge for the treating physician. In recent years ventilation of patients with acute hypoxic lung injury has changed fundamentally. Besides the use of low tidal volumes, the most beneficial setting of positive end-expiratory pressure (PEEP) has been in the focus of researchers. The findings allow adaption of treatment to milder forms of acute lung injury and severe forms. Additionally computed tomography techniques to assess the pulmonary situation and recruitment potential as well as bed-side techniques to adjust PEEP on the ward have been modified and improved. This review gives an outline of recent developments in PEEP adjustment for patients suffering from acute hypoxic and hypercapnic lung injury and explains the fundamental pathophysiology necessary as a basis for correct treatment.

  2. Type-IV DCT, DST, and MDCT algorithms with reduced numbers of arithmetic operations

    CERN Document Server

    Shao, Xuancheng

    2007-01-01

    We present algorithms for the type-IV discrete cosine transform (DCT-IV) and discrete sine transform (DST-IV), as well as for the modified discrete cosine transform (MDCT) and its inverse, that achieve a lower count of real multiplications and additions than previously published algorithms, without sacrificing numerical accuracy. Asymptotically, the operation count is reduced from ~2NlogN to ~(17/9)NlogN for a power-of-two transform size N. These results are derived by considering the DCT to be a special case of a DFT of length 8N, with certain symmetries, and then pruning redundant operations from a recent improved fast Fourier transform algorithm (based on a recursive rescaling of the conjugate-pair split radix algorithm). The improved algorithms for DST-IV and MDCT follow immediately from the improved count for the DCT-IV.

  3. Robust method for extracting the pulmonary vascular trees from 3D MDCT images

    Science.gov (United States)

    Taeprasartsit, Pinyo; Higgins, William E.

    2011-03-01

    Segmentation of pulmonary blood vessels from three-dimensional (3D) multi-detector CT (MDCT) images is important for pulmonary applications. This work presents a method for extracting the vascular trees of the pulmonary arteries and veins, applicable to both contrast-enhanced and unenhanced 3D MDCT image data. The method finds 2D elliptical cross-sections and evaluates agreement of these cross-sections in consecutive slices to find likely cross-sections. It next employs morphological multiscale analysis to separate vessels from adjoining airway walls. The method then tracks the center of the likely cross-sections to connect them to the pulmonary vessels in the mediastinum and forms connected vascular trees spanning both lungs. A ground-truth study indicates that the method was able to detect on the order of 98% of the vessel branches having diameter >= 3.0 mm. The extracted vascular trees can be utilized for the guidance of safe bronchoscopic biopsy.

  4. Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Kyung; Kim, Jeong Ho; Hwang, Kyung Hoon; Choi, In Suck; Choi, Soo Jin; Choe, Won Sick [Gachon University Gil Hospital, Incheon (Korea, Republic of); Yoon, Min Ki [Good Samaritan Hospital, Pohang (Korea, Republic of)

    2010-06-15

    The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EMG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.

  5. Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings.

    Science.gov (United States)

    Yoon, Kibo; Song, Soon Young; Lee, Chang Hwa; Ko, Byung Hee; Lee, Seunghun; Kang, Bo Kyeong; Kim, Mi Mi

    2017-04-01

    The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

  6. Reducing radiation dose to selected organs by selecting the tube start angle in MDCT helical scans: A Monte Carlo based study

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Di; Zankl, Maria; DeMarco, John J.; Cagnon, Chris H.; Angel, Erin; Turner, Adam C.; McNitt-Gray, Michael F. [David Geffen School of Medicine at UCLA, Los Angeles, California 90024 (United States); German Research Center for Environmental Health (GmbH), Institute of Radiation Protection, Helmholtz Zentrum Muenchen, Ingolstaedter Landstrasse 1, 85764 Neuherberg (Germany); David Geffen School of Medicine at UCLA, Los Angeles, California 90024 (United States)

    2009-12-15

    Purpose: Previous work has demonstrated that there are significant dose variations with a sinusoidal pattern on the peripheral of a CTDI 32 cm phantom or on the surface of an anthropomorphic phantom when helical CT scanning is performed, resulting in the creation of ''hot'' spots or ''cold'' spots. The purpose of this work was to perform preliminary investigations into the feasibility of exploiting these variations to reduce dose to selected radiosensitive organs solely by varying the tube start angle in CT scans. Methods: Radiation dose to several radiosensitive organs (including breasts, thyroid, uterus, gonads, and eye lenses) resulting from MDCT scans were estimated using Monte Carlo simulation methods on voxelized patient models, including GSF's Baby, Child, and Irene. Dose to fetus was also estimated using four pregnant female models based on CT images of the pregnant patients. Whole-body scans were simulated using 120 kVp, 300 mAs, both 28.8 and 40 mm nominal collimations, and pitch values of 1.5, 1.0, and 0.75 under a wide range of start angles (0 deg. - 340 deg. in 20 deg. increments). The relationship between tube start angle and organ dose was examined for each organ, and the potential dose reduction was calculated. Results: Some organs exhibit a strong dose variation, depending on the tube start angle. For small peripheral organs (e.g., the eye lenses of the Baby phantom at pitch 1.5 with 40 mm collimation), the minimum dose can be 41% lower than the maximum dose, depending on the tube start angle. In general, larger dose reductions occur for smaller peripheral organs in smaller patients when wider collimation is used. Pitch 1.5 and pitch 0.75 have different mechanisms of dose reduction. For pitch 1.5 scans, the dose is usually lowest when the tube start angle is such that the x-ray tube is posterior to the patient when it passes the longitudinal location of the organ. For pitch 0.75 scans, the dose is lowest

  7. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis.

    Science.gov (United States)

    Kalra, N; Agrawal, P; Mittal, V; Kochhar, R; Gupta, V; Nada, R; Singh, R; Khandelwal, N

    2014-03-01

    Abdominal tuberculosis (TB) is the sixth most common extrapulmonary site of involvement. The sites of involvement in abdominal tuberculosis, in descending order of frequency, are lymph nodes, genitourinary tract, peritoneal cavity, and gastrointestinal tract. The radiological armamentarium for evaluating tuberculosis of the small bowel (SBTB) includes barium studies (small bowel follow-through, SBFT), CT (multidetector CT, CT enterography, and CT enteroclysis), ultrasound (sonoenteroclysis), and magnetic resonance imaging (MRI; enterography and enteroclysis). In this review, we illustrate the abnormalities at MDCT enterography in 20 consecutive patients with SB TB and also describe extraluminal findings in these patients. MDCT enterography allows non-invasive good-quality assessment of well-distended bowel loops and the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall in all three planes and allows examination of all bowel loops, especially the ileal loops, which are mostly superimposed. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement in intestinal TB. The most common abnormality is short-segment strictures with symmetrical concentric mural thickening and homogeneous mural enhancement. Other findings include lymphadenopathy, ascites, enteroliths, peritoneal thickening, and enhancement. In conclusion, MDCT enterography is a comprehensive technique for the evaluation of SB TB.

  8. Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won [Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of); Park, Seong Jin [Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of)

    2014-06-15

    To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. (orig.)

  9. Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Ryusuke; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Yoshida, Tamiko; Okazaki, Emi; Kumita, Shin-ichiro; Owan, Chojin [Nippon Medical School, Department of Radiology, Graduate School of Medicine, Tokyo (Japan)

    2012-10-15

    To evaluate the safety of contrast-enhanced MDCT in patients with renal impairment. We conducted a retrospective review of 938 patients with stable renal insufficiency (eGFR between 15 and 60 ml/min) who underwent contrast-enhanced MDCT. SCr levels were measured at baseline and 48-72 h after contrast medium administration. The incidence of contrast-induced nephropathy (CIN) in the total study population was assessed. As a control group, 1,164 separate patients with renal insufficiency who did not receive contrast medium for CT were also reviewed. The overall incidence of CIN in the patient population with renal insufficiency was 6.1 %; the incidence was 4.4 %, 10.5 % and 10.0 % for patients whose eGFR was 45-60, 30-45 and {<=}30 ml/min, respectively (P < 0.01). In the control group, 5.8 % of patients showed an increase in the SCr level from the baseline. The increase in the SCr level showed no significant difference between the patients who received CM and those who did not (P = 0.82) The risk of CIN from contrast-enhanced MDCT in patients with renal insufficiency appeared to be low, and there was no significant difference in the incidence of CIN in comparison with patients who did not receive CM. (orig.)

  10. Beak-Like Extension of the Pancreatic Uncinate Process on MDCT: Is It Hyperplasia or Movement?

    Science.gov (United States)

    Omeri, Ahmad Khalid; Matsumoto, Shunro; Kiyonaga, Maki; Takaji, Ryo; Yamada, Yasunari; Mori, Hiromu

    2016-01-01

    We aimed to evaluate the pancreatic uncinate process with a beak-like extension (BLE) beyond the left border of the superior mesenteric artery, to define the cause of BLE, and to differentiate BLE from hyperplasia. We retrospectively reviewed 1042 triple-phase contrast-enhanced multidetector-row computed tomography (3P-CE-MDCT) examinations of 500 patients. Finally, 38 patients (28 men, 10 women; mean age, 66 years) with 140 3P-CE-MDCT images showing BLE were studied regarding BLE size, contour, and cause. The superior mesenteric artery position was also evaluated. Beak-like extensions were found in 7.6% of patients. Most were caused by movement of the small bowel mesentery (n = 21, 55%), with deviation of mesenteric vessels or mass effect from expanded adjacent organs (n = 3, 8%). Seven patients (18.5%) had true hyperplasia. Beak-like extension is caused by movement of the small bowel mesentery with deviation of mesenteric vessels or by adjacent organ expansion. Beak-like extension closely mimics other pathology on nonenhanced MDCT.

  11. Efficient stereological approaches for the volumetry of a normal or enlarged spleen from MDCT images

    Energy Technology Data Exchange (ETDEWEB)

    Mazonakis, Michalis; Stratakis, John; Damilakis, John [University of Crete, Department of Medical Physics, Faculty of Medicine, P.O. Box 2208, Iraklion, Crete (Greece)

    2015-06-01

    To introduce efficient stereological approaches for estimating the volume of a normal or enlarged spleen from MDCT. All study participants underwent an abdominal MDCT. The first group included 20 consecutive patients with splenomegaly and the second group consisted of 20 subjects with a normal spleen. Splenic volume estimations were performed using the stereological point counting method. Stereological assessments were optimized using the systematic slice sampling procedure. Planimetric measurements based on manual tracing of splenic boundaries on each slice were taken as reference values. Stereological analysis using five to eight systematically sampled slices provided enlarged splenic volume estimations with a mean precision of 4.9 ± 1.0 % in a mean time of 2.3 ± 0.4 min. A similar measurement duration and error was observed for normal splenic volume assessment using four to seven systematically selected slices. These stereological approaches slightly but insignificantly overestimated the volume of a normal and enlarged spleen compared to planimetry (P > 0.05) with a mean difference of -1.3 ± 4.3 % and -2.7 ± 5.2 %, respectively. The two methods were highly correlated (r ≥ 0.96). The variability of repeated stereological estimations was below 3.8 %. The proposed stereological approaches enable the rapid, reproducible, and accurate splenic volume estimation from MDCT data in patients with or without splenomegaly. (orig.)

  12. Superwideband Bandwidth Extension Using Normalized MDCT Coefficients for Scalable Speech and Audio Coding

    Directory of Open Access Journals (Sweden)

    Young Han Lee

    2013-01-01

    Full Text Available A bandwidth extension (BWE algorithm from wideband to superwideband (SWB is proposed for a scalable speech/audio codec that uses modified discrete cosine transform (MDCT coefficients as spectral parameters. The superwideband is first split into several subbands that are represented as gain parameters and normalized MDCT coefficients in the proposed BWE algorithm. We then estimate normalized MDCT coefficients of the wideband to be fetched for the superwideband and quantize the fetch indices. After that, we quantize gain parameters by using relative ratios between adjacent subbands. The proposed BWE algorithm is embedded into a standard superwideband codec, the SWB extension of G.729.1 Annex E, and its bitrate and quality are compared with those of the BWE algorithm already employed in the standard superwideband codec. It is shown from the comparison that the proposed BWE algorithm relatively reduces the bitrate by around 19% with better quality, compared to the BWE algorithm in the SWB extension of G.729.1 Annex E.

  13. A retrospective feasibility study of biweekly, reduced-dose docetaxel in Asian patients with castrate-resistant, metastatic prostate cancer.

    Science.gov (United States)

    Kim, Hae Su; Lee, Ji Yun; Lee, Su Jin; Lim, Ho Yeong; Sung, Hyun Hwan; Jeon, Hwang Gyun; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Lee, Hyun Moo; Choi, Han-Yong; Park, Se Hoon

    2017-08-22

    The aim of this retrospective study was to evaluate the clinical outcomes of reduced dose, biweekly docetaxel chemotherapy for Korean patients with castrate-resistant prostate cancer (CRPC). We retrospectively reviewed the medical records of 48 patients with metastatic CRPC who were treated with a biweekly regimen (intravenous docetaxel 40 mg/m(2) on day 1 plus prednisolone 5 mg twice daily) between 2012 and 2015 at Samsung Medical Center (Seoul, Korea). Prior to the adoption of a biweekly regimen in Oct 2013, our institutional standard chemotherapy was docetaxel 75 mg/m(2) every 3 weeks for patients with CRPC (n = 24). After Oct 2013, all chemotherapy-naïve patients with CRPC received a 40 mg/m(2) biweekly regimen (n = 24). The primary end point was a PSA response, defined as a greater than 50% decline in PSA level from baseline. The baseline characteristics of the patients in the two treatment groups were similar. The most common cause of treatment discontinuation was disease progression, which was exhibited by 17 patients (71%) in the 3-weekly group and 20 (75%) in the biweekly group. PSA responses were observed in 12 (50%) and 11 (46%) patients in the 3-weekly and biweekly groups, respectively (p = 0.683). Time to treatment failure (TTTF, 4.5 vs 3.9 months) and time-to-progression (TTP, 5.0 vs 4.2 months) were not significantly different between the 3-weekly and biweekly groups. Within the limitations of a retrospective study, the biweekly reduced dose docetaxel regimen was active and well-tolerated in Korean patients with metastatic CRPC.

  14. Control of abdominal and expiratory intercostal muscle activity during vomiting - Role of ventral respiratory group expiratory neurons

    Science.gov (United States)

    Miller, Alan D.; Tan, L. K.; Suzuki, Ichiro

    1987-01-01

    The role of ventral respiratory group (VRG) expiratory (E) neurons in the control of abdominal and internal intercostal muscle activity during vomiting was investigated in cats. Two series of experiments were performed: in one, the activity of VRG E neurons was recorded during fictive vomiting in cats that were decerebrated, paralyzed, and artificially ventilated; in the second, the abdominal muscle activity during vomiting was compared before and after sectioning the axons of descending VRG E neurons in decerebrate spontaneously breathing cats. The results show that about two-thirds of VRG E neurons that project at least as far caudally as the lower thoracic cord contribute to internal intercostal muscle activity during vomiting. The remaining VRG E neurons contribute to abdominal muscle activation. As shown by severing the axons of the VRG E neurons, other, as yet unidenified, inputs (either descending from the brain stem or arising from spinal reflexes) can also produce abdominal muscle activation.

  15. Control of abdominal and expiratory intercostal muscle activity during vomiting - Role of ventral respiratory group expiratory neurons

    Science.gov (United States)

    Miller, Alan D.; Tan, L. K.; Suzuki, Ichiro

    1987-01-01

    The role of ventral respiratory group (VRG) expiratory (E) neurons in the control of abdominal and internal intercostal muscle activity during vomiting was investigated in cats. Two series of experiments were performed: in one, the activity of VRG E neurons was recorded during fictive vomiting in cats that were decerebrated, paralyzed, and artificially ventilated; in the second, the abdominal muscle activity during vomiting was compared before and after sectioning the axons of descending VRG E neurons in decerebrate spontaneously breathing cats. The results show that about two-thirds of VRG E neurons that project at least as far caudally as the lower thoracic cord contribute to internal intercostal muscle activity during vomiting. The remaining VRG E neurons contribute to abdominal muscle activation. As shown by severing the axons of the VRG E neurons, other, as yet unidenified, inputs (either descending from the brain stem or arising from spinal reflexes) can also produce abdominal muscle activation.

  16. Respiratory and hemodynamic effects of diminished expiratory flow during artificial ventilation

    NARCIS (Netherlands)

    W. van Rooyen (Willem)

    1986-01-01

    textabstractThe supposition, that a diminished expiratory flow (DEF) during artificial ventilation will improve blood-gas exchange. especially in obstructive pulmonary disease and that DEF improves blood-gas exchange better than a comparable positive end-expiratory pressure (PEEP. producing the same

  17. Simulation of Interpersonal Transport of Expiratory Droplets and Droplet Nuclei between Two Standing Manikins

    DEFF Research Database (Denmark)

    Liu, Li; Y, Li,

    2012-01-01

    Interpersonal transport of expiratory droplets and droplet nuclei constitutes a prerequisite for the transmission of pathogens as well as the transmission of respiratory diseases. Numerical simulations considering droplet evaporation and droplet nucleus sizes were carried out, using two detailed...... the existence of direct spray route of the interpersonal transport of expiratory droplets....

  18. 21 CFR 868.5965 - Positive end expiratory pressure breathing attachment.

    Science.gov (United States)

    2010-04-01

    ... attachment. 868.5965 Section 868.5965 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... Positive end expiratory pressure breathing attachment. (a) Identification. A positive end expiratory pressure (PEEP) breathing attachment is a device attached to a ventilator that is used to elevate...

  19. Demonstration of vascular abnormalities compressing esophagus by MDCT: Special focus on dysphagia lusoria

    Energy Technology Data Exchange (ETDEWEB)

    Alper, Fatih [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey)]. E-mail: fatihrad@yahoo.com; Akgun, Metin [Department of Chest Diseases, Medical Faculty, Atatuerk University, Erzurum (Turkey); Kantarci, Mecit [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey); Eroglu, Atilla [Department of Thoracic Surgery, Medical Faculty, Atatuerk University, Erzurum (Turkey); Ceyhan, Elvan [Department of Mathematics, College of Arts and Sciences, Koc University, Istanbul (Turkey); Onbas, Omer [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey); Duran, Cihan [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Okur, Adnan [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey)

    2006-07-15

    Purpose: Dysphagia lusoria (DL) is described in the literature as difficulty in swallowing caused by vascular abnormalities. The most common cause is an aberrant right subclavian artery (SCA) which passes behind the esophagus and is also called arteria lusoria (AL). Our aim was to demonstrate the use of multidetector computed tomography (MDCT) in the diagnosis of AL, as there is no comprehensive study investigating the role of MDCT in such cases. Material and methods: A total of 38 consecutive patients, comprising of 23 females (61%) and 15 males (39%), who had extrinsic compression were included in the study. These patients are selected from the cases who were admitted due to their gastrointestinal symptoms, such as dysphagia, epigastric pain, chronic nausea, vomiting, etc. The mean age of patients was 40 {+-} 25 years (range 15-65). Following barium esophagogram and then endoscopy performed, MDCT angiography was carried out on the same or the following few days. MDCT sections were examined to determine the following: presence of vascular abnormality; the diameter and angle of that vascular structure; and the compressed area of esophagus. Radiological findings and dysphagia scores were also compared. Results: In each of 15 cases, there was a compression due to vascular abnormality which were all located between the esophagus and the spine. There was an esophageal compression in each of 12 cases, due to right aberrant SCA, in one case due to right superior aortic arch and in two cases due to both right aortic arch and left SCA with Kommerell's diverticulum. The mean diameter and the angle of AL were 16.4 mm and 48.8{sup o}, respectively, and the mean area of pressured esophagus was 194.7 mm{sup 2}. Dysphagia scores of the cases was 1 in thirteen cases and 2 in two cases. However, dysphagia scores were not correlated with these parameters. Conclusions: MDCT angiography is a useful diagnostic tool for evaluation of patients with dysphagia, especially caused by a

  20. Ultra-low dose abdominal MDCT: Using a knowledge-based Iterative Model Reconstruction technique for substantial dose reduction in a prospective clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Khawaja, Ranish Deedar Ali, E-mail: rkhawaja@mgh.harvard.edu [MGH Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Singh, Sarabjeet; Blake, Michael; Harisinghani, Mukesh; Choy, Gary; Karosmangulu, Ali; Padole, Atul; Do, Synho [MGH Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Brown, Kevin; Thompson, Richard; Morton, Thomas; Raihani, Nilgoun [CT Research and Advanced Development, Philips Healthcare, Cleveland, OH (United States); Koehler, Thomas [Philips Technologie GmbH, Innovative Technologies, Hamburg (Germany); Kalra, Mannudeep K. [MGH Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)

    2015-01-15

    Highlights: • Limited abdominal CT indications can be performed at a size specific dose estimate of (SSDE) 1.5 mGy (∼0.9 mSv) in smaller patients (BMI less than or equal to 25 kg/m{sup 2}) using a knowledge based Iterative Model Reconstruction (IMR) technique. • Evaluation of liver tumors and pathologies is unacceptable at this reduced dose with IMR technique especially in patients with a BMI greater than 25 kg/m{sup 2}. • IMR body soft tissue and routine settings perform substantially better than IMR sharp plus setting in reduced dose CT images. • At SSDE of 1.5 mGy, objective image noise in reduced dose IMR images is 8–56% less than compared to standard dose FBP images, with lowest image noise in IMR body-soft tissue images. - Abstract: Purpose: To assess lesion detection and image quality parameters of a knowledge-based Iterative Model Reconstruction (IMR) in reduced dose (RD) abdominal CT examinations. Materials and methods: This IRB-approved prospective study included 82 abdominal CT examinations performed for 41 consecutive patients (mean age, 62 ± 12 years; F:M 28:13) who underwent a RD CT (SSDE, 1.5 mGy ± 0.4 [∼0.9 mSv] at 120 kV with 17–20 mAs/slice) immediately after their standard dose (SD) CT exam (10 mGy ± 3 [∼6 mSv] at 120 kV with automatic exposure control) on 256 MDCT (iCT, Philips Healthcare). SD data were reconstructed using filtered back projection (FBP). RD data were reconstructed with FBP and IMR. Four radiologists used a five-point scale (1 = image quality better than SD CT to 5 = image quality unacceptable) to assess both subjective image quality and artifacts. Lesions were first detected on RD FBP images. RD IMR and RD FBP images were then compared side-by-side to SD-FBP images in an independent, randomized and blinded fashion. Friedman's test and intraclass correlation coefficient were used for data analysis. Objective measurements included image noise and attenuation as well as noise spectral density (NSD) curves

  1. Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Svenningsen, Sarah; Paulin, Gregory A; Sheikh, Khadija; Guo, Fumin; Hasany, Aasim; Kirby, Miranda; Rezai, Roya Etemad; McCormack, David G; Parraga, Grace

    2016-01-01

    Evidence-based guidance for the use of airway clearance techniques (ACT) in chronic obstructive pulmonary disease (COPD) is lacking in-part because well-established measurements of pulmonary function such as the forced expiratory volume in 1s (FEV1) are relatively insensitive to ACT. The objective of this crossover study was to evaluate daily use of an oscillatory positive expiratory pressure (oPEP) device for 21-28 days in COPD patients who were self-identified as sputum-producers or non-sputum-producers. COPD volunteers provided written informed consent to daily oPEP use in a randomized crossover fashion. Participants completed baseline, crossover and study-end pulmonary function tests, St. George's Respiratory Questionnaire (SGRQ), Patient Evaluation Questionnaire (PEQ), Six-Minute Walk Test and (3)He magnetic resonance imaging (MRI) for the measurement of ventilation abnormalities using the ventilation defect percent (VDP). Fourteen COPD patients, self-identified as sputum-producers and 13 COPD-non-sputum-producers completed the study. Post-oPEP, the PEQ-ease-bringing-up-sputum was improved for sputum-producers (p = 0.005) and non-sputum-producers (p = 0.04), the magnitude of which was greater for sputum-producers (p = 0.03). There were significant post-oPEP improvements for sputum-producers only for FVC (p = 0.01), 6MWD (p = 0.04), SGRQ total score (p = 0.01) as well as PEQ-patient-global-assessment (p = 0.02). Clinically relevant post-oPEP improvements for PEQ-ease-bringing-up-sputum/PEQ-patient-global-assessment/SGRQ/VDP were observed in 8/7/9/6 of 14 sputum-producers and 2/0/3/3 of 13 non-sputum-producers. The post-oPEP change in (3)He MRI VDP was related to the change in PEQ-ease-bringing-up-sputum (r = 0.65, p = 0.0004) and FEV1 (r = -0.50, p = 0.009). In COPD patients with chronic sputum production, PEQ and SGRQ scores, FVC and 6MWD improved post-oPEP. FEV1 and PEQ-ease-bringing-up-sputum improvements were related to improved ventilation providing

  2. Detection of biliary and vascular anatomy in living liver donors: Value of gadobenate dimeglumine enhanced MR and MDCT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Artioli, Diana, E-mail: diansadiana@gmail.com [Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milano (Italy); Tagliabue, Marianna; Aseni, Paolo; Sironi, Sandro; Vanzulli, Angelo [Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milano (Italy)

    2010-11-15

    Objective: To evaluate the performance of magnetic resonance (MR) and multidetector computed tomography (MDCT) in the assessment of living donor's vascular and biliary anatomy, having surgical findings as reference standard. Methods: Thirty-two living liver donors underwent MR cholangiography (1.5-T; standard cholangiography pulse sequences and delayed acquisitions after administration of biliary contrast agent) for biliary anatomy evaluation. MDCT (16-row multidetector scanner, multiphase protocol, 3 mm slice thickness) was also performed in all cases for the assessment of vascular anatomy before transplantation. Hepatic veins (<4 mm in diameter) were not considered. MR and MDCT images interpretation was performed by two reviewers by consensus, based on source axial images, multiplanar reformats, and three-dimensional (3D) postprocessing images. Surgical intraoperative findings were used as standard of reference. Results: At surgery, 17 biliary anomalies, 3 portal anomalies, 32 venous and 8 arterial variants were found in the 32 patients. MR correctly identified 15/17 biliary anomalies, with a sensitivity of 88% and a specificity of 93%. MDCT correctly identified 8/8 arterial, 3/3 portal and 29/32 venous variants, with a sensitivity of 100% and 91%, respectively, and a specificity of 100%. Conclusions: MR and MDCT proved to be efficient in evaluating living liver donor's biliary and vascular anatomy.

  3. Application of MPVR and TL-VR with 64-row MDCT in neonates with congenital EA and distal TEF.

    Science.gov (United States)

    Wen, Yang; Peng, Yun; Zhai, Ren-You; Li, Ying-Zi

    2011-03-28

    To assess the application of multiple planar volume reconstruction (MPVR) and three-dimensional (3D) transparency lung volume rendering (TL-VR) with 64-row multidetector-row computed tomography (MDCT) in neonates with congenital esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). Twenty neonates (17 boys, 3 girls) with EA and distal TEF at a mean age of 4.6 d (range 1-16 d) were enrolled in this study. A helical scan of 64-row MDCT was performed at the 64 mm × 0.625 mm collimation. EA and TEF were reconstructed with MPVR and TL-VR, respectively. Initial diagnosis of EA was made by chest radiography showing the inserted catheter in the proximal blind-ended esophageal pouch. Manifestations of MDCT images were compared with the findings at surgery. MDCT showed the proximal and distal esophageal pouches in 20 cases. No significant difference was observed in gaps between the proximal and distal esophageal pouches detected by MPVR and TL-VR. The lengths of gaps between the proximal and distal esophageal pouches detected by MPVR and TL-VR correlated well with the findings at surgery (R = 0.87, P VR images showed the orifice of TEF in 4 cases. EA and distal TEF can be reconstructed using MPVR and TL-VR of 64-row MDCT, which is a noninvasive technique to demonstrate the distal esophageal pouches and inter-pouch distance in neonates with EA and distal TEF.

  4. MR-Imaging of teeth and periodontal apparatus: an experimental study comparing high-resolution MRI with MDCT and CBCT.

    Science.gov (United States)

    Gaudino, Chiara; Cosgarea, Raluca; Heiland, Sabine; Csernus, Réka; Beomonte Zobel, Bruno; Pham, Mirko; Kim, Ti-Sun; Bendszus, Martin; Rohde, Stefan

    2011-12-01

    The aim of this study was (1) to assess the ability of magnetic resonance imaging (MRI) to visualize dental and periodontal structures and (2) to compare findings with multidetector computed tomography (MDCT) and cone beam CT (CBCT). Four porcine mandibles were examined with (1) 3T-MRI, (2) MDCT and (3) CBCT. Two observers independently reviewed MR, MDCT and CBCT images and assessed image quality of different dental and periodontal structures. To assess quantitatively the accuracy of the different imaging technique, both observers measured burr holes, previously drilled in the mandibles. Dental structures, e.g. teeth roots, pulpa chamber and dentin, were imaged accurately with all imaging sources. Periodontal space and cortical/trabecular bone were better visualized by MRI (p < 0.001). MRI could excellently display the lamina dura, not detectable with MDCT and only inconstant visible with CBCT (p < 0.001). Burr hole measurements were highly precise with all imaging techniques. This experimental study shows the diagnostic feasibility of MRI in visualization of teeth and periodontal anatomy. Detection of periodontal structures was significantly better with MRI than with MDCT or CBCT. Prospective trials have to evaluate further the potential benefit of MRI in a clinical setting.

  5. MR-Imaging of teeth and periodontal apparatus: an experimental study comparing high-resolution MRI with MDCT and CBCT

    Energy Technology Data Exchange (ETDEWEB)

    Gaudino, Chiara; Csernus, Reka; Pham, Mirko; Bendszus, Martin; Rohde, Stefan [University Hospital Heidelberg, Department of Neuroradiology, Heidelberg (Germany); Cosgarea, Raluca; Kim, Ti-Sun [University Hospital Heidelberg, Department of Periodontology, Heidelberg (Germany); Heiland, Sabine [University Hospital Heidelberg, Section of Experimental Radiology, Heidelberg (Germany); Beomonte Zobel, Bruno [University Campus Bio-Medico of Rome, Department of Radiology, Interdisciplinary Center for Biomedical Research, Rome (Italy)

    2011-12-15

    The aim of this study was (1) to assess the ability of magnetic resonance imaging (MRI) to visualize dental and periodontal structures and (2) to compare findings with multidetector computed tomography (MDCT) and cone beam CT (CBCT). Four porcine mandibles were examined with (1) 3T-MRI, (2) MDCT and (3) CBCT. Two observers independently reviewed MR, MDCT and CBCT images and assessed image quality of different dental and periodontal structures. To assess quantitatively the accuracy of the different imaging technique, both observers measured burr holes, previously drilled in the mandibles. Dental structures, e.g. teeth roots, pulpa chamber and dentin, were imaged accurately with all imaging sources. Periodontal space and cortical/trabecular bone were better visualized by MRI (p < 0.001). MRI could excellently display the lamina dura, not detectable with MDCT and only inconstant visible with CBCT (p < 0.001). Burr hole measurements were highly precise with all imaging techniques. This experimental study shows the diagnostic feasibility of MRI in visualization of teeth and periodontal anatomy. Detection of periodontal structures was significantly better with MRI than with MDCT or CBCT. Prospective trials have to evaluate further the potential benefit of MRI in a clinical setting. (orig.)

  6. Dysanapsis ratio as a predictor for expiratory flow limitation.

    Science.gov (United States)

    Smith, Joshua R; Rosenkranz, Sara K; Harms, Craig A

    2014-07-01

    To determine the efficacy of the dysanapsis ratio (DR) in predicting expiratory flow limitation during exercise, 146 subjects (73 men, 73 women) performed standard pulmonary function and maximal incremental exercise tests. Tidal flow-volume loops were recorded at maximal exercise with maximal flow-volume loops measured pre- and post-exercise. Men had larger (p0.05). V˙O2max was not different (p>0.05) between the EFL subjects compared to the non-EFL subjects for both men and women. Men with EFL compared to non-EFL men had smaller FVC (5.16±0.89L vs. 5.67±0.86L, pEFL compared to non-EFL had significantly smaller DR (0.18±0.05 vs. 0.24±0.05), but similar FVC (3.88±0.52 vs. 4.12±0.64, p>0.05). A DR threshold was not determined; however, a DR continuum exists with increasing DR leading to decreased prevalence of EFL. In conclusion, DR is effective in determining the likelihood of EFL at maximal exercise.

  7. Inhomogeneous response of expiratory muscle activity to cold block of the ventral medullary surface.

    Science.gov (United States)

    Chonan, T; Okabe, S; Hida, W; Izumiyama, T; Kikuchi, Y; Takishima, T

    1991-11-01

    We assessed the effects of cooling the ventral medullary surface (VMS) on the activity of chest wall and abdominal expiratory muscles in eight anesthetized artificially ventilated dogs after vagotomy and denervation of the carotid sinus nerves. Electromyograms (EMGs) of the triangularis sterni, internal intercostal, abdominal external oblique, abdominal internal oblique, and transversus abdominis muscles were measured with EMG of the diaphragm as an index of inspiratory activity. Bilateral localized cooling (2 x 2 mm) in the thermosensitive intermediate part of the VMS produced temperature-dependent reduction in the EMG of diaphragm and abdominal muscles. The rib cage expiratory EMGs were little affected at 25 degrees C; their amplitudes decreased at lower VMS temperatures (less than 20 degrees C) but by significantly fewer degrees than the diaphragmatic and abdominal expiratory EMGs at a constant VMS temperature. With moderate to severe cooling (less than 20 degrees C) diaphragmatic EMG disappeared, but rib cage expiratory EMGs became tonic and resumed a phasic pattern shortly before the recovery of diaphragmatic EMG during rewarming of the VMS. These results indicate that the effects of cooling the VMS differ between the activity of rib cage and abdominal expiratory muscles. This variability may be due to inhomogeneous inputs from the VMS to expiratory motoneurons or to a different responsiveness of various expiratory motoneurons to the same input either from the VMS or the inspiratory neurons.

  8. Proposal Intensity Adequacy of Expiratory Effort and Heart Rate Behavior During the Valsalva Maneuver in Preadolescents

    Directory of Open Access Journals (Sweden)

    Mario Augusto Paschoal

    2014-08-01

    Full Text Available Background: When performing the Valsalva maneuver (VM, adults and preadolescents produce the same expiratory resistance values. Objective: To analyze heart rate (HR in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method: The maximal expiratory pressure (MEP was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2 were analyzed and compared in periods before, during (0-10 and 10-20 s, and after VM using nonparametric tests. Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4% and 25 (55.5% of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

  9. MDCT after balloon kyphoplasty: analysis of vertebral body architecture one year after treatment of osteoporotic fractures; MDCT nach Ballonkyphoplastie: Analyse der Wirbelkoerperarchitektur 1 Jahr nach Behandlung osteoporotischer Sinterungsfrakturen

    Energy Technology Data Exchange (ETDEWEB)

    Roehrl, B.; Dueber, C. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinik Mainz (Germany); Sadick, M. [Inst. fuer Radiologie, Universitaetsklinikum Mannheim (Germany); Brocker, K.; Voggenreiter, G.; Obertacke, U. [Zentrum fuer Orthopaedie und Traumatologie, Universitaetsklinikum Mannheim (Germany); Brade, J. [Inst. fuer Medizinische Statistik und Biometrie, Universitaetsklinikum Mannheim (Germany)

    2006-08-15

    Purpose: to evaluate the value of MDCT in the monitoring of vertebral body architecture after balloon kyphoplasty and observe morphological changes of the vertebral body. Material and methods: during a period of 26 months, 66 osteoporotic fractures of the vertebral bodies were treated with percutanous balloon kyphoplasty. The height of the vertebral body, width of spinal space, sagittal indices, kyphosis und COBB angle, and cement leakage were evaluated by computed tomography before and after treatment and in a long-term follow up. Statistical analysis was performed by calculating quantitative constant parameters of descriptive key data. In addition, parametric and distribution-free procedures were performed for all questions. Results: after kyphoplasty, the treated vertebral bodies showed a significant gain in the height of the leading edge (0.15 cm; p < 0.0001) and in the central part of the vertebral body (0.17 cm; p < 0.0001). The height of the trailing edge did not change significantly. A corresponding gain in the sagittal index was found. The index remained stable during follow-up. Treated vertebral bodies as well as untreated references showed a comparable loss of height over the period of one year. The shape of the vertebral bodies remained stable. In comparison to these findings, treated vertebral bodies showed a reduced loss of height. A significant change in kyphosis und the COBB angle was noted. In total, pallacos leakage was detected in 71% of cases. Conclusion: MDCT is an accurate method for evaluating vertebral body architecture after treatment with balloon kyphoplasty. (orig.)

  10. Prevalence of 'high-riding' superior pericardial recesses on thin-section 16-MDCT scans

    Energy Technology Data Exchange (ETDEWEB)

    Basile, Antonio [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy)]. E-mail: antodoc@yahoo.com; Bisceglie, Paola [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Giulietti, Giorgio [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Calcara, Giacomo [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Figuera, Michele [Department of Radiology, Ospedale Vittorio Emanuele, Via Plebiscito 628, 95124 Catania (Italy); Mundo, Elena [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Granata, Antonio [Department of Nephrology, Ospedale Vittorio Emanuele, Via Plebiscito 628, 95124 Catania (Italy); Runza, Giuseppe [Department of Radiology, Policlinico Universitario, Via del Vespro 129, 90127 Palermo (Italy); Privitera, Carmelo [Department of Radiology, Ospedale Vittorio Emanuele, Via Plebiscito 628, 95124 Catania (Italy); Privitera, Giambattista [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy); Patti, Maria Teresa [Department of Radiology and Interventional Radiology, Ospedale Ferrarotto, via Citelli, 8 95124 Catania (Italy)

    2006-08-15

    Objective: The aim of this study was to evaluate the prevalence of 'high-riding' superior pericardial recess (HRSPR) on thin-section (1 mm) 16-multidetector computed tomography (MDCT) scans. Materials and methods: Three hundred and fourteen consecutive chest CT scans obtained with a thin-section 16 MDCT were retrospectively evaluated. The prevalence and characteristic of HRSPR were analyzed. Results: HRSPR was depicted in 21 patients (11 men and 10 women) (6.6%) who ranged in age from 28 to 72 years (mean age, 57 years). The extended recesses were rounded/oval shaped in five patients and triangular, spindle, half moon or irregular shaped in the other 16 patients. Conclusion: Our data suggest as HRSPRs are more frequently and better depicted on thinsection MDCT scans, and this improves the capability to distinguish this superior extension of the superior aortic recess from abnormal findings such as lymphadenopathy, cystic lesions, and aortic dissection.

  11. Renal cell carcinoma metastases to the pancreas - Value of arterial phase imaging at MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Corwin, Michael T. [Univ. of California, Davis Medical Center, Dept. of Radiology, Sacramento (United States)], e-mail: Michael.corwin@ucdmc.ucdavis.edu; Lamba, Ramit; McGahan, John P. [Univ. of California, Davis Medical Center, Dept. of Radiology, Sacramento (United States); Wilson, Machelle [Univ. of California, Davis, Dept. of Public Health Sciences (United States)

    2013-04-15

    Background: The pancreas is an increasingly recognized site of renal cell carcinoma metastases. It is important to determine the optimal MDCT protocol to best detect RCC metastases to the pancreas. Purpose: To compare the rate of detection of renal cell carcinoma metastases to the pancreas between arterial and portal venous phase MDCT. Material and Methods: A retrospective review of CTs of the abdomen yielded six patients with metastatic RCC to the pancreas. Five of six patients had pathologically proven clear cell RCC. Two blinded reviewers independently reported the number of pancreatic lesions seen in arterial and venous phases. Each lesion was graded as definite or possible. The number of lesions was determined by consensus review of both phases. Attenuation values were obtained for metastatic lesions and adjacent normal pancreas in both phases. Results: There were a total of 24 metastatic lesions to the pancreas. Reviewer 1 identified 20/24 (83.3%) lesions on the arterial phase images and 13/24 (54.2%) lesions on the venous phase. Seventeen of 20 (85.0%) arterial lesions were deemed definite and 9/13 (69.2%) venous lesions were definite. Reviewer 2 identified 19/24 (79.2%) lesions on the arterial phase and 14/24 (58.3%) on the venous phase. Seventeen of 19 (89.5%) arterial lesions were definite and 7/14 (50%) venous lesions were definite. Mean attenuation differential between lesion and pancreas was 114 HU and 39 HU for arterial and venous phases, respectively (P<0.0001). Conclusion: Detection of RCC metastases to the pancreas at MDCT is improved using arterial phase imaging compared to portal venous phase imaging.

  12. Juxtapapillary duodenal diverticula: MDCT findings in 1010 patients and proposal for a new classification.

    Science.gov (United States)

    Wiesner, W; Beglinger, Ch; Oertli, D; Steinbrich, W

    2009-01-01

    The aim of this study is to analyze the MDCT findings of juxtapapillary duodenal diverticula (JPDD) and to propose a new radiological classification. CT-examinations of 1010 consecutive patients, all examined by 16-row MDCT of the abdomen over a time period of 20 months were retrospectively analyzed. All study patients were examined by triple phase CT (native, arterial and portal venous CT scan) of the abdomen and all recieved positive oral contrast prior to the examination. Thirty-three patients showed a juxtapapillary duodenal diverticulum, which could be seen on all CT scans, but jusually was depicted most clearly on the thin collimated arterial phase CT images. Size of diverticula range from 4 mm to 4.5 cm (mean 1.7 cm). In 17 cases the diverticulum was located ventrally to the vaterian sphincter complex, extending less or more into the pancreas at the site where the dorsal and the ventral anlage of the pancreas have fused (type I). 12 diverticula were located dorsally to the sphincter complex (type II). Three patients presented with a bilobated juxtapapillary diverticulum extending to both sides, ventrally and dorsally (type III) and one patient showed a little diverticulum ventrally to the minor papilla (type IV).Three patients presented with food impaction in the diverticulum but only one of these patients with a large IPDD showed a Lemmel-syndrome, whereas the other three patients with non-calculous extrahepatic cholostasis showed larger diverticula without food impaction. MDCT allows to identify four different types of juxtapapillary duodenal diverticula and using the proposed classification may be helpful for a more exact, anatomy based radiological description of this CT finding.

  13. Coronary fly-through or virtual angioscopy using dual-source MDCT data.

    Science.gov (United States)

    van Ooijen, Peter M A; de Jonge, Gonda; Oudkerk, Matthijs

    2007-11-01

    Coronary fly-through or virtual angioscopy (VA) has been studied ever since its invention in 2000. However, application was limited because it requires an optimal computed tomography (CT) scan and time-consuming post-processing. Recent advances in post-processing software facilitate easy construction of VA, but until now image quality was insufficient in most patients. The introduction of dual-source multidetector CT (MDCT) could enable VA in all patients. Twenty patients were scanned using a dual-source MDCT (Definition, Siemens, Forchheim, Germany) using a standard coronary artery protocol. Post-processing was performed on an Aquarius Workstation (TeraRecon, San Mateo, Calif.). Length travelled per major branch was recorded in millimetres, together with the time required in minutes. VA could be performed in every patient for each of the major coronary arteries. The mean (range) length of the automated fly-through was 80 (32-107) mm for the left anterior descending (LAD), 75 (21-116) mm for the left circumflex artery (LCx), and 109 (21-190) mm for the right coronary artery (RCA). Calcifications and stenoses were visualised, as well as most side branches. The mean time required was 3 min for LAD, 2.5 min for LCx, and 2 min for the RCA. Dual-source MDCT allows for high quality visualisation of the coronary arteries in every patient because scanning with this machine is independent of the heart rate. This is clearly shown by the successful VA in all patients. Potential clinical value of VA should be determined in the near future.

  14. Clinical significance of pneumatosis intestinalis - correlation of MDCT-findings with treatment and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Treyaud, Marc-Olivier; Duran, Rafael; Knebel, Jean-Francois; Meuli, Reto A.; Schmidt, Sabine [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Zins, Marc [Fondation Hopital St Joseph, Department of Radiology, Paris (France)

    2017-01-15

    To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome. Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome. The most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03). In emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia. (orig.)

  15. MDCT findings after elbow dislocation: a retrospective study of 140 patients

    Energy Technology Data Exchange (ETDEWEB)

    Sormaala, Markus J. [Helsinki University Central Hospital, Medical Imaging Center, Helsinki (Finland); Turku University Hospital, Medical Imaging Center, Turku (Finland); Helsinki University Central Hospital, Toeoeloe Trauma Center, Helsinki (Finland); Sormaala, Annastiina; Koskinen, Seppo K. [Helsinki University Central Hospital, Medical Imaging Center, Helsinki (Finland); Helsinki University Central Hospital, Toeoeloe Trauma Center, Helsinki (Finland); Mattila, Ville M. [Tampere University Hospital, Department of Orthopedic Surgery and Trauma, Tampere (Finland); Karolinska Hospital, Department of Orthopedic Surgery, Stockholm (Sweden)

    2014-04-15

    To assess the number and anatomical location of fractures associated with elbow dislocation, to study the correlation between the direction of dislocation and the trauma energy, and to assess radiographs' diagnostic performance characteristics for fractures using MDCT as a reference standard. A retrospective study was performed at a level 1 trauma center, finding a total of 140 patients who had sustained an elbow dislocation and who had undergone a subsequent MDCT examination. The CT and radiographs of the patient were reviewed by two musculoskeletal radiologists. CT images were analyzed for the site and size of the fracture fragments. In addition, the primary direction of the dislocation, patients' age, and gender were recorded. Trauma energy was also assessed. One hundred and thirty-four out of 140 patients (96 %) had a fracture that was seen on the correlative CT examination. The most common anatomical fracture locations were the coronoid process of the ulna 84 out of 140 (60 %), the radial head 75 out of 140 (54 %), and the humeral capitellum 57 out of 140 (41 %). Multiple fractures were seen in 71 out of 134 (53 %) patients with fractures. The left elbow was more commonly dislocated than the right one. The overall sensitivity of the radiographs was 62 % and the specificity 96 %. Small fractures and impaction fractures are almost invariably present in elbow dislocations, and half of the patients have more than one fracture. Radiographs have a sensitivity of only 62 %. MDCT is an invaluable method for determining the extent of bony injury and revealing occult fractures. (orig.)

  16. MDCT of acute subaxial cervical spine trauma: a mechanism-based approach.

    Science.gov (United States)

    Raniga, Sameer B; Menon, Venugopal; Al Muzahmi, Khamis S; Butt, Sajid

    2014-06-01

    Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3-C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or "fingerprints" on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging "pearls" in differentiating "look-alike" lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma. Teaching Points • Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications.

  17. A New Fast Algorithm of MDCT%一种新的MDCT快速算法

    Institute of Scientific and Technical Information of China (English)

    徐盛; 胡剑凌; 陈健

    2000-01-01

    The modified discrete cosine transform (MDCT) is a part of the time domain aliasing cancellation (TDAC), and it becomes a key technique in high quality audio coding. In MPEG4, both MPEG-2 AAC and TwinVQ treat MDCT as an important filterbank tool. In some practical applications, such as digital audio station (DAS) and Studio, the computation speed of the coder is crucial. Therefore, we present a DCT-based fast algorithm of MDCT, while the former ones are FFT-based. All the operations of the proposed algorithm are real value operations, while those of FFT-based algorithm are complex value operations. Due to its unique half-butter-fly core and symmetry, fewer operations and less memory are needed in the new algorithm than those in References. The proposed algorithm is suitable for float-point implementation. The results show that faster computation speed is achieved using the new algorithm. This new algorithm can be introduced not only in high quality audio coding, but also in speech coding and other signal processing applications with similar filterbank tools.%改进型的离散余弦变换(Modified discrete cosine transform)作为良好的时频分析工具在音频编码中广泛应用。本文提出了一种基于快速DCT变换的MDCT快速算法,与其他文献的算法相比,其运算量明显减少。

  18. Multidetector CT (MD-CT) in the diagnosis of uncertain open globe injuries.

    Science.gov (United States)

    Hoffstetter, P; Schreyer, A G; Schreyer, C I; Jung, E M; Heiss, P; Zorger, N; Framme, C

    2010-02-01

    To evaluate the significance of multislice CT for the diagnosis of uncertain penetrating globe injuries. Based on a retrospective chart review between 2002 and 2007, we identified 59 patients presenting with severe ocular trauma with uncertain rupture of the globe due to massive subconjunctival and/or anterior chamber hemorrhage. The IOP (intraocular pressure) was within normal range in all patients. High resolution multidetector CT (MD-CT) scans (16 slice scans) with axial and coronar reconstructions were performed in all patients. The affected eye was examined for signs of penetrating injury such as abnormal eye shape, scleral irregularities, lens dislocation or intravitreal hemorrhages. Four experienced radiologists read the CT scans independently. Beside the diagnosis, the relevant morphological criteria and the optimal plane orientation (axial or coronar) were specified. The sensitivity, specificity, and negative and positive predictive value were calculated. Additionally the interobserver variability was determined by applying the Cohen's kappa test. Surgical sclera inspections were performed in all cases as a standard of reference. The evaluations of the CT examination were compared with the surgery reports. 59 patients were evaluated (42 men, 17 women). The mean age was 29 years (range 7 - 91). In 17 patients a rupture of the globe was diagnosed during surgery. 12 of these 17 penetrating injuries (70.6 %) were classified correctly by MDCT, 5 of the 17 (29.4 %) were not detectable. 42 patients did not have an open globe injury. 41 of these patients were diagnosed correctly negative by MDCT, and one patient was classified false positive. This results in a sensitivity of 70 % with a specificity of 98 %. There was high inter-rater agreement with kappa values between 0.89 - 0.96. Most discrepancies were caused by wrong negative findings. The most frequent morphologic criteria for open globe injury were the deformation (n = 10) and the volume reduction (n = 7) of

  19. Diagnostic performance of 64-MDCT and 1.5-T MRI with high-resolution sequences in the T staging of gastric cancer: a comparative analysis with histopathology.

    Science.gov (United States)

    Anzidei, M; Napoli, A; Zaccagna, F; Di Paolo, P; Zini, C; Cavallo Marincola, B; Geiger, D; Catalano, C; Passariello, R

    2009-10-01

    This study was undertaken to compare the accuracy of magnetic resonance (MR) imaging and 64-slice multidetector computed tomography (64-MDCT) in the T staging of gastric carcinoma in comparison with histopathology. Forty patients with an endoscopic diagnosis of gastric carcinoma underwent preoperative MR imaging and 64-MDCT, both of which were performed after i.v. injection of scopolamine and water distension of the stomach. In the MR imaging protocol, we acquired T2-weighted turbo spin-echo (TSE) sequences, true fast imaging steady-state free precession (true-FISP) and gadolinium-enhanced T1-weighted volumetric interpolated breath-hold examination (VIBE) 3D sequences. Contrastenhanced CT scans were obtained in the arterial and venous phases. Two groups of radiologists independently reviewed the MR and 64-MDCT images. The results were compared with pathology findings. In the evaluation of T stage, 64-MDCT had 82.5% and MR imaging had 80% sensitivity. Accuracy of MR imaging was slightly higher than that of 64-MDCT in identifying T1 lesions (50% vs 37.5%), whereas the accuracy of 64-MDCT was higher in differentiating T2 lesions (81.2% vs 68.7%). The accuracy of MR imaging and 64-MDCT did not differ significantly in the evaluation of T3-T4 lesions (p>0.05). Understaging was observed in 20% of cases with MR imaging and in 17.5% with 64-MDCT. MR imaging and 64-MDCT accuracy levels did not differ in advanced stages of disease, whereas MR imaging was superior in identifying early stages of gastric cancer and can be considered a valid alternative to MDCT in clinical practice.

  20. Comparison of measurements from digital cephalometric radiographs and 3D MDCT-synthetized cephalometric radiographs and the effect of head position

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Ja; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul [School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2009-09-15

    To investigate the reproducibilities and compare the measurements in digital and MDCT-synthesized cephalometric radiograph, and to investigate the effect of head position on the measurement during imaging with MDCT. Twenty-two dry skulls (combined with mandible) were used in this study. Conventional digital cephalometric radiograph was taken in standard position, and MDCT was taken in standard position and two rotated position (10 .deg. C left rotation and 10 .deg. C right tilting). MDCT data were imported in OnDemand and lateral cephalometric radiograph were synthesized from 3D virtual models. Two types of rotated MDCT data were synthesized with default mode and with corrected mode using both ear rods. For all six images, sixteen angular and eleven linear measurements were made in V-Ceph three times. Reproducibility of measurements was assessed using repeated measures ANOVA and ICC. Linear and angular measurements were compared between digital and five MDCTsynthesized images by Student t-test. All measurements in six types of cephalometric radiograph were not statistically different under ICC examination. Measurements were not different between digital and MDCT-synthesized images (P> .05). Measurements in MDCT-synthesized image in 10 .deg. C left rotation or 10 .deg. C right tilting position showed possibility of difference from digital image in some measurements, and possibility of improvement via realignment of head position using both ear rods. MDCT-synthesized cephalometric radiograph can substitute conventional cephalometric radiograph. The error on head position during imaging with MDCT have possibility that can produce measurement errors with MDCT-synthesized image, and these position error can be corrected by realignment of the head position using both ear rods.

  1. Using the MDCT thick slab MinIP method for the follow-up of pulmonary emphysema

    OpenAIRE

    Lan, Hai; Nishitani, Hiromu; NISHIHARA, Sadamitsu; Ueno, Junji; Takao, Shoichiro; Iwamoto, Seiji; Kawanaka, Takashi; Mahmut, Mawlan; Qingge, Si

    2011-01-01

    Purpose : The purpose of this study was to evaluate the usefulness of thick slab minimum intensity projection (MinIP) as a follow-up method in patients with pulmonary emphysema. This method was used to determine the presence or absence of changes over time in the lung field based on multi-detector-row CT (MDCT) data. Methods : Among patients diagnosed with pulmonary emphysema who underwent 16-MDCT (slice thickness, 1 mm) twice at an interval of 6 months or more, 12 patients wit...

  2. Effect of reduced doses of mesosulfuron + iodosulfuron to control weeds in no-till wheat under Mediterranean conditions

    Energy Technology Data Exchange (ETDEWEB)

    Barros, J. F. C.; Basch, G.; Freixial, R.; Carvalho, M.

    2009-07-01

    Field experiments were carried out over three years (2004-05, to 2006-07) to study the efficacy of a post-emergence dual-purpose herbicide (mesosulfuron - methyl (3%) + iodosulfuron - methyl - sodium (0.6%) + mefenpyr - diethyl (9%) to control Lolium rigidum Gaud. and broad-leaved weeds in no-till wheat (Triticum aestivum L.). A ready herbicide mixture was used at three doses (6+1.2, 9+1.8 and 12+2.4 g a.i. ha{sup 1}) on two dates (beginning of tillering for L. rigidum and 2-3 pair of leaves for broad-leaved weeds, and complete tillering for L. rigidum and 5-6 pair of leaves for broad-leaved weeds) with three different application volumes (100, 200 and 300 L ha{sup -}1). The results of the present study reveal that using lower than the recommended dose (12+2.4 g ha{sup -}1), the herbicide mixture controls L. rigidum better than it controls some broad-leaved weeds. Effective weed control, which was achieved mainly through the application at the first weed development stage, provided higher grain yields. The lower control efficacy of more developed L. rigidum and broad-leaved weeds and a longer period of competition between crop and weeds are responsible for the significantly lower crop yields for the delayed application. Within each application timing significant differences were obtained among the dose/volume combinations, with the exception of the first application regarding L. rigidum control, indicating that a reduction in herbicide dose is possible, but only for certain dose/volume combinations. Nonetheless, weed control was maintained across an array of dose/volume combinations, especially with L. rigidum, thus, our results demonstrate that reduced doses can effectively control weeds if applied early. (Author) 31 refs.

  3. Cisplatin-based chemotherapy followed by focal, reduced-dose irradiation for pediatric primary central nervous system germinomas.

    Science.gov (United States)

    Douglas, James G; Rockhill, Jason K; Olson, James M; Ellenbogen, Richard G; Geyer, J Russell

    2006-01-01

    The objective of this study was to evaluate retrospectively one institution's experience treating pediatric central nervous system (CNS) pure germinomas with platinum-based chemotherapy followed by focal, reduced-dose irradiation. Eight patients were identified with localized, pure CNS germinomas from 1993 to 2004 at the authors' institution. The median age at diagnosis was 13 years (range 7-19). The median follow-up was 40 months (range 8-141). The tumor location was suprasellar in four, the pineal region in three, and the third ventricle in one. Irradiation was started a median of 20 weeks (range 17-22) from diagnosis and consisted of conformal fields to the primary site as determined by the initial diagnostic MR plus a 1.5- to 2-cm margin. Six of the eight patients received a dose of 3,060 cGy; two patients received 3,600 cGy. The 5-year actuarial event free survival was 71% (56-86%, 95% CI). Two patients suffered marginal (at field edge) failures and both were salvaged using reinduction platinum-based chemotherapy followed by cranial spinal irradiation and a boost to the primary tumor. The 5-year actuarial overall survival was 100%. There were no spinal failures. These data suggest that a reduction in both volume and dose (30.6-36 Gy) retains the excellent survival rates for patients with localized, pure germinomas of the CNS. A higher rate of ventricular relapse rate is observed, although salvage of those patients is feasible.

  4. Peak expiratory flow variability, bronchial responsiveness, and susceptibility to ambient air pollution in adults

    NARCIS (Netherlands)

    Boezen, M; Schouten, Jan; Rijcken, B; Vonk, J; Gerritsen, J; Hoek, G; Brunekreef, B; Postma, D

    1998-01-01

    Bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability are associated expressions of airway lability, yet probably reflect different underlying pathophysiologic mechanisms. We investigated whether both measures can be used interchangeably to identify subjects who are suscepti

  5. EFFECT OF POSITIVE EXPIRATORY PRESSURE ON BREATHING PATTERN IN HEALTHY-SUBJECTS

    NARCIS (Netherlands)

    VANDERSCHANS, CP; DEJONG, W; DEVRIES, G; POSTMA, DS; KOETER, GH; VANDERMARK, TW

    1993-01-01

    The purpose of this study was to register breathing patterns, in healthy subjects, during breathing with a positive expiratory pressure. Integrated electromyographic (IEMG) activity of the following muscles was assessed: scalene muscle, parasternal muscle and abdominal muscles, using surface electro

  6. Simulation of Interpersonal Transport of Expiratory Droplets and Droplet Nuclei between Two Standing Manikins

    DEFF Research Database (Denmark)

    Liu, Li; Y, Li,

    2012-01-01

    Interpersonal transport of expiratory droplets and droplet nuclei constitutes a prerequisite for the transmission of pathogens as well as the transmission of respiratory diseases. Numerical simulations considering droplet evaporation and droplet nucleus sizes were carried out, using two detailed...

  7. Time course of expiratory propofol after bolus injection as measured by ion molecule reaction mass spectrometry.

    Science.gov (United States)

    Hornuss, Cyrill; Wiepcke, Dirk; Praun, Siegfried; Dolch, Michael E; Apfel, Christian C; Schelling, Gustav

    2012-04-01

    Propofol in exhaled breath can be detected and monitored in real time by ion molecule reaction mass spectrometry (IMR-MS). In addition, propofol concentration in exhaled breath is tightly correlated with propofol concentration in plasma. Therefore, real-time monitoring of expiratory propofol could be useful for titrating intravenous anesthesia, but only if concentration changes in plasma can be determined in exhaled breath without significant delay. To evaluate the utility of IMR-MS during non-steady-state conditions, we measured the time course of both expiratory propofol concentration and the processed electroencephalography (EEG) as a surrogate outcome for propofol effect after an IV bolus induction of propofol. Twenty-one patients scheduled for routine surgery were observed after a bolus of 2.5 mg kg(-1) propofol for induction of anesthesia. Expiratory propofol was measured using IMR-MS and the cerebral propofol effect was estimated using the bispectral index (BIS). Primary endpoints were time to detection of expiratory propofol and time to onset of propofol's effect on BIS, and the secondary endpoint was time to peak effect (highest expiratory propofol or lowest BIS). Expiratory propofol and changes in BIS were first detected at 43 ± 21 and 49 ± 11 s after bolus injection, respectively (P = 0.29). Peak propofol concentrations (9.2 ± 2.4 parts-per-billion) and lowest BIS values (23 ± 4) were reached after 208 ± 57 and 219 ± 62 s, respectively (P = 0.57). Expiratory propofol concentrations measured by IMR-MS have similar times to detection and peak concentrations compared with propofol effect as measured by the processed EEG (BIS). This suggests that expiratory propofol concentrations may be useful for titrating intravenous anesthesia.

  8. Change in Tongue Morphology in Response to Expiratory Resistance Loading Investigated by Magnetic Resonance Imaging

    OpenAIRE

    2013-01-01

    [Purpose] The purpose of this study was to investigate the effect of expiratory resistance load on the tongue area encompassing the suprahyoid and genioglossus muscles. [Subjects] The subjects were 30 healthy individuals (15 males, 15 females, mean age: 28.9 years). [Methods] Magnetic resonance imaging was used to investigate morphological changes in response to resistive expiratory pressure loading in the area encompassing the suprahyoid and genioglossus muscles. Images were taken when water...

  9. Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, Orlando; Castelguidone, Elisabetta de Lutio di; Granata, Vincenza; D' Errico, Adolfo Gallipoli (Dept. of Radiology, National Cancer Institute ' Fondazione G Pascale' (Italy)), email: orlandcat@tin.it; Sandomenico, Claudia (Dept. of Esophago-gastro-bilio-pancreatic Oncology, National Cancer Institute ' Fondazione G Pascale' (Italy)); Petrillo, Mario (Dept. of Radiology, Second Univ. of Naples (Italy)); Aprea, Pasquale (Dept. of Critical Illness and Anaesthesiology, National Cancer Institute ' Fondazione G Pascale' , Naples, (Italy))

    2011-02-15

    Background: Venous thrombosis is a common occurrence in cancer patients, developing spontaneously or in combination with indwelling central venous devices (CVD). Purpose: To analyze the multidetector CT (MDCT) prevalence, appearance, and significance of catheter related thoracic venous thrombosis in oncologic patients and to determine the percentage of thrombi identified in the original reports. Material and Methods: Five hundred consecutive patients were considered. Inclusion criteria were: presence of a CVD; availability of a contrast-enhanced MDCT; and cancer history. Exclusion criteria were: direct tumor compression/infiltration of the veins; poor image quality; device tip not in the scanned volume; and missing clinical data. Seventeen (3.5%) out of the final 481 patients had a diagnosis of venous thrombosis. Results: Factors showing the highest correlation with thrombosis included peripherally-inserted CVD, right brachiocephalic vein tip location, patient performance status 3, metastatic stage disease, ongoing chemotherapy, and longstanding CVD. The highest prevalence was in patients with lymphoma, lung carcinoma, melanoma, and gynecologic malignancies. Eleven out of 17 cases had not been identified in the original report. Conclusion: CVD-related thrombosis is not uncommon in cancer patients and can also be observed in outpatients with a good performance status and a non-metastatic disease. Thrombi can be very tiny. Radiologists should be aware of the possibility to identify (or overlook) small thrombi

  10. Accuracy of Monte Carlo simulations compared to in-vivo MDCT dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Bostani, Maryam, E-mail: mbostani@mednet.ucla.edu; McMillan, Kyle; Cagnon, Chris H.; McNitt-Gray, Michael F. [Departments of Biomedical Physics and Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90024 (United States); Mueller, Jonathon W. [United States Air Force, Keesler Air Force Base, Biloxi, Mississippi 39534 (United States); Cody, Dianna D. [University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030 (United States); DeMarco, John J. [Departments of Biomedical Physics and Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90024 (United States)

    2015-02-15

    Purpose: The purpose of this study was to assess the accuracy of a Monte Carlo simulation-based method for estimating radiation dose from multidetector computed tomography (MDCT) by comparing simulated doses in ten patients to in-vivo dose measurements. Methods: MD Anderson Cancer Center Institutional Review Board approved the acquisition of in-vivo rectal dose measurements in a pilot study of ten patients undergoing virtual colonoscopy. The dose measurements were obtained by affixing TLD capsules to the inner lumen of rectal catheters. Voxelized patient models were generated from the MDCT images of the ten patients, and the dose to the TLD for all exposures was estimated using Monte Carlo based simulations. The Monte Carlo simulation results were compared to the in-vivo dose measurements to determine accuracy. Results: The calculated mean percent difference between TLD measurements and Monte Carlo simulations was −4.9% with standard deviation of 8.7% and a range of −22.7% to 5.7%. Conclusions: The results of this study demonstrate very good agreement between simulated and measured doses in-vivo. Taken together with previous validation efforts, this work demonstrates that the Monte Carlo simulation methods can provide accurate estimates of radiation dose in patients undergoing CT examinations.

  11. Assessment of patient and occupational dose in established and new applications of MDCT fluoroscopy.

    Science.gov (United States)

    Joemai, Raoul M S; Zweers, Dirk; Obermann, Wim R; Geleijns, Jacob

    2009-04-01

    This study aimed to assess patient dose and occupational dose in established and new applications of MDCT fluoroscopy. Electronic personal dosimeters were used to measure occupational dose equivalent. Effective patient dose was derived from the recorded dose-length product. Acquisition parameters that were observed during CT fluoroscopy (CTF) provided the basis for the estimation of an entrance skin dose profile. Two hundred ten CT-guided interventional procedures were included in the study. The median effective patient dose was 10 mSv (range, 0.1-235 mSv; 107 procedures). The median peak entrance skin dose was 0.4 Sv (0.1-2.1 Sv; 27 procedures). From 547 measurements of occupational dose equivalent, a median occupational effective dose of 3 muSv per procedure was derived for the interventional radiologists and 0.4 muSv per procedure for the assisting radiologists and radiology technologists. The estimated maximum occupational effective dose reached 0.4 mSv. The study revealed high effective patient doses, up to 235 mSv, mainly for relatively new applications such as CTF-guided radiofrequency ablations using MDCT, vertebroplasty, and percutaneous ethanol injections of tumors. Entrance doses were occasionally in the range of the warning level for deterministic skin effects but were always below the threshold for serious deterministic effects. The complexity of the procedure, expected benefits of the treatment, and general health state of the patient contribute to the justification of observed high effective patient doses.

  12. MDCT of the liver in obese patients: evaluation of a different method to optimize iodine dose.

    Science.gov (United States)

    Rengo, Marco; Bellini, Davide; Businaro, Rita; Caruso, Damiano; Azzara, Gabriella; De Santis, Domenico; Picchia, Simona; Biondi, Tommaso; Eid, Marwen; Boschiero, Dario; Laghi, Andrea

    2017-04-27

    To prospectively compare two different approaches for estimating the amount of intravenous contrast media (CM) needed for multiphasic MDCT of the liver in obese patients. This single-center, HIPAA-compliant prospective study was approved by our Institutional Review Board. Ninety-six patients (55 men, 41 women), with a total of 42 hypovascular liver lesions, underwent MDCT of the liver. The amount of contrast medium injected was computed according to the patient's lean body weight which was estimated using either a bioimpedance device (Group A) or the James formula (Group B). The following variables were compared between the two groups: the amount of contrast medium injected (in grams of Iodine, gI), the contrast enhancement index (CEI) and the lesion-to-liver contrast-to-noise ratio. Protocols A and B yielded significant differences in the amount of CM injected (mean values 41.9 ± 4.41 gI in Group A vs. 35.9 ± 5.75 gI in Group B; P = 0.021). The mean CEI value and lesion-to-liver contrast-to-noise ratio measured on the portal phase were significantly higher with protocol A than with protocol B (P < 0.05). Our study shows that the adoption of a bioimpedance device in obese patients improves liver parenchymal enhancement and lesion conspicuity.

  13. MDCT of the abdominal aorta: basics, technical improvements, and clinical applications

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, C.; Fraioli, F.; Danti, M.; Napoli, A.; Votta, V.; Lanciotti, K.; Bertoletti, L.; Passariello, R. [Dept. of Radiological Sciences, Univ. of Rome ' ' La Sapienza' ' (Italy)

    2003-11-01

    The recent introduction into clinical practice of multidetector-row spiral CT (MDCT) [1] with simultaneous acquisition of multiple channels has had a substantial effect on CT angiography allowing the acquisition of large volumes at high resolution, with excellent visualization of small branches also, including distal collaterals of the celiac trunk and superior and inferior mesenteric arteries (Fig. 1 a, b). Other advantages of multidetector-row over single-slice spiral CT include better separation of different vascular phases of enhancement, more efficient use of contrast material administered intravenously, and comparable, if not better, image quality. For example, the entire abdomen can now be (a) routinely imaged in its entirety with thin sections in a single short breath-hold, (b) repeatedly scanned during early arterial, late arterial, and venous phases, and (c) examined with high-quality multiplanar reconstructions, which are easily generated immediately. In this article we focus on and review the major aspects, advantages, and clinical applications of MDCT in the evaluation of the abdominal aorta. (orig.)

  14. MDCT Findings of Denim-Sandblasting-Induced Silicosis: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Senturk Senem

    2010-04-01

    Full Text Available Abstract Background Denim sandblasting is as a novel cause of silicosis in Turkey, with reports of a recent increase in cases and fatal outcomes. We aimed to describe the radiological features of patients exposed to silica during denim sandblasting and define factors related to the development of silicosis. Methods Sixty consecutive men with a history of exposure to silica during denim sandblasting were recruited. All CT examinations were performed using a 64-row multi-detector CT (MDCT. The nodules were qualitatively and semi-quantitatively analyzed by grading nodular profusion (NP on CT images. Results Silicosis was diagnosed radiologically in 73.3% of patients (44 of 60. The latency period (the time between initial exposure and radiological imaging and duration of silica exposure was longer in patients diagnosed with silicosis than in those without silicosis (p Conclusions The duration of exposure and the latency period are important for development of silicosis in denim sandblasters. MDCT is a useful tool in detecting findings of silicosis in workers who has silica exposure.

  15. Can outer-to-outer diameter be used alone in diagnosing appendicitis on 128-slice MDCT?

    Institute of Scientific and Technical Information of China (English)

    Jamal; Yaqoob; Muhammad; Idris; Muhammad; Shahbaz; Alam; Nazia; Kashif

    2014-01-01

    AIM: To assess the frequency of visualization, position and diameter of normal appendix on 128-slice multidetector computed tomography(MDCT) in adult population.METHODS: Retrospective cross sectional study conducted at Radiology Department, Dallah Hospital, Riyadh, Saudi Arabia from March 2013 to October 2013. Non-enhanced computed tomography scans of abdomen and pelvis of 98 patients presenting with hematuria(not associated with abdominal pain, fever or colonic disease) were reviewed by two radiologists, blinded to patient history. The study group included 55 females and 43 males with overall mean age of 54.7 years(range 21 to 94 years). The coronal reformatted images were reviewed in addition to the axial images. The frequency of visualization of appendix was recorded with assessment of position, diameter and luminal contents.RESULTS: The appendix was recorded as definitely visualized in 99% of patients and mean outer-to-outer diameter of the appendix was 5.6 ± 1.3 mm(range 3.0-11.0 mm).CONCLUSION: MDCT with its multiplanar reformation display is extremely useful for visualization of normal appendix. The normal appendix is very variable in its position and diameter. In the absence of other signs, the diagnosis of acute appendix should not be made solely on outer-to-outer appendiceal diameter.

  16. Decreased peak expiratory flow in pediatric passive smokers

    Directory of Open Access Journals (Sweden)

    Fitri Yanti

    2011-08-01

    Full Text Available Background Indonesia ranks fifth among countries with the highest aggregate levels of tobacco consumption in the world. Infants and children exposed to environmental tobacco smoke have increased rates of asthma, respiratory and ear infections, as well as reduced lung function. The effects of tobacco smoke exposure on lung function in children have been reported to be dependent on the source of smoke and the length and dose of exposure. Lung function may also be affected by a child’s gender and asthma status. Objective To compare peak expiratory flow (PEF in pediatric passive smokers to that of children not exposed to second hand smoke, and to define factors that may affect PEF in passive smokers. Methods In August 2009 we conducted a cross-sectional study at an elementary school in the Langkat district. Subjects were aged 6 to 12 years, and divided into two groups: passive smokers and those not exposed to secondhand smoke. Subjects’ PEFs were measured with a Mini-Wright peak flow meter. Measurements were performed in triplicate with the highest value recorded as the PEF. Demographic data including age, sex, weight, height, family income, parental education levels and occupations were obtained through questionnaires. Results Of the 170 participants, 100 were passive smokers and 70 were not exposed to secondhand smoke. Age distribution, weight and height were similar in both groups. We observed a significant difference in PEFs between the group of passive smokers and the group not exposed to secondhand smoke, 211.3 L/minute (SD 61.08 and 242.7 L/minute (SD 77.09, respectively (P < 0.005. The number of years of exposure to smoke (P = 0.079 and the number of cigarettes smoked daily in the household (P = 0.098 did not significantly influence PEF. Conclusion The PEF in pediatric passive smokers was significantly lower than that of children not exposed to secondhand smoke. PEF in passive smokers was not influenced by the number of years of smoke

  17. Influence that oscillating positive expiratory pressure using predetermined expiratory pressures has on the viscosity and transportability of sputum in patients with bronchiectasis.

    Science.gov (United States)

    Ramos, Ercy Mara Cipulo; Ramos, Dionei; Iyomasa, Daniela Mizusaki; Moreira, Graciane Laender; Melegati, Kátia Cristina Teixeira; Vanderlei, Luiz Carlos Marques; Jardim, José Roberto; Oliveira, Adriana Siqueira de

    2009-12-01

    To determine the effectiveness of oscillating positive expiratory pressure (OPEP) using predetermined expiratory pressures on the viscosity and transportability of sputum in patients with bronchiectasis. The study involved 15 stable patients with bronchiectasis (7 males; mean age = 53 +/- 16 years), submitted to two consecutive OPEP interventions, with a 24-h interval between the two, using positive expiratory pressures set at 15 cmH2O (P15) and 25 cmH2O (P25). The protocol consisted of a voluntary cough; another voluntary cough 20 min later, designated time zero (T0); a 10-min rest period; and two 10-min series (S1 and S2, using OPEP at P15 and P25 in both), with a 10-min interval between the two. The viscosity and transportability of sputum were evaluated by viscometry, relative transport velocity on frog palate, transport in a simulated cough machine and contact angle. Sputum samples were collected at T0, after S1 and after S2. Specific statistical tests were performed depending on the type of data distribution. In comparison with the values obtained at T0, sputum viscosity decreased significantly after S1 at P15 and after S2 at P25. There were no significant differences among all of the samples in terms of transportability. The fact that sputum viscosity decreased whether OPEP was performed at P15 or at P25 suggests that there is no need to generate high expiratory pressure to achieve the desired result.

  18. Bowel preparation for colonoscopy using standard vs reduced doses of sodium phosphate: A single-blind randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    Tatsuya; Koshitani; Mayumi; Kawada; Toshikazu; Yoshikawa

    2014-01-01

    AIM: To evaluate the efficacy of a colonoscopy prepa-ration that utilizes a reduced dose of sodium phosphate(NaP) and an adjunct.METHODS: Sixty-two patients requiring screening colonoscopies were studied. Each patient was randomly allocated to receive either 50 NaP tablets(50 g) or 30 NaP tablets(30 g) with 10 mL of 0.75% sodium pico-sulfate for bowel preparation. NaP was administered at a rate of five tablets(5 g) or three tablets(3 g) every 15 min with 200 mL of water, beginning five to six hours before colonoscopy. The sodium picosulfate was administered with 200 mL of water on the night before the procedure. Both groups were compared in term of the efficacies of colonic cleansing, the time required for completion of the bowel preparation, and acceptability of the preparation.RESULTS: Sixty patients(n = 30 for each group) were analyzed. The cleansing efficacy tended to be higher in the 30 g NaP plus sodium picosulfate group as as-sessed by the mean total Ottawa scale score(50 g NaP6.70 ± 1. 42 vs 30 g NaP plus sodium picosulfate 6.17 ± 1.18 P = 0.072). The mean time for bowel prepara-tion tended to be shorter in the 30 g NaP plus sodium picosulfate group(50 g NaP 189.9 ± 64.0 min vs 30 g NaP plus sodium picosulfate 161.8 ± 57.6 min, P = 0.065). There were no significant differences between the two groups in the acceptability of the preparations(50 g NaP 83.3% vs 30 g NaP plus sodium picosulfate 86.7%, P = 0.500). There were no adverse events re-lated to bowel preparation in either of the groups.CONCLUSION: The colonoscopy preparation that uti-lized 30 g NaP with sodium picosulfate was comparable to that utilizing 50 g NaP. This novel bowel preparation might be useful before colonoscopy.

  19. Osteoid osteoma and osteoid osteoma-mimicking lesions: biopsy findings, distinctive MDCT features and treatment by radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Becce, Fabio [Centre Hospitalier Universitaire Vaudois, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Universite Paris Descartes, Department of Radiology B, Hopital Cochin, AP-HP, Paris (France); Theumann, Nicolas [Centre Hospitalier Universitaire Vaudois, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Rochette, Antoine; Campagna, Raphael; Drape, Jean-Luc; Feydy, Antoine [Universite Paris Descartes, Department of Radiology B, Hopital Cochin, AP-HP, Paris (France); Larousserie, Frederique [Universite Paris Descartes, Department of Anatomic Pathology, Hopital Cochin, AP-HP, Paris (France); Cherix, Stephane; Mouhsine, Elyazid [Centre Hospitalier Universitaire Vaudois, Department of Orthopaedic and Traumatologic Surgery, Lausanne (Switzerland); Guillou, Louis [University Institute of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Anract, Philippe [Universite Paris Descartes, Department of Orthopaedic Surgery, Hopital Cochin, AP-HP, Paris (France)

    2010-10-15

    To report the biopsy findings of osteoid osteoma (OO) and OO-mimicking lesions, assess their distinctive multidetector computed tomography (MDCT) features and evaluate treatment by radiofrequency ablation (RFA). In this multicentric retrospective study, 80 patients (54 male, 26 female, mean age 24.1 years, range 5-48) with presumed (clinical and MDCT features) OO were treated by percutaneous RFA between May 2002 and June 2009. Per-procedural biopsies were always performed. The following MDCT features were assessed: skeletal distribution and location within the bone, size, central calcification, surrounding osteosclerosis and periosteal reaction. Clinical success of RFA was evaluated. Histopathological diagnoses were: 54 inconclusive biopsies, 16 OO, 10 OO-mimicking lesions (5 chronic osteomyelitis, 3 chondroblastoma, 1 eosinophilic granuloma, 1 fibrous dysplasia). OO-mimicking lesions were significantly greater in size (p = 0.001) and presented non-significant trends towards medullary location (p = 0.246), moderate surrounding osteosclerosis (p = 0.189) and less periosteal reaction (p = 0.197), compared with OO. Primary success for ablation of OO-mimicking lesions was 100% at 1 month, 85.7% at 6 and 12 months, and 66.7% at 24 months. Secondary success was 100%. Larger size, medullary location, less surrounding osteosclerosis and periosteal reaction on MDCT may help differentiate OO-mimicking lesions from OO. OO-mimicking lesions are safely and successfully treated by RFA. (orig.)

  20. [MDCT features and anatomic-pathological basis of the diseases in central thoracic-abdominal junctional region].

    Science.gov (United States)

    Ye, Yilan; Yang, Zhigang; Li, Hua; Deng, Wen; Li, Yuan; Guo, Yingkun

    2012-02-01

    This paper is to determine relationship between MDCT features and anatomic-pathology of the diseases in central thoracic-abdominal junctional region. 3 cadavers were cut transversely and another 3 vertically to observe the anatomy of thoracic-abdominal junctional zone. 93 patients with diseases in central thoracic-abdominal junctional zone were scanned with MDCT. The correlation between MDCT features of the diseases in central thoracic-abdominal junctional region and the anatomic-pathology of the diseases in this region was evaluated. On cadaver sections, central thoracic-abdominal junctional region was an area between anterior chest wall and dorsal spine in vertical direction. The region was separated into upper and lower sections by diaphragm. The upper section mainly contains heart and pericardium, while the lower contains broad ligament and left lobe of liver. The hiatus of diaphragm are vena caval foramen, esophageal foramen and aortic foramen in anterior-posterior turn. In the present study, 23 patients had portal hypertension, 18 had dissection of aorta, 8 got diseases in inferior vena cava, 9 had lymphoma, 12 got diseases in multiple vertebrae, 7 had lower thoracic esophageal carcinoma accompanied with metastasis in upper abdominal lymph nodes, 9 had carcinoma of abdominal esophagus and/or gastric cardia, 4 had esophageal hiatal hernia and 3 patients had neurogenic tumor in posterior mediastinum and/or superior spatium retroperitoneale. The MDCT features and distribution of the diseases in central thoracic-abdominal junctional region influence the anatomic-pathology characteristics in this region.

  1. Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes

    Directory of Open Access Journals (Sweden)

    Reem Hassan Bassiouny

    2014-09-01

    Conclusion: Using a systematic pattern approach MDCT has proved to be an extremely useful noninvasive method for evaluation of patients with acute RLQP, allowing diagnosis and management of not only the most common conditions such as appendicitis but also less common conditions.

  2. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Runza, G. [Department of Radiology, University of Palermo (Italy)], E-mail: grunza@sirm.org; La Grutta, L.; Alaimo, V. [Department of Radiology, University of Palermo (Italy); Evola, S. [Department of Cardiology, University of Palermo (Italy); Lo Re, F.; Bartolotta, T.V. [Department of Radiology, University of Palermo (Italy); Cademartiri, F. [Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam (Netherlands); Department of Radiology and Cardiology, Cardiovascular CT Unit, University Hospital, Parma (Italy); Midiri, M. [Department of Radiology, University of Palermo (Italy)

    2007-10-15

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.

  3. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

    Directory of Open Access Journals (Sweden)

    Nitin P Ghonge

    2014-01-01

    Full Text Available As Laparoscopic Donor Nephrectomy (LDN offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know.

  4. Application of MPVR and TL-VR with 64-row MDCT in neonates with congenital EA and distal TEF

    Institute of Scientific and Technical Information of China (English)

    Yang Wen; Yun Peng; Ren-You Zhai; Ying-Zi Li

    2011-01-01

    AIM: To assess the application of multiple planar volume reconstruction (MPVR) and three-dimensional (3D) transparency lung volume rendering (TL-VR) with 64-row multidetector-row computed tomography (MDCT) in neonates with congenital esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). METHODS: Twenty neonates (17 boys, 3 girls) with EA and distal TEF at a mean age of 4.6 d (range 1-16 d) were enrolled in this study. A helical scan of 64-row MDCT was performed at the 64 mm × 0.625 mm collimation. EA and TEF were reconstructed with MPVR and TL-VR, respectively. Initial diagnosis of EA was made by chest radiography showing the inserted catheter in the proximal blind-ended esophageal pouch. Manifestations of MDCT images were compared with the findings at surgery. RESULTS: MDCT showed the proximal and distal esophageal pouches in 20 cases. No significant difference was observed in gaps between the proximal and distal esophageal pouches detected by MPVR and TLVR. The lengths of gaps between the proximal and distal esophageal pouches detected by MPVR and TL-VR correlated well with the findings at surgery (R = 0.87, P < 0.001). The images of MPVR revealed the orifice of TEF in 13 cases, while TL-VR images showed the orifice of TEF in 4 cases. CONCLUSION: EA and distal TEF can be reconstructed using MPVR and TL-VR of 64-row MDCT, which is a noninvasive technique to demonstrate the distal esophageal pouches and inter-pouch distance in neonates with EA and distal TEF.

  5. Change in Tongue Morphology in Response to Expiratory Resistance Loading Investigated by Magnetic Resonance Imaging

    Science.gov (United States)

    Yanagisawa, Yukio; Matsuo, Yoshimi; Shuntoh, Hisato; Mitamura, Masaaki; Horiuchi, Noriaki

    2013-01-01

    [Purpose] The purpose of this study was to investigate the effect of expiratory resistance load on the tongue area encompassing the suprahyoid and genioglossus muscles. [Subjects] The subjects were 30 healthy individuals (15 males, 15 females, mean age: 28.9 years). [Methods] Magnetic resonance imaging was used to investigate morphological changes in response to resistive expiratory pressure loading in the area encompassing the suprahyoid and genioglossus muscles. Images were taken when water pressure was sustained at 0%, 10%, 30%, and 50% of maximum resistive expiratory pressure. We then measured tongue area using image analysis software, and the morphological changes were analyzed using repeated measures analysis of variance followed by post hoc comparisons. [Results] A significant change in the tongue area was detected in both sexes upon loading. Multiple comparison analysis revealed further significant differences in tongue area as well as changes in tongue area in response to the different expiratory pressures. [Conclusion] The findings demonstrate that higher expiratory pressure facilitates greater reduction in tongue area. PMID:24259824

  6. A Rare Presentation of an Entrapment in a Liver Transplant Candidate Depicted by MDCT Angiography

    Science.gov (United States)

    Kantarci, Mecit; Aydin, Unal; Doganay, Selim; Aydinli, Bulent; Yuce, Ihsan; Polat, Kamil Yalcin

    2010-01-01

    Hypertrophic caudate lobe veins can mimic a normal venous configuration. In cases of multiple vascular collaterals, Doppler evaluations must be conducted, and the flow direction of these veins as well as the IVC should be evaluated. If the flow in the IVC is reversed, Budd-Chiari syndrome should be suspected; moreover, at the supra diaphragmatic level, which may be considered a blind spot, particularly for radiologists, a web should be searched for in the area where the IVC opens into the right atrium. In this study, we present the unique findings of multidetector computed tomography (MDCT) angiography for a liver transplant candidate with Budd-Chiari syndrome caused by a web in the proximal IVC. PMID:25610132

  7. [Radiation dose reduction using a non-linear image filter in MDCT].

    Science.gov (United States)

    Nakashima, Junya; Takahashi, Toshiyuki; Takahashi, Yoshimasa; Imai, Yasuhiro; Ishihara, Yotaro; Kato, Kyoichi; Nakazawa, Yasuo

    2010-05-20

    The development of MDCT enabled various high-quality 3D imaging and optimized scan timing with contrast injection in a multi-phase dynamic study. Since radiation dose tends to increase to yield such high-quality images, we have to make an effort to reduce radiation dose. A non-linear image filter (Neuro 3D filter: N3D filter) has been developed in order to improve image noise. The purpose of this study was to evaluate the physical performance and effectiveness of this non-linear image filter using phantoms, and show how we can reduce radiation dose in clinical use of this filter. This N3D filter reduced radiation dose by about 50%, with minimum deterioration of spatial reduction in phantom and clinical studies. This filter shows great potential for clinical application.

  8. Acute colonic diverticulitis: an update on clinical classification and management with MDCT correlation.

    Science.gov (United States)

    Barat, Maxime; Dohan, Anthony; Pautrat, Karine; Boudiaf, Mourad; Dautry, Raphael; Guerrache, Youcef; Pocard, Marc; Hoeffel, Christine; Eveno, Clarisse; Soyer, Philippe

    2016-09-01

    Currently, the most commonly used classification of acute colonic diverticulitis (ACD) is the modified Hinchey classification, which corresponds to a slightly more complex classification by comparison with the original description. This modified classification allows to categorize patients with ACD into four major categories (I, II, III, IV) and two additional subcategories (Ia and Ib), depending on the severity of the disease. Several studies have clearly demonstrated the impact of this classification for determining the best therapeutic approach and predicting perioperative complications for patients who need surgery. This review provides an update on the classification of ACD along with a special emphasis on the corresponding MDCT features of the different categories and subcategories. This modified Hinchey classification should be known by emergency physicians, radiologists, and surgeons in order to improve patient care and management because each category has a specific therapeutic approach.

  9. Data compression in wireless sensors network using MDCT and embedded harmonic coding.

    Science.gov (United States)

    Alsalaet, Jaafar K; Ali, Abduladhem A

    2015-05-01

    One of the major applications of wireless sensors networks (WSNs) is vibration measurement for the purpose of structural health monitoring and machinery fault diagnosis. WSNs have many advantages over the wired networks such as low cost and reduced setup time. However, the useful bandwidth is limited, as compared to wired networks, resulting in relatively low sampling. One solution to this problem is data compression which, in addition to enhancing sampling rate, saves valuable power of the wireless nodes. In this work, a data compression scheme, based on Modified Discrete Cosine Transform (MDCT) followed by Embedded Harmonic Components Coding (EHCC) is proposed to compress vibration signals. The EHCC is applied to exploit harmonic redundancy present is most vibration signals resulting in improved compression ratio. This scheme is made suitable for the tiny hardware of wireless nodes and it is proved to be fast and effective. The efficiency of the proposed scheme is investigated by conducting several experimental tests.

  10. Lateralized odontoid in plain film radiography. Sign of fractures? A comparison study with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Keller, S.; Bieck, K.; Karul, M.; Schoennagel, B.; Adam, G.; Habermann, C.; Yamamura, J. [University Hospital Hamburg Eppendorf (Germany). Dept. of Diagnostic and Interventional Radiology

    2015-09-15

    To evaluate X-ray standards for the detection of odontoid fractures. Summary of background data: Cervical spine fractures are a common finding in emergency medicine, accounting for 1 - 3 % of injuries. Involvement of the C1 / C2 complex is found in 25 % of cases, affecting the odontoid peg in 55 - 80 %. Regarding the consequences of missed fractures, radiographic techniques built the groundwork for further treatment procedures. As standardized X-ray measurements have not been established, the incidence of unrecognized cervical spine fracture is expected to be up to 20 %. The establishment of X-ray-based guidelines is also limited by the presumed low specificity and sensitivity of distance measurements caused by rotational distortion which leads to a rising popularity of CT. 79 (age 60 ± 26 yrs) patients with lateralization of the odontoid process on conventional plain film radiography (anteroposterior, lateral, and open mouth odontoid process view projection) were examined. The distance between the odontoid process and lateral mass of C1, angles of vertical odontoid line and basis of C2 were measured in the ap view. In the lateral view, dorsal alignment and atlantodental distance were assessed. MDCT examinations were used as a reference. Discriminatory power test was applied to assess significance. 8/79 (10.1 %) odontoid process fractures were found. Diagnosis was achieved on conventional radiographs in 6 patients. Neither distance and angle measurements between odontoid and C1 nor the dorsal alignment of the vertebral bodies differed significantly between healthy and affected patients. Decentralization of the odontoid process is not necessarily an indirect sign for its fracture. In patients with suspected injury of the odontoid process, an MDCT scan might be the method of choice to rule out a fracture.

  11. MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas: experience in 47 patients

    Energy Technology Data Exchange (ETDEWEB)

    Gordon, Robert W.; Shinagare, Atul B. [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Tirumani, Sree Harsha; Jagannathan, Jyothi P.; Ramaiya, Nikhil H. [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Dana-Farber Cancer Institute, Harvard Medical School, Department of Imaging, Boston, MA (United States); Kurra, Vikram [Dana-Farber Cancer Institute, Harvard Medical School, Department of Imaging, Boston, MA (United States); Hornick, Jason L. [Brigham and Women' s Hospital, Harvard Medical School, Department of Pathology, Boston, MA (United States)

    2014-05-15

    To describe MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas (LMS). In this IRB-approved, HIPAA-compliant retrospective study, we included 47 patients (23 women, 24 men; mean age: 55.3 years, range: 17-85 years) with pathologically confirmed extremity LMS seen at our adult tertiary cancer center between 2000 and 2012. MRI/MDCT of primary tumors in 23 patients and follow-up in all patients were reviewed by two radiologists in consensus. Clinical data were extracted from electronic medical records. Primary tumors were distributed in bones (6 out of 47), deep soft tissues (24 out of 47), and superficial soft tissues (17 out of 47). On imaging (bone = 4, deep soft tissue = 11, superficial soft tissue = 8), compared with skeletal muscle, they were T1 iso-hypointense and T2 hyperintense. Bone LMS were metaphyseal tumors with cortical destruction (3 out of 4). Deep soft-tissue LMS were large with hemorrhage (7 out of 11) and necrosis (10 out of 11). Superficial soft-tissue LMS were relatively smaller, homogeneously enhancing (6 out of 8) tumors. Distant metastases developed in 32 out of 47 patients (bone LMS [6 out of 6], deep soft-tissue LMS [18 out of 24], superficial soft-tissue LMS [8 out of 17]), commonly to lung (29 out of 47) and bone (14 out of 47). At the time of writing, 22 out of 36 patients (bone LMS [4 out of 6], deep soft-tissue LMS [15 out of 24], superficial soft-tissue LMS [4 out of 17]) have died. There was no statistically significant correlation between metastatic disease and tumor size or grade. Extremity LMS arise in bones and in the deep and superficial soft tissues, frequently metastasize to the lungs, and have a poor prognosis. Superficial LMS tend to have a better prognosis than bone or deep soft-tissue LMS. (orig.)

  12. Computed tomographic appearance of the anterior diaphragm: evaluation with 64-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Bum Sang; Kim, Sung Jin; Park, Kil Sun; Cha, Sang Hoon; Han, Gi Seok; Bae, Il Hun; Lee, Seung Young; Jeon, Min Hee [College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju (Korea, Republic of)

    2007-09-15

    To re-evaluate the appearance of the anterior diaphragm by the use of MDCT. We performed a retrospective review of 81 consecutive patients that underwent chest CT by using 64 channel MDCT. We classified the anterior diaphragm as three types (types 1-3) based on 5 mm axial scans: a line behind the xiphoid, a discontinuity and opening anteriorly, and the presence of broad and poorly defined bands. We also classified the anterior diaphragm as three types (types A-C) using 2 mm sagittal reformation images, based on the shape of the anterior diaphragmatic fibers traveling from the base of the pericardium to the xiphoid: a downward slope, an upward slope, and a flat shape, and compared the two groups using a correlation determined by statistical analysis. We could classify the appearance of the anterior diaphragm for all cases on the axial scans and sagittal reformation images. The number of types 1, 2, 3 on the axial scans was 30.9%, 38.3%, and 30.9% and the number of types A, B, C on the sagittal reformation images was 33.3%, 22.2%, and 44.4%, respectively. Type A was seen for 92% of type 1 cases, type C was seen for 88% of type 3 cases, and type B was seen for 54.8% of type 2 cases. The types seen between the axial and sagittal reformation images showed a significant agreement (r = 0.868, {rho} < 0.01). The shape of the anterior diaphragm correlated with the relationship between the base of the pericardium and the xiphoid.

  13. Use of mass vaccination with a reduced dose of REV 1 vaccine for Brucella melitensis control in a population of small ruminants.

    Science.gov (United States)

    Scharp, D W; al Khalaf, S A; al Muhanna, M W; Cheema, R A; Godana, W

    1999-06-01

    Mass vaccination with reduced dose 1/50 Rev 1 strain live vaccine (1-2 10(9) colony forming units), administered subcutaneously, over a four and a half year period reduced the prevalence of Brucella melitensis in Kuwait's small ruminant population from 5.8% in 1993 to 2.02% in 1997. Serological test results using the Rose Bengal Plate Test, Rivanol Agglutination Test and Complement Fixation showed no evidence of persistence of positive serology in animals nine or more months after vaccination. Questionnaires and post-vaccination flock inspections found that the effects on gestation (abortions) were minimal--and not proven to be due to the vaccine. The conclusion from these findings is that mass vaccination with reduced dose Rev 1 administered by the subcutaneous route is a practical field strategy for control of Brucella melitensis.

  14. Upper airway collapsibility evaluated by a negative expiratory pressure test in severe obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Salvatore Romano

    2011-01-01

    Full Text Available OBJECTIVES: To investigate the usefulness of measuring upper airway collapsibility with a negative expiratory pressure application as a screening test for severe obstructive sleep apnea (OSA. INTRODUCTION: OSA is a risk factor for cardiovascular disease, and it may have serious consequences. Its recognition may have important implications during the perioperative period. Increased upper airway collapsibility is one of the main determinants of OSA, and its evaluation could be useful for identifying this condition. METHODS: Severe OSA and normal subjects (24 in each group were matched by body mass index and referred to our sleep laboratory. The subjects were enrolled in an overnight sleep study, and a diurnal negative expiratory pressure test was performed. Flow drop (DV and expiratory volume were measured in the first 0.2 s (V02 of the negative expiratory pressure test. RESULTS: DV (% and V02 (% values were statistically different between normal and OSA subjects. OSA patients showed a greater decrease in flow than normal subjects. In addition, severely OSA patients exhaled during the first 0.2 s of the negative expiratory pressure application was an average of only 11.2% of the inspired volume compared to 34.2% for the normal subjects. Analysis of the receiver operating characteristics showed that V02 (% and DV (% could accurately identify severe OSA in subjects with sensitivities of 95.8% and 91.7%, respectively, and specificities of 95.8% and 91.7%, respectively. CONCLUSIONS: V02 (% and DV (% are highly accurate parameters for detecting severe OSA. The pharyngeal collapsibility measurement, which uses negative expiratory pressure during wakefulness, is predictive of collapsibility during sleep.

  15. Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Jun Sung Moon

    2013-02-01

    Full Text Available BackgroundA 64-slice multidetector computed tomography (MDCT is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM.MethodsA total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years. We compared significant coronary stenosis (>50% luminal narrowing in MDCT with invasive coronary angiography (ICA by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.ResultsOf the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109 were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226 were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222, 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74, 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m2 and coronary calcium score did not also affect the diagnostic accuracy of MDCT.ConclusionThe 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.

  16. Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Gruber, M. [Medical University of Vienna, Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Vienna (Austria); Bauer, J.S.; Dobritz, M.; Woertler, K.; Rummeny, E.J.; Baum, T. [Technische Universitaet Muenchen, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); Beer, A.J. [Technische Universitaet Muenchen, Department of Nuclear Medicine, Munich (Germany); Wolf, P. [Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Munich (Germany)

    2013-02-15

    To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD{sub MDCT} values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 x BMD{sub MDCT} - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 x BMD{sub MDCT} - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures. (orig.)

  17. A Reduced-Dose Seasonal Trivalent Influenza Vaccine Is Safe and Immunogenic in Adult and Elderly Patients in a Randomized Controlled Trial

    Science.gov (United States)

    Tamas, Ferenc; Jankovics, Istvan

    2012-01-01

    With the recent pandemic of influenza A (H1N1) and vaccine shortages, there has been considerable interest in developing influenza vaccines with reduced doses, allowing for increased production capacity. Here we report a prospective, randomized, double-blind, single-center clinical trial of a reduced-dose whole-virion inactivated, adjuvanted influenza vaccine in adult and elderly volunteers. A total of 234 subjects, including 120 adults (18 to 60 years of age) and 114 elderly subjects (>60 years of age) were enrolled to receive either 6 μg or the conventional 15-μg dose of seasonal trivalent influenza vaccines. The subjects were followed for safety analysis, and serum samples were obtained to assess immunogenicity by hemagglutination inhibition testing. The subjects developed antibody responses against the seasonal influenza A virus H1N1 and H3N2 strains, as well as the seasonal influenza B virus included in the vaccines. Single doses of 6 μg fulfilled licensing criteria for seasonal influenza vaccines. No significant differences in rates of seroconversion or seroprotection or in geometric mean titers were found between the two dosage levels. All adverse events were rare, mild, and transient. We found that the present reduced-dose vaccine is safe and immunogenic in healthy adult and elderly subjects and triggers immune responses that comply with licensing criteria. PMID:22219315

  18. MDCT quantification is the dominant parameter in decision–making regarding chest tube drainage for stable patients with traumatic pneumothorax

    OpenAIRE

    Cai, Wenli; Lee, June-Goo; Fikry, Karim; Yoshida, Hiroyuki; Novelline, Robert; De Moya, Marc

    2012-01-01

    It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate v...

  19. MDCT abnormalities of small- and medium-sized bronchus in active tuberculosis: a new angle on an old disease.

    Science.gov (United States)

    Oh, Jin Kyoung; Ahn, Myeong Im; Jung, Jung Im; Kim, Young Kyoon; Oh, Eun-Jee; Park, Yeon-Joon; Han, Dae Hee

    2011-03-01

    The incidence and findings of tuberculous invasion of the peripheral bronchus have not been fully investigated with MDCT. Purpose To evaluate the prevalence and findings of MDCT abnormalities of small- and medium-sized bronchus (SMB) in active pulmonary tuberculosis (TB). Using multiplanar reformation, 35 consecutive MDCT scans (follow-up exams available in 14 patients with a mean interval of 8.1 months) were assessed for following abnormalities of SMB: bronchial impaction (BI), wall thickening, dilatation, peribronchial cuff of soft tissue, and bronchocavitary fistula. It was also assessed whether tree-in-buds (TIB) have a tendency to distribute in the territories of diseased SMB, and whether SMB abnormalities are present in patients with relatively mild disease. SMB abnormalities were observed in 23 (65.7%) patients with active TB. The most frequent finding was wall thickening (n = 18, 51.4%), followed by BI (n = 13, 37.1%; zigzag-shaped in four), dilatation (n = 11, 31.4%), amputated appearance of air column (n = 11, 31.4%), peribronchial cuff of soft tissue (n = 10, 28.6%), and bronchocavitary fistula (n =8, 22.9%). TIB (n = 29; absent in two patients with SMB) was mainly within (n = 14) or close to (n = 4) the territory of diseased SMB. Follow-up CT frequently showed improvement of wall thickening (11/12) and persistence of bronchial dilatation (11/13). SMB abnormality was present in all of six patients with mild disease. MDCT shows that tuberculous invasion of the peripheral bronchus may be more frequent than previously thought, of which findings include wall thickening, BI, dilatation, amputated appearance of air column, peribronchial cuff of soft tissue and bronchocavitary fistula.

  20. Accuracy of water-enema multidetector computed tomography (WE-MDCT) in colon cancer staging: a prospective study.

    Science.gov (United States)

    Sibileau, E; Ridereau-Zins, Catherine; Vanel, D; Pavageau, A H; Bertrais, S; Metivier-Cesbron, E; Venara, A; Aubé, C

    2014-10-01

    To assess the accuracy of water-enema multidetector computed tomography (WE-MDCT) in extra-rectal colon cancer staging. Fifty-three patients (mean age 70 years) with extra-rectal colon cancer proven by colonoscopy and biopsy were prospectively evaluated by preoperative WE-MDCT. CT scans were both intraluminal (water enema or WE) and intravenous (iodinated) contrast enhanced (CE). All patients underwent surgery. Tumors were classified with the TNM staging system. Noted CT features were: tumor size and location; tumor form and edges; spread to the pericolic fat or neighboring organs; thickening of retroperitoneal fascia; number, size, and enhancement of the peritumoral lymph nodes. Tumors were classified on CT into 3 T-stage groups: T1/T2, T3, and T4. Lymph nodes were classified by their density after injection [positive over 100 Hounsfield units (HU)]. Tumor localization to the specific colon segment was correct in all the cases. The agreement between WE-MDCT staging and histopathology staging was good (k = 0.64). An irregular and bowl-shaped aspect of the external edges of tumor provided excellent sensitivity for T3/T4 inclusion (Se 97.7%, NPV 85.7%). Thickening of a fascia or the abdominal wall provided good specificity for T4 stage (Sp 88.1%, NPV 94.9%). Enhancement over 100 HU of at least one peritumoral lymph node was the best criterion of N+ staging (Sp 67.7%, NPV 87.5%). WE-MDCT permits good staging of colon cancer based on objective features.

  1. Evaluation of a single-pass continuous whole-body 16-MDCT protocol for patients with polytrauma.

    Science.gov (United States)

    Nguyen, Duy; Platon, Alexandra; Shanmuganathan, Kathirkamanathan; Mirvis, Stuart E; Becker, Christoph D; Poletti, Pierre-Alexandre

    2009-01-01

    The purpose of this study was to compare a conventional multiregional MDCT protocol with two continuous single-pass whole-body MDCT protocols in imaging of patients with polytrauma. Ninety patients with polytrauma underwent whole-body 16-MDCT with a conventional (n=30) or one of two single-pass (n=60) protocols. The conventional protocol included unenhanced scans of the head and cervical spine and contrast-enhanced helical scans (140 mL, 4 mL/s, 300 mg I/mL) of the thorax and abdomen. The single-pass protocols consisted of unenhanced scans of the head followed by one-sweep acquisition from the circle of Willis through the pubic symphysis with a biphasic (150 mL, 6 and 4 mL/s, 300 mg I/mL) or monophasic (110 mL, 4 mL/s, 400 mg I/mL) injection. Acquisition times and interval delays between head, chest, and abdominal scans were recorded. Contrast enhancement was measured in the aortic arch, liver, spleen, and kidney. Diagnostic image quality in the same areas was assessed on a 4-point scale. Median acquisition times for the single-pass protocols were significantly shorter (-42.5%) than the acquisition time for the conventional protocol. No significant differences were found in mean enhancement values in the aorta, liver, spleen, and kidney for the three protocols. The image quality with both single-pass protocols was better than that with the conventional protocol in assessment of the mediastinum and cervical spine (p<0.05). There was no significant difference between the single-pass protocols. Use of single-pass continuous whole-body MDCT protocols can significantly decrease examination time for patients with polytrauma and improve image quality compared with a conventional serial scan protocol. Monophasic injection with highly concentrated contrast medium can reduce injection flow rate and should therefore be preferred to a biphasic injection technique.

  2. Use of Preprocedural MDCT for Cardiac Implantable Electric Device Lead Extraction: Frequency of Findings That Change Management.

    Science.gov (United States)

    Ehieli, Wendy L; Boll, Daniel T; Marin, Daniele; Lewis, Robert; Piccini, Jonathan P; Hurwitz, Lynne M

    2017-04-01

    Five percent of cardiac implantable electric devices (CIEDs) are removed each year. Percutaneous extraction is preferred but can be complicated if the leads adhere to the vasculature or perforate. The goal of this study is to assess the frequency of findings on dedicated MDCT that alter preprocedural planning for percutaneous CIED extraction. One hundred patients with CIEDs who underwent MDCT before percutaneous lead extraction were analyzed. Major findings that could preclude percutaneous removal, including lead course and termination, were distinguished from moderately significant findings that could alter but not preclude percutaneous removal, including endofibrosis of leads to the vasculature, lead termination abnormalities, central vein stenosis, or thrombus. Incidental findings were characterized separately. Findings were correlated with preprocedural decisions, the extraction procedure performed, and procedural outcomes. Twenty-six women and 74 men with 125 right ventricular leads, 84 right atrial leads, and 26 coronary venous leads were evaluated. Major findings were present in 7% of patients, including six patients with lead perforation and one with a lead coursing outside a tricuspid annuloplasty ring. Moderately significant findings of endothelial fibrosis were found in 78% of patients. The central veins were narrowed or occluded in 42% of patients, and thrombus was present in 2% of patients. Thirty-six percent of patients had incidental findings, and 4% of patients had unexpected findings requiring immediate inpatient attention. MDCT performed before CIED lead extraction is able to identify major and moderately significant findings that can alter either percutaneous extraction or preprocedural planning. The use of dedicated preprocedural MDCT can help to stratify patient risk, guide decision making by the proceduralist, and identify non-catheter-related findings that affect patient management.

  3. Abdominal muscle activity during breathing with and without inspiratory and expiratory loads in healthy subjects.

    Science.gov (United States)

    Mesquita Montes, António; Baptista, João; Crasto, Carlos; de Melo, Cristina Argel; Santos, Rita; Vilas-Boas, João Paulo

    2016-10-01

    Central Nervous System modulates the motor activities of all trunk muscles to concurrently regulate the intra-abdominal and intra-thoracic pressures. The study aims to evaluate the effect of inspiratory and expiratory loads on abdominal muscle activity during breathing in healthy subjects. Twenty-three higher education students (21.09±1.56years; 8males) breathed at a same rhythm (inspiration: two seconds; expiration: four seconds) without load and with 10% of the maximal inspiratory or expiratory pressures, in standing. Surface electromyography was performed to assess the activation intensity of rectus abdominis, external oblique and transversus abdominis/internal oblique muscles, during inspiration and expiration. During inspiration, transversus abdominis/internal oblique activation intensity was significantly lower with inspiratory load when compared to without load (p=0.009) and expiratory load (p=0.002). During expiration, the activation intensity of all abdominal muscles was significantly higher with expiratory load when compared to without load (pmuscle to modulate the intra-abdominal pressure for the breathing mechanics.

  4. Dead space and slope indices from the expiratory carbon dioxide tension-volume curve

    NARCIS (Netherlands)

    A.H. Kars (Alice); J.M. Bogaard (Jan); Th. Stijnen (Theo); J. de Vries; A.F.M. Verbraak (Anton); C. Hilvering

    1997-01-01

    textabstractThe slope of phase 3 and three noninvasively determined dead space estimates derived from the expiratory carbon dioxide tension (PCO2) versus volume curve, including the Bohr dead space (VD,Bohr), the Fowler dead space (VD,Fowler) and pre-interface expirate

  5. Modeling the Fate of Expiratory Aerosols and the Associated Infection Risk in an Aircraft Cabin Environment

    DEFF Research Database (Denmark)

    Wan, M.P.; To, G.N.S.; Chao, C.Y.H.

    2009-01-01

    The transport and deposition of polydispersed expiratory aerosols in an aircraft cabin were simulated using a Lagrangian-based model validated by experiments conducted in an aircraft cabin mockup. Infection risk by inhalation was estimated using the aerosol dispersion data and a model was developed...

  6. Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

    NARCIS (Netherlands)

    Fournell, A.; Scheeren, T. W. L.; Picker, O.; Schwarte, L. A.; Wolf, M; Bucher, HU; Rudin, M; VanHuffel, S; Wolf, U; Bruley, DF; Harrison, DK

    2012-01-01

    Mechanical ventilation with positive end-expiratory pressure (PEEP) is an indispensable tool in the management of respiratory failure to preserve or improve lung function and systemic oxygenation. However, PEEP per se may also, as has been shown in experimental animals, impair regional microcirculat

  7. Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children

    NARCIS (Netherlands)

    T. Jartti; P. Lehtinen; T. Vuorinen; A.D.M.E. Osterhaus (Albert); O. Ruuskanen; R. Österback (Riika); B.G. van den Hoogen (Bernadette)

    2004-01-01

    textabstractWe studied the viral etiology of acute expiratory wheezing (bronchiolitis, acute asthma) in 293 hospitalized children in a 2-year prospective study in Finland. A potential causative viral agent was detected in 88% of the cases. Eleven different viruses were represented. Respiratory

  8. EFFECT OF POSITIVE EXPIRATORY PRESSURE BREATHING IN PATIENTS WITH CYSTIC-FIBROSIS

    NARCIS (Netherlands)

    VANDERSCHANS, CP; VANDERMARK, TW; DEVRIES, G; PIERS, DA; BEEKHUIS, H; DANKERTROELSE, JE; POSTMA, DS; KOETER, GH

    The effect of positive expiratory pressure breathing, alone and in combination with coughing, was investigated in eight patients with cystic fibrosis. Functional residual capacity and total lung capacity was measured with a body plethysmograph before, during, and immediately after breathing with

  9. Changes in forced expiratory volume in 1 second over time in COPD

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Edwards, Lisa D; Scanlon, Paul D

    2011-01-01

    A key feature of chronic obstructive pulmonary disease (COPD) is an accelerated rate of decline in forced expiratory volume in 1 second (FEV(1)), but data on the variability and determinants of this change in patients who have established disease are scarce....

  10. THE EFFECT OF SUBMAXIMAL INHALATION ON MEASURES DERIVED FROM FORCED EXPIRATORY SPIROMETRY

    Science.gov (United States)

    THE EFFECT OF SUBMAXIMAL INHALATION ON MEASURES DERIVED FROM FORCED EXPIRATORY SPIROMETRY. William F. McDonnell Human Studies Division, NHEERL, U.S. Environmental Protection Agency, RTP, NC 27711. Short-term exposure to ozone results in a neurally-mediated decrease in the ab...

  11. Changes in forced expiratory volume in 1 second over time in COPD

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Edwards, Lisa D; Scanlon, Paul D

    2011-01-01

    A key feature of chronic obstructive pulmonary disease (COPD) is an accelerated rate of decline in forced expiratory volume in 1 second (FEV(1)), but data on the variability and determinants of this change in patients who have established disease are scarce....

  12. Expiratory computed tomographic techniques: a cause of a poor rate of change in lung volume.

    Science.gov (United States)

    Morikawa, Keiko; Okada, Fumito; Mori, Hiromu

    2015-01-01

    Ninety-nine patients (29 males and 70 females; mean age, 57.1 years; range, 22-81 years) were included in this study to evaluate the factors affecting smaller lung volume changes in expiratory high-resolution computed tomography performed to depict air trapping. All patients underwent inspiratory and expiratory chest thin-section CT examinations and pulmonary function tests. Air trapping on CT images was graded subjectively. All variables (age, sex, diagnosis, pulmonary function index, and air trapping score) were compared with the degree of change in lung volume between the inspiratory and expiratory CT examinations. The variables affecting a lower degree of volume change were vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), and the FEV1.0/FVC ratio. Bronchiolitis obliterans was the dominant diagnosis in patients with insufficient degrees of breath holding and in patients with negative air trapping scores despite an abnormal air trapping index. An insufficient degree of lung changes between inspiration and expiration on CT examinations represented bronchiolitis obliterans, which resulted in low FEV1.0 and FEV1.0/FVC values. Changes in the time gap from the announcement of exhalation and breath holding to the start of scanning most effectively indicated air trapping in patients with bronchiolar disorders.

  13. Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Ryusuke, E-mail: rywakana@nms.ac.jp; Kumita, Shin-ichiro; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Okazaki, Emi; Kiriyama, Tomonari; Hakozaki, Kenta; Tani, Hitomi; Miki, Izumi; Takeda, Minako

    2013-10-01

    Purpose: The purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. Materials and methods: Institutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60 mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48–72 h after contrast administration. Results: The overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P = .027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0–20.5, P = .046). Conclusions: Anemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT.

  14. Detection of Lymph Nodes Metastasis in Biliary Carcinomas: Morphological Criteria by MDCT and the Clinical Impact of DWI-MRI.

    Science.gov (United States)

    Morine, Yuji; Shimada, Mitsuo; Imura, Satoru; Ikemoto, Tetsuya; Hanaoka, Jun; Kanamoto, Mami; Ishibashi, Hiroki; Utsunomiya, Tohru

    2015-06-01

    This study was conducted to assess the usefulness of multi-slice CT (MDCT) and diffusion weighted MR images (DWI-MRI) for diagnosis of metastatic lymph nodes (LNs) in biliary carcinomas. Eighteen patients with biliary carcinomas (total 121 LNs) underwent surgical resection were included. In MDCT, the following criteria were measured: the maximum diameter, the enhanced value and the long and short axis (L/S) ratio. In DWI-MRI, the apparent diffusion coefficients (ADCs) were measured from ADC maps. In ROC analysis, the maximum diameter has the highest diagnostic power with area under curves of 0.903. And when the maximum diameter 8 mm and L/S ratio is less than 2, the accuracy was improved with a sensitivity of 81%, positive predictive value (PPV) of 45%. In DWI-MRI, ADCs values of metastatic LNs significantly lower than that of non-metastatic LNs (mean: 1.65 vs. 2.11 x10 3mm2/s). When the ADC value of 1.8 x10(-3) was used as a cut-off value, the best results were obtained with sensitivity of 75%, PPV of 82%. Using MDCT, diagnosis of LNs metastasis should be more than 8mm diameter and less than 2 of L/S ratio. In addition, DWI-MRI is more useful modality for diagnosis of LNs metastasis.

  15. Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

    Science.gov (United States)

    Borges, Lúcia Faria; Saraiva, Mateus Sasso; Saraiva, Marcos Ariel Sasso; Macagnan, Fabrício Edler; Kessler, Adriana

    2017-01-01

    Objective To review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults. Methods Systematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded. Results The search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation. Conclusion There is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive. PMID

  16. Feasibility of using single-slice MDCT to evaluate visceral abdominal fat in an urban pediatric population.

    Science.gov (United States)

    Blitman, Netta M; Baron, Lindsay Stanton; Berkenblit, Robert G; Schoenfeld, Alan H; Markowitz, Morri; Freeman, Katherine

    2011-08-01

    Obesity is a growing clinical problem, especially among children of low socioeconomic status. Increased visceral abdominal fat is implicated in the metabolic syndrome and its health consequences. The purpose of this study is to validate measurement of a single MDCT slice as a predictor of total visceral abdominal fat and to correlate over a wide range of body mass indexes (BMIs). A two-phase retrospective analysis was performed. For validation, MDCTs of 21 consecutive healthy children (8-14 years old) were reviewed. In these cases, visceral abdominal fat and subcutaneous abdominal fat area were calculated using a body fat analysis function from single 0.625-mm MDCT slices at the umbilicus and were compared with total visceral abdominal fat area as measured from T11 to the coccyx. Subsequently, visceral abdominal fat area was obtained from single slices at the umbilicus from abdominal MDCT scans of 146 consecutive healthy children (age range, 6-14 years; 80 boys and 66 girls; 77 Hispanic, 41 African American, 15 white, and 13 multiracial or other race) for whom BMI was available. Associations between visceral abdominal fat area and sex, race, and BMI were determined. Effective radiation dose for a 1.25-mm axial MDCT slice was calculated using a mathematic model that uses derived scaling factors for pediatric patients. Visceral abdominal fat area obtained from a 0.625-mm slice at the umbilicus was highly correlated with total visceral abdominal fat area (r = 0.96; p abdominal fat area from single slices at the umbilicus was significantly correlated with BMI (r = 0.72; p abdominal fat area was significantly lower in African American children compared with others (median, 14 vs 22 cm(2); p = 0.02) and was not associated with sex. In our population, the effective radiation dose from the smallest obtainable slice was 0.015-0.019 mSv/37-54 kg of patient weight. Visceral abdominal fat area calculated from a single abdominal MDCT slice obtained in children is highly

  17. Sinonasal imaging after Caldwell-Luc surgery: MDCT findings of an abandoned procedure in times of functional endoscopic sinus surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nemec, Stefan Franz; Peloschek, Philipp; Koelblinger, Claus; Mehrain, Sheida; Krestan, Christian Robert; Czerny, Christian [Department of Radiology, Division of Neuroradiology and Musculoskeletalradiology, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna (Austria)

    2009-04-15

    Background and purpose: Today, functional endoscopic sinus surgery (FESS) is performed in most of the patients with sinonasal inflammatory disease. The postoperative imaging findings of FESS in multidetector computed tomography (MDCT) considerably differ from those of historic Caldwell-Luc (CL) maxillary sinus surgery which is an uncommon procedure today. Thus, the postoperative CL imaging findings may lead to diagnostic confusion and misinterpretation. Therefore, this study explicitly presents the MDCT findings of post-CL patients which have not been described previously. Methods: Twenty-eight patients with clinically suspected sinusitis and documented history of CL-procedure underwent 16 row MDCT (MDCT Mx8000 IDT Philips) with multiplanar reconstructions of the paranasal sinuses in the axial plane. The following parameters were used: 140 kV, 50 mAs; 16 mm x 0.75 mm detector collimation; 1 mm reconstructed slice thickness; 0.5 mm increment. The studies were reconstructed with a bone algorithm (W3000/L600; 1 mm slice thickness) in axial plane and coronal plane (3 mm slice thickness). The images were retrospectively evaluated for the presence of normal surgery-related and pathological findings. Results: Surgery-related imaging characteristics presented as follows: an anterior and a medial bony wall defect and sclerosis and sinus wall thickening were observed in all 28/28 cases (100%). Collaps of the sinus cavity was seen in 26/28 cases (92.9%). Furthermore, inflammatory disease of the operated sinus(es) was found in 23/28 cases (82.1%): 14/28 patients (50%) had inflammatory mucosal thickening of the operated sinus(es) as well as of other sinonasal cavities and 9/28 patients (32.1%) had inflammatory mucosal thickening limited to the operated sinus(es). A postoperative mucocele was depicted in 3/28 cases (10.7%). 2/28 patients (7.1%) showed neither maxillary nor other mucosal swelling. Conclusion: MDCT with multiplanar reconstructions is a precise method to evaluate

  18. Effects of Positive End-Expiratory Pressure on Oscillated Volume during High-Frequency Chest Compression in Children with Cystic Fibrosis

    Directory of Open Access Journals (Sweden)

    Cara F Dosman

    2003-01-01

    Full Text Available OBJECTIVE: To investigate the effects of positive end-expiratory pressure (PEEP on end-expiratory lung volume (EELV and mean oscillated volume (Vosc during high frequency chest compression (HFCC.

  19. Correlation between epicardial adipose tissue and severity of coronary artery stenosis evaluated by 64-MDCT.

    Science.gov (United States)

    Yang, Chunying; Li, Liang; Zha, Yunfei; Peng, Zhoufeng

    2016-01-01

    The purpose was to investigate the correlation between epicardial adipose tissue (EAT) thickness, EAT volume, and severity of coronary artery stenosis. We retrospectively enrolled 188 patients that underwent coronary computed tomography (CT) angiography for clinically suspected coronary artery disease using 64-MDCT. Images were reconstructed using a retrospective electrocardiogram-gated algorithm with 0.625-mm-thick sections. EAT thickness and volume were calculated. The coronary CT angiography showed 106 patients who had coronary artery pathology (178 lesions), 21 patients with moderate stenosis (27 lesions), 12 patients with severe stenosis (18 lesions), and 6 patients with complete occlusion (8 lesions). EAT thickness, EAT volume, and Gensini score were statistically different among groups (FT=32.306, FV=27.743, F=110.483, P=.000). Pearson correlation analysis showed that Gensini score had significantly positive correlation with EAT thickness and volume, respectively. EAT thickness and volume demonstrated a positive correlation with severity of coronary artery stenosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Determination of the chemical composition of human renal stones with MDCT: influence of the surrounding media

    Science.gov (United States)

    Grosjean, Romain; Sauer, Benoît; Guerra, Rui; Kermarrec, Isabelle; Ponvianne, Yannick; Winninger, Daniel; Daudon, Michel; Blum, Alain; Felblinger, Jacques; Hubert, Jacques

    2007-03-01

    The selection of the optimal treatment method for urinary stones diseases depends on the chemical composition of the stone and its corresponding fragility. MDCT has become the most used modality to determine rapidly and accurately the presence of stones when evaluating urinary lithiasis treatment. That is why several studies have tempted to determine the chemical composition of the stones based on the stone X-ray attenuation in-vitro and invivo. However, in-vitro studies did not reproduce the normal abdominal wall and fat, making uncertain the standardization of the obtained values. The aim of this study is to obtain X-ray attenuation values (in Hounsfield Units) of the six more frequent types of human renal stones (n=217) and to analyze the influence of the surrounding media on these values. The stones were first placed in a jelly, which X-ray attenuation is similar to that of the human kidney (30 HU at 120 kV). They were then stuck on a grid, scanned in a water tank and finally scanned in the air. Significant differences in CT-attenuation values were obtained with the three different surrounding media (jelly, water, air). Furthermore there was an influence of the surrounding media and consequently discrepancies in determination of the chemical composition of the renal stones. Consequently, CT-attenuation values found in in-vitro studies cannot really be considered as a reference for the determination of the chemical composition except if the used phantom is an anthropomorphic one.

  1. Interaction between intra-abdominal pressure and positive-end expiratory pressure

    Directory of Open Access Journals (Sweden)

    Jamili Anbar Torquato

    2009-02-01

    Full Text Available OBJECTIVE: The aim of this study was to quantify the interaction between increased intra-abdominal pressure and Positive-End Expiratory Pressure. METHODS: In 30 mechanically ventilated ICU patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a Positive-End Expiratory Pressure level of zero and 10 cm H2O. The measurements were repeated after placing a 5 kg weight on the patients' belly. RESULTS: After the addition of 5 kg to the patients' belly at zero Positive-End Expiratory Pressure, both intra-abdominal pressure (p<0.001 and plateau pressures (p=0.005 increased significantly. Increasing the Positive-End Expiratory Pressure levels from zero to 10 cm H2O without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165. However, plateau pressures increased significantly (p< 0.001. Increasing Positive-End Expiratory Pressure from zero to 10 cm H2O and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001 and plateau pressure from 18.26 to 27.2 (p<0.001. Maintaining Positive-End Expiratory Pressure at 10 cm H2O and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001 but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83. CONCLUSIONS: The addition of a 5kg weight onto the abdomen significantly increased both IAP and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. However, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using PEEP. In these patients, the intra-abdominal pressure must also be measured.

  2. Vaccination of adult animals with a reduced dose of Brucella abortus S19 vaccine to control brucellosis on dairy farms in endemic areas of India.

    Science.gov (United States)

    Chand, Puran; Chhabra, Rajesh; Nagra, Juhi

    2015-01-01

    Bovine brucellosis is an economically important disease which seriously affects dairy farming by causing colossal losses. It can be controlled by practicing vaccination of animals with Brucella abortus S19 vaccine (S19 vaccine). In the present study, adult bovines were vaccinated on seven dairy farms with a reduced dose of S19 vaccine to control brucellosis. Serological screening of adult animals (N = 1,082) by Rose Bengal test (RBT) and ELISA prior to vaccination revealed the presence and absence of brucellosis on five and two farms, respectively. The positive animals (N = 171) were segregated and those which tested negative (N = 911) were vaccinated by conjunctival route with a booster after 4 months. The conjunctival vaccination induced weak antibody response in animals, which vanished within a period of 9 to 12 weeks. Abortion in 12 animals at various stages of pregnancy and post-vaccination was recorded, but none was attributed to S19 vaccine. However, virulent B. abortus was incriminated in six heifers, and the cause of abortion could not be established in six animals. The six aborted heifers perhaps acquired infection through in utero transmission or from the environment which remained undetected until abortion. These findings suggested that vaccination of adult animals with a reduced dose of S19 vaccine by conjunctival route did not produce adverse effects like abortion in pregnant animals and persistent vaccinal antibody titers, which are the major disadvantages of subcutaneous vaccination of adult animals.

  3. Utility of Postmortem Autopsy via Whole-Body Imaging: Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Jang Gyu; Kim, Dong Hun; Paik, Sang Hyun [National Institute of Scientific Investigation, Seoul (Korea, Republic of)

    2010-08-15

    We prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings. Five cadavers were subjected to whole-body, 16- channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings. Most of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. A postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations

  4. Utility of Postmortem Autopsy via Whole-Body Imaging: Initial Observations Comparing MDCT and 3.0T MRI Findings with Autopsy Findings

    Science.gov (United States)

    Cha, Jang Gyu; Kim, Dong Hun; Kim, Dae Ho; Paik, Sang Hyun; Park, Jai Soung; Park, Seong Jin; Lee, Hae Kyung; Hong, Hyun Sook; Choi, Duek Lin; Chung, Nak Eun; Lee, Bong Woo; Seo, Joong Seok

    2010-01-01

    Objective We prospectively compared whole-body multidetector computed tomography (MDCT) and 3.0T magnetic resonance (MR) images with autopsy findings. Materials and Methods Five cadavers were subjected to whole-body, 16-channel MDCT and 3.0T MR imaging within two hours before an autopsy. A radiologist classified the MDCT and 3.0T MRI findings into major and minor findings, which were compared with autopsy findings. Results Most of the imaging findings, pertaining to head and neck, heart and vascular, chest, abdomen, spine, and musculoskeletal lesions, corresponded to autopsy findings. The causes of death that were determined on the bases of MDCT and 3.0T MRI findings were consistent with the autopsy findings in four of five cases. CT was useful in diagnosing fatal hemorrhage and pneumothorax, as well as determining the shapes and characteristics of the fractures and the direction of external force. MRI was effective in evaluating and tracing the route of a metallic object, soft tissue lesions, chronicity of hemorrhage, and bone bruises. Conclusion A postmortem MDCT combined with MRI is a potentially powerful tool, providing noninvasive and objective measurements for forensic investigations. PMID:20592923

  5. Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children.

    Science.gov (United States)

    Jartti, Tuomas; Lehtinen, Pasi; Vuorinen, Tytti; Osterback, Riika; van den Hoogen, Bernadette; Osterhaus, Albert D M E; Ruuskanen, Olli

    2004-06-01

    We studied the viral etiology of acute expiratory wheezing (bronchiolitis, acute asthma) in 293 hospitalized children in a 2-year prospective study in Finland. A potential causative viral agent was detected in 88% of the cases. Eleven different viruses were represented. Respiratory syncytial virus (RSV) (27%), enteroviruses (25%), rhinovirus (24%), and nontypable rhino/enterovirus (16%) were found most frequently. In infants, RSV was found in 54% and respiratory picornaviruses (rhinovirus and enteroviruses) in 42% of the cases. In older children, respiratory picornaviruses dominated (65% of children ages 1-2 years and 82% of children ages > or =3 years). Human metapneumovirus was detected in 4% of all children and in 11% of infants. To prevent and treat acute expiratory wheezing illnesses in children, efforts should be focused on RSV, enterovirus, and rhinovirus infections.

  6. Abdominal wall reconstruction for large incisional hernia restores expiratory lung function

    DEFF Research Database (Denmark)

    Jensen, Kristian K; Backer, Vibeke; Jorgensen, Lars N

    2016-01-01

    BACKGROUND: Respiratory complications secondary to intermittent intra-abdominal hypertension and/or atelectasis are common after abdominal wall reconstruction for large incisional hernias. It is unknown if the respiratory function of this patient group is affected long term or impairs activities...... of daily living. We hypothesized that abdominal wall reconstruction for large incisional hernia would not lead to improved, long-term pulmonary function or respiratory quality of life. METHODS: Eighteen patients undergoing open abdominal wall reconstruction with mesh for a large incisional hernia...... wall reconstruction showed a significantly greater improvement of percent predicted peak expiratory flow compared with patients undergoing colorectal resection. CONCLUSION: Abdominal wall reconstruction for large incisional hernia improved long-term expiratory lung function. Respiratory quality of life...

  7. Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial.

    Science.gov (United States)

    Rochat, Isabelle; Leis, Patricia; Bouchardy, Marie; Oberli, Christine; Sourial, Hendrika; Friedli-Burri, Margrit; Perneger, Thomas; Barazzone Argiroffo, Constance

    2012-03-01

    Chest physiotherapy (CP) using passive expiratory manoeuvres is widely used in Western Europe for the treatment of bronchiolitis, despite lacking evidence for its efficacy. We undertook an open randomised trial to evaluate the effectiveness of CP in infants hospitalised for bronchiolitis by comparing the time to clinical stability, the daily improvement of a severity score and the occurrence of complications between patients with and without CP. Children slow expiratory technique, slow accelerated expiratory flow, rarely induced cough) or group 2 without CP. All children received standard care (rhinopharyngeal suctioning, minimal handling, oxygen for saturation ≥92%, fractionated meals). Ninety-nine eligible children (mean age, 3.9 months), 50 in group 1 and 49 in group 2, with similar baseline variables and clinical severity at admission. Time to clinical stability, assessed as primary outcome, was similar for both groups (2.9 ± 2.1 vs. 3.2 ± 2.8 days, P = 0.45). The rate of improvement of a clinical and respiratory score, defined as secondary outcome, only showed a slightly faster improvement of the respiratory score in the intervention group when including stethoacoustic properties (P = 0.044). Complications were rare but occurred more frequently, although not significantly (P = 0.21), in the control arm. In conclusion, this study shows the absence of effectiveness of CP using passive expiratory techniques in infants hospitalised for bronchiolitis. It seems justified to recommend against the routine use of CP in these patients.

  8. Negative Expiratory Pressure Technique: An Awake Test to Measure Upper Airway Collapsibility in Adolescents

    Science.gov (United States)

    Carrera, Helena Larramona; Marcus, Carole L.; McDonough, Joseph M.; Morera, Joan C. Oliva; Huang, Jingtao; Farre, Ramon; Montserrat, Josep M.

    2015-01-01

    Study Objectives: Upper airway (UA) collapsibility is a major pathophysiologic feature of the obstructive sleep apnea syndrome (OSAS). In adolescents, it is measured by obtaining the slope of pressure-flow relationship (SPF) while applying negative nasal pressure during sleep. An easier technique to assess UA collapsibility, consisting of application of negative expiratory pressure (NEP) during wakefulness, has demonstrated differences between control and OSAS subjects. We hypothesized that the NEP technique would correlate with SPF as a measurement of UA collapsibility in adolescents. Design: During wakefulness, NEP of −5 cm H2O in the seated and supine position was applied during the first second of expiration. The area under the expiratory flow-volume curve during NEP was compared to tidal breathing (RatioNEP). In addition, adolescents underwent SPF measurements during sleep. Two SPF techniques were performed to measure the activated and relatively hypotonic UA. Setting: Pediatric sleep laboratory. Participants: Seven adolescents with OSAS and 20 controls. Results: In the seated position, there was a correlation between RatioNEP and both hypotonic SPF (r = −0.39, P = 0.04) and activated SPF (r = −0.62, P = 0.001). In the supine position, there was a correlation between RatioNEP and activated SPF (r = −0.43, P = 0.03) and a trend for hypotonic SPF (r = −0.38, P = 0.06). Conclusions: The negative expiratory pressure (NEP) technique correlates with the hypotonic and activated slope of pressure-flow relationship measurements. The seated position showed the strongest correlation. The NEP technique can be used as an alternative method to evaluate upper airway collapsibility in adolescents. Citation: Carrera HL, Marcus CL, McDonough JM, Morera JC, Huang J, Farre R, Montserrat JM. Negative expiratory pressure technique: an awake test to measure upper airway collapsibility in adolescents. SLEEP 2015;38(11):1783–1791. PMID:26158888

  9. Effect of Dialysis on Maximum Inspiratory and Expiratory Pressures in End Stage Renal Disease Patients

    OpenAIRE

    2015-01-01

    Background: Muscle weakness especially weakness of the respiratory muscles is a complication of chronic kidney disease. The cause of muscle weakness is the accumulation of excessive amounts of urea and other toxins. The aim of this study was to assess the effect of hemodialysis on respiratory muscle strength by measuring maximum inspiratory (PI max) and expiratory pressure (PE max). Materials and Methods: A cross sectional study was carried out on 31 patients with chronic kidney disease at Mo...

  10. Acoustic characteristics of voluntary expiratory sounds after swallow for detecting dysphagia.

    Science.gov (United States)

    Yamashita, M; Yokoyama, K; Takei, Y; Furuya, N; Nakamichi, Y; Ihara, Y; Takahashi, K; Groher, M E

    2014-09-01

    This research was designed to investigate the acoustic characteristics of voluntary expiratory sounds after swallow for detecting dysphagia. Forty-nine patients with complaints of swallow difficulty received a videofluorographic (VF) examination. They were divided into three groups: nine who did not have any apparent disease (Group N), 22 patients with head and neck cancer (Group H&N) and 18 patients with other diseases including cerebrovascular disease (Group OD). After liquid barium swallows, they exhaled voluntarily without voicing. Videofluorographic findings were classified into four groups: normal (Normal), acceptable swallow (Acceptable), swallow with residue (Resid) and swallows with penetration or aspiration (Pen/Asp). The duration of expiratory sounds was measured on the time waveform. Frequency characteristics of expiratory sounds were obtained using one-third octave band analysis ranging from 62·5 to 2000·0 Hz of central frequency. The averaged level of the 1000·0-Hz band was chosen as the reference band level (RB level). The revised averaged level of each band was obtained by subtracting the RB level from the averaged level of each band. Zero decibel of the revised magnitude of the 125·0-Hz band was set as the critical value to differentiate dysphagia (Resid or Pen/Asp) from no dysphagia (Normal or Acceptable). Comparison of this assessment with VF findings showed a significant percentage agreement (85·4%). These results suggest that frequency characteristics of post-swallow expiratory sounds can differentiate dysphagia from no dysphagia among multiple dysphagic patient groups. © 2014 John Wiley & Sons Ltd.

  11. Expiratory muscle loading increases intercostal muscle blood flow during leg exercise in healthy humans

    Science.gov (United States)

    Athanasopoulos, Dimitris; Louvaris, Zafeiris; Cherouveim, Evgenia; Andrianopoulos, Vasilis; Roussos, Charis; Zakynthinos, Spyros

    2010-01-01

    We investigated whether expiratory muscle loading induced by the application of expiratory flow limitation (EFL) during exercise in healthy subjects causes a reduction in quadriceps muscle blood flow in favor of the blood flow to the intercostal muscles. We hypothesized that, during exercise with EFL quadriceps muscle blood flow would be reduced, whereas intercostal muscle blood flow would be increased compared with exercise without EFL. We initially performed an incremental exercise test on eight healthy male subjects with a Starling resistor in the expiratory line limiting expiratory flow to ∼ 1 l/s to determine peak EFL exercise workload. On a different day, two constant-load exercise trials were performed in a balanced ordering sequence, during which subjects exercised with or without EFL at peak EFL exercise workload for 6 min. Intercostal (probe over the 7th intercostal space) and vastus lateralis muscle blood flow index (BFI) was calculated by near-infrared spectroscopy using indocyanine green, whereas cardiac output (CO) was measured by an impedance cardiography technique. At exercise termination, CO and stroke volume were not significantly different during exercise, with or without EFL (CO: 16.5 vs. 15.2 l/min, stroke volume: 104 vs. 107 ml/beat). Quadriceps muscle BFI during exercise with EFL (5.4 nM/s) was significantly (P = 0.043) lower compared with exercise without EFL (7.6 nM/s), whereas intercostal muscle BFI during exercise with EFL (3.5 nM/s) was significantly (P = 0.021) greater compared with that recorded during control exercise (0.4 nM/s). In conclusion, increased respiratory muscle loading during exercise in healthy humans causes an increase in blood flow to the intercostal muscles and a concomitant decrease in quadriceps muscle blood flow. PMID:20507965

  12. Peak expiratory flow rate in healthy children aged 6-17 years

    DEFF Research Database (Denmark)

    Høst, A; Høst, A H; Ibsen, T

    1994-01-01

    Peak expiratory flow rate (PEFR) was measured in a cross-sectional study in 861 healthy Danish schoolchildren aged 6-17 years using a Mini Wright peak flowmeter. We found a strong correlation between PEFR and height, age and sex. The results were comparable with those from previous studies using...... coefficient in this large sample. Among healthy children without previous asthma, earlier episodes of recurrent wheezing were reported in 8.8% and a significantly lower PEFR was found in this group....

  13. [Cerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique].

    Science.gov (United States)

    Bassani, Mariana Almada; Caldas, Jamil Pedro Siqueira; Netto, Abimael Aranha; Marba, Sérgio Tadeu Martins

    2016-06-01

    To assess the impact of respiratory therapy with the expiratory flow increase technique on cerebral hemodynamics of premature newborns. This is an intervention study, which included 40 preterm infants (≤34 weeks) aged 8-15 days of life, clinically stable in ambient air or oxygen catheter use. Children with heart defects, diagnosis of brain lesion and/or those using vasoactive drugs were excluded. Ultrasonographic assessments with transcranial Doppler flowmetry were performed before, during and after the increase in expiratory flow session, which lasted 5minutes. Cerebral blood flow velocity and resistance and pulsatility indices in the pericallosal artery were assessed. Respiratory physical therapy did not significantly alter flow velocity at the systolic peak (p=0.50), the end diastolic flow velocity (p=0.17), the mean flow velocity (p=0.07), the resistance index (p=0.41) and the pulsatility index (p=0.67) over time. The expiratory flow increase technique did not affect cerebral blood flow in clinically-stable preterm infants. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  14. Inspiratory and expiratory computed tomographic volumetry for lung volume reduction surgery.

    Science.gov (United States)

    Morimura, Yuki; Chen, Fengshi; Sonobe, Makoto; Date, Hiroshi

    2013-06-01

    Three-dimensional (3D) computed tomographic (CT) volumetry has been introduced into the field of thoracic surgery, and a combination of inspiratory and expiratory 3D-CT volumetry provides useful data on regional pulmonary function as well as the volume of individual lung lobes. We report herein a case of a 62-year-old man with severe emphysema who had undergone lung volume reduction surgery (LVRS) to assess this technique as a tool for the evaluation of regional lung function and volume before and after LVRS. His postoperative pulmonary function was maintained in good condition despite a gradual slight decrease 2 years after LVRS. This trend was also confirmed by a combination of inspiratory and expiratory 3D-CT volumetry. We confirm that a combination of inspiratory and expiratory 3D-CT volumetry might be effective for the preoperative assessment of LVRS in order to determine the amount of lung tissue to be resected as well as for postoperative evaluation. This novel technique could, therefore, be used more widely to assess local lung function.

  15. Cerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique

    Directory of Open Access Journals (Sweden)

    Mariana Almada Bassani

    2016-06-01

    Full Text Available Abstract Objective: To assess the impact of respiratory therapy with the expiratory flow increase technique on cerebral hemodynamics of premature newborns. Methods: This is an intervention study, which included 40 preterm infants (≤34 weeks aged 8-15 days of life, clinically stable in ambient air or oxygen catheter use. Children with heart defects, diagnosis of brain lesion and/or those using vasoactive drugs were excluded. Ultrasonographic assessments with transcranial Doppler flowmetry were performed before, during and after the increase in expiratory flow session, which lasted 5min. Cerebral blood flow velocity and resistance and pulsatility indices in the pericallosal artery were assessed. Results: Respiratory physical therapy did not significantly alter flow velocity at the systolic peak (p=0.50, the end diastolic flow velocity (p=0.17, the mean flow velocity (p=0.07, the resistance index (p=0.41 and the pulsatility index (p=0.67 over time. Conclusions: The expiratory flow increase technique did not affect cerebral blood flow in clinically-stable preterm infants.

  16. Role of multi-detector computed tomography (MDCT in management of post percutaneous nephrolithotomy (PCNL bleeding [v1; ref status: indexed, http://f1000r.es/205

    Directory of Open Access Journals (Sweden)

    Arvind P Ganpule

    2013-11-01

    Full Text Available Objective: To evaluate the role of multidetector computerized tomography (MDCT angiography in post percutaneous nephrolithotomy (PCNL bleed and compare findings with conventional angiography (CA. Material and methods: We conducted a retrospective analysis of patients who had post PCNL bleeding and subsequently underwent a MDCT angiography followed by CA. We reviewed eight patients, who presented between January 2009 and January 2013. We performed a MDCT angiography on a 16 slice GE bright speed CT scanner. All angiographies were done by using the Digital Subtraction Angiography Suite. The angioembolisation, if required, was conducted by an interventional nephrologist, specializing in therapeutic embolisation. Results: The mean age of the patients was 42±17 years. Mean time of post PCNL bleed presentation was 10.06±7.9 days. Five patients presented with aneurysm and three presented with an AV fistula with pseudoaneurysm. The right renal unit was involved in six cases and the left in two cases. The lower polar segmental artery was involved in six cases and the upper polar artery in two cases. The CA and MDCT findings matched in all cases and the MDCT helped the clinician to assess and embolise the appropriate arterial tree. Conclusion: MDCT is rapid, reproducible and noninvasive. MDCT angiography performed in the setting of post PCNL bleeding provides an accurate assessment of the site and nature of bleeding. The MDCT angiography matched the CA findings in all patients in the present study.

  17. Posterolateral surface electrical stimulation of abdominal expiratory muscles to enhance cough in spinal cord injury.

    Science.gov (United States)

    Butler, Jane E; Lim, Julianne; Gorman, Robert B; Boswell-Ruys, Claire; Saboisky, Julian P; Lee, Bonsan B; Gandevia, Simon C

    2011-02-01

    Spinal cord injury (SCI) patients have respiratory complications because of abdominal muscle weakness and paralysis, which impair the ability to cough. This study aims to enhance cough in high-level SCI subjects (n = 11, SCI at or above T6) using surface electrical stimulation of the abdominal muscles via 2 pairs of posterolaterally placed electrodes. From total lung capacity, subjects performed maximum expiratory pressure (MEP) efforts against a closed airway and voluntary cough efforts. Both efforts were performed with and without superimposed trains of electrical stimulation (50 Hz, 1 second) at a submaximal intensity set to evoke a gastric pressure (P(ga)) of 40 cm H(2)O at functional residual capacity. In the MEP effort, stimulation increased the maximal P(ga) (from 21.4 ± 7.0 to 59.0 ± 5.7 cm H(2)O) and esophageal pressure (P(es); 47.2 ± 11.7 to 65.6 ± 13.6 cm H(2)O). During the cough efforts, stimulation increased P(ga) (19.5 ± 6.0 to 57.9 ± 7.0 cm H(2)O) and P(es) (31.2 ± 8.7 to 56.6 ± 10.5 cm H(2)O). The increased expiratory pressures during cough efforts with stimulation increased peak expiratory flow (PEF, by 36% ± 5%), mean expiratory flow (by 80% ± 8%), and expired lung volume (by 41% ± 16%). In every subject, superimposed electrical stimulation improved peak expiratory flow during cough efforts (by 0.99 ± 0.12 L/s; range, 0.41-1.80 L/s). Wearing an abdominal binder did not improve stimulated cough flows or pressures. The increases in P(ga) and PEF with electrical stimulation using the novel posterolateral electrode placement are 2 to 3 times greater than improvements reported in other studies. This suggests that posterolateral electrical stimulation of abdominal muscles is a simple noninvasive way to enhance cough in individuals with SCI.

  18. Short-term effects of positive expiratory airway pressure in patients being weaned from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Marcelo de Mello Rieder

    2009-05-01

    Full Text Available OBJECTIVE: To investigate the feasibility and the cardiorespiratory effects of using positive expiratory airway pressure, a physiotherapeutic tool, in comparison with a T-tube, to wean patients from mechanical ventilation. METHODS/DESIGN: A prospective, randomized, cross-over study. SETTING: Two intensive care units. PATIENTS AND INTERVENTIONS: We evaluated forty patients who met weaning criteria and had been mechanically-ventilated for more than 48 hours, mean age 59 years, including 23 males. All patients were submitted to the T-tube and Expiratory Positive Airway Pressure devices, at 7 cm H2O, during a 30-minute period. Cardiorespiratory variables including work of breathing, respiratory rate (rr, peripheral oxygen saturation (SpO2, heart rate (hr, systolic, diastolic and mean arterial pressures (SAP, DAP, MAP were measured in the first and thirtieth minutes. The condition was analyzed as an entire sample set (n=40 and was also divided into subconditions: chronic obstructive pulmonary disease (n=14 and non-chronic obstructive pulmonary disease (non- chronic obstructive pulmonary disease (n=26 categories. Comparisons were made using a t-test and Analysis of Variance. The level of significance was p < 0.05. RESULTS: Our data showed an increase in work of breathing in the first and thirtieth minutes in the EPAP condition (0.86+ 0.43 and 1.02+1.3 as compared with the T-tube condition (0.25+0.26 and 0.26+0.35 (p<0.05, verified by the flow-sensor monitor (values in J/L. No statistical differences were observed when comparing the Expiratory Positive Airway Pressure and T-tube conditions with regard to cardiorespiratory measurements. The same result was observed for both chronic obstructive pulmonary disease and non- chronic obstructive pulmonary disease subconditions. CONCLUSIONS: Our study demonstrated that, in weaning patients from mechanical ventilation, the use of a fixed level of Expiratory Positive Airway Pressure caused an increase in work of

  19. Feasibility and diagnostic accuracy of a low radiation exposure protocol for prospective ECG-triggering coronary MDCT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Pontone, G., E-mail: gianluca.pontone@ccfm.it [Centro Cardiologico Monzino, IRCCS, Milan (Italy); Andreini, D. [Centro Cardiologico Monzino, IRCCS, Milan (Italy); Bartorelli, A.L. [Centro Cardiologico Monzino, IRCCS, Milan (Italy); Department of Cardiovascular Sciences, University of Milan, Milan (Italy); Bertella, E.; Mushtaq, S.; Foti, C.; Formenti, A.; Chiappa, L.; Annoni, A.; Cortinovis, S.; Baggiano, A.; Conte, E.; Bovis, F.; Veglia, F.; Ballerini, G. [Centro Cardiologico Monzino, IRCCS, Milan (Italy); Agostoni, P.; Fiorentini, C. [Centro Cardiologico Monzino, IRCCS, Milan (Italy); Department of Cardiovascular Sciences, University of Milan, Milan (Italy); Pepi, M. [Centro Cardiologico Monzino, IRCCS, Milan (Italy)

    2012-03-15

    Aim: To compare the feasibility, accuracy, and effective radiation dose (ED) of multidetector computed tomography (MDCT) in the detection of coronary artery disease using a combined ED-saving strategy including prospective electrocardiogram (ECG) triggering with a short x-ray window and a body mass index (BMI)-adapted imaging protocol using adaptive statistical iterative reconstruction (ASIR; group 1), in comparison with a prospective ECG triggering strategy alone (group 2). Materials and methods: One hundred and seventy patients scheduled for invasive coronary angiography (ICA) were evaluated. Fourteen patients were not eligible for MDCT. The remaining 156 patients were randomized to group 1 (78 patients) and group 2 (78 patients). Eight and 11 patients in groups 1 and 2, respectively, were excluded after randomization because the patients' heart rates were >65 beats/min. MDCT images were assessed for feasibility, signal-to-noise ration (SNR), and contrast-to-noise ratio (CNR), accuracy in detection of coronary stenoses >50% versus ICA and for ED. Results: The feasibility, SNR, CNR, accuracy in a segment-based and patient-based model were similar in both groups (97 versus 95%, 14.5 {+-} 3.9 versus 14.2 {+-} 4.1, 16 {+-} 4.6 versus 16.5 {+-} 4.4, 95 versus 94% and 97 versus 99%, respectively). The ED in group 1 was 72% lower than in group 2 (2.1 {+-} 1.2 versus 7.5 {+-} 1.8 mSv, respectively; p < 0.01). Conclusions: The use of a multi-parametric ED saving protocol results in a significant reduction in ED without a negative impact on accuracy.

  20. The diagnostic value of direct CT arthrography using MDCT in the evaluation of acetabular labral tear: with arthroscopic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Yong-Chan; Kim, Jae Yoon [Chung-Ang University College of Medicine, Department of Orthopaedic Surgery, Seoul (Korea, Republic of); Choi, Jung-Ah; Lee, Guen Young; Kang, Heung Sik [Seoul National University Bundang Hospital, Departments of Radiology, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam (Korea, Republic of); Lee, Young-Kyun; Koo, Kyung-Hoi [Seoul National University Bundang Hospital, Orthopaedic Surgery, Seoul National University College of Medicine, Seongnam (Korea, Republic of)

    2013-05-15

    The purpose of this study was first, to determine the sensitivity, specificity, and accuracy of MDCT arthrography (CTA) for the diagnosis of acetabular labral tear and sulcus; second, to correlate tear types using the Lage classification system on CTA compared with the arthroscopic classification; and third, to correlate CTA localization with arthroscopic localization. Direct CTA was performed using 16- or 64-slice MDCT in 126 hips (124 patients) who had chronic groin pain and positive impingement test. Images were reviewed and evaluated by two experienced musculoskeletal radiologists preoperatively. CTA findings were compared with arthroscopic findings in 58 hips (56 patients) under consensus by two orthopedic surgeons. Forty-one of the 58 hips were diagnosed as labral tears on CT arthrography. Forty-three of the 58 hips were shown to have a labral tear on arthroscopy. Sensitivity, specificity, and accuracy for detecting labral tear and sulcus by CTA were 90.7%, 86.7%, and 89.7%, and 93.8%, 97.6% and 96.6% respectively for observer 1, and 90.7% and 80.0%, 87.9% and 87.5%, 95.2%, and 93.1 % respectively for observer 2. Thirty-five out of 41 hips (85%) that were diagnosed with labral tear on CTA correlated substantially with arthroscopic Lage classification (kappa coefficient = 0.65). CTA and arthroscopic findings showed similar distribution patterns of the tears with most lesions located in antero- and postero-superior areas (p = 0.013). Direct CT arthrography using MDCT may be a useful diagnostic technique in the detection of acetabular labral tear. (orig.)

  1. Automated diagnosis of interstitial lung diseases and emphysema in MDCT imaging

    Science.gov (United States)

    Fetita, Catalin; Chang Chien, Kuang-Che; Brillet, Pierre-Yves; Prêteux, Françoise

    2007-09-01

    Diffuse lung diseases (DLD) include a heterogeneous group of non-neoplasic disease resulting from damage to the lung parenchyma by varying patterns of inflammation. Characterization and quantification of DLD severity using MDCT, mainly in interstitial lung diseases and emphysema, is an important issue in clinical research for the evaluation of new therapies. This paper develops a 3D automated approach for detection and diagnosis of diffuse lung diseases such as fibrosis/honeycombing, ground glass and emphysema. The proposed methodology combines multi-resolution 3D morphological filtering (exploiting the sup-constrained connection cost operator) and graph-based classification for a full characterization of the parenchymal tissue. The morphological filtering performs a multi-level segmentation of the low- and medium-attenuated lung regions as well as their classification with respect to a granularity criterion (multi-resolution analysis). The original intensity range of the CT data volume is thus reduced in the segmented data to a number of levels equal to the resolution depth used (generally ten levels). The specificity of such morphological filtering is to extract tissue patterns locally contrasting with their neighborhood and of size inferior to the resolution depth, while preserving their original shape. A multi-valued hierarchical graph describing the segmentation result is built-up according to the resolution level and the adjacency of the different segmented components. The graph nodes are then enriched with the textural information carried out by their associated components. A graph analysis-reorganization based on the nodes attributes delivers the final classification of the lung parenchyma in normal and ILD/emphysematous regions. It also makes possible to discriminate between different types, or development stages, among the same class of diseases.

  2. Adult exposures from MDCT including multiphase studies: first Italian nationwide survey

    Energy Technology Data Exchange (ETDEWEB)

    Palorini, Federica; Origgi, Daniela [Fisica Sanitaria Istituto Europeo di Oncologia, Milan (Italy); Granata, Claudio [UOC di Radiologia Istituto Giannina Gaslini, Genoa (Italy); Matranga, Domenica [Universita degli Studi di Palermo, Dipartimento di Scienze per la Promozione della Salute e Materno-infantile ' ' G. D' Alessandro' ' , Palermo (Italy); Salerno, Sergio [Policlinico Universita di Palermo, Dipartimento di Scienze Radiologiche, Palermo (Italy)

    2014-02-15

    To evaluate the radiation dose in routine multidetector computed tomography (MDCT) examinations in Italian population. This was a retrospective multicentre study included 5,668 patients from 65 radiology departments who had undergone common CT protocols: head, chest, abdomen, chest-abdomen-pelvis (CAP), spine and cardiac. Data included patient characteristics, CT parameters, volumetric CT dose index (CTDI{sub vol}) and dose length product (DLP) for each CT acquisition phase. Descriptive statistics were calculated, and a multi-regression analysis was used to outline the main factors affecting exposure. The 75th percentiles of CTDI{sub vol} (mGy) and DLP (mGy cm) for whole head were 69 mGy and 1,312 mGy cm, respectively; for chest, 15 mGy and 569 mGy cm; spine, 42 mGy and 888 mGy cm; cardiac, 7 mGy and 131 mGy cm for calcium score, and 61 mGy and 1,208 mGy cm for angiographic CT studies. High variability was present in the DLP of abdomen and CAP protocols, where multiphase examinations dominated (71 % and 73 % respectively): for abdomen, 18 mGy, with 555 and 920 mGy cm in abdomen and abdomen-pelvis acquisitions respectively; for CAP, 17 mGy, with 508, 850 and 1,200 mGy cm in abdomen, abdomen-pelvis and CAP acquisitions respectively. The results of this survey could help in the definition of updated diagnostic reference levels (DRL). (orig.)

  3. Optimal dose of contrast medium for depiction of hypervascular HCC on dynamic MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Fujigai, Tetsuya, E-mail: tetuyafu2000@yahoo.co.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Kumano, Seishi, E-mail: kumano@radiol.med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Okada, Masahiro, E-mail: mokada@radiol.med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Hyodo, Tomoko, E-mail: Hyoudo@radiol.med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Imaoka, Izumi, E-mail: iizumi@med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Yagyu, Yukinobu, E-mail: y-yagyu@med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Ashikaga, Ryuichiro, E-mail: ryuman@med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Ishii, Kazunari, E-mail: ishii@med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan); Murakami, Takamichi, E-mail: murakami@med.kindai.ac.jp [Department of Radiology, Kinki University School of Medicine, Osakasayama City, Osaka 589-8511 (Japan)

    2012-11-15

    Purpose: The purpose of this study is to prospectively investigate the optimal dose of contrast medium for the depiction of hypervascular hepatocellular carcinoma (HCC) during the hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) of dynamic MDCT. Materials and methods: The study included 128 patients, out of these patients, 36 patients were found to have 56 hypervascular HCCs. Sixty-three patients were assigned to receive a dose of 525 mgI/kg with protocol A, and 62 received a dose of 630 mgI/kg with protocol B. Measurements of the attenuation values of the abdominal aorta, portal vein, hepatic vein, hepatic parenchyma and HCC during the HAP, PVP and DP were taken. Tumor-liver contrast (TLC) was calculated from the attenuation value of the hepatic parenchyma and HCC. Results: The aortic attenuation value with protocol B (351, 166, and 132 HU) was significantly higher than that with protocol A (313, 153, and 120 HU) during all the phases, (P < 0.01 for all phases). The hepatic enhancement from unenhanced baseline with protocol B (25.2, 63.6, 50.6 HU) was significantly higher than that with protocol A (20.2, 55.1 and 43.0 HU) during all the phases, (P < 0.01 for all phases). The TLC with protocol B (37.4, -11.8 and -13.6 HU) was significantly higher than that with protocol A (28.0, -9.8 and -12.1 HU) during HAP (P = 0.042). Conclusion: The administration of 630 mgI/kg of body weight depicts hypervascular HCC more clearly during HAP and shows sufficient hepatic enhancement of 50 HU during DP.

  4. Vascular Injuries to the Neck After Penetrating Trauma: Diagnostic Performance of 40- and 64-MDCT Angiography.

    Science.gov (United States)

    Bodanapally, Uttam K; Dreizin, David; Sliker, Clint W; Boscak, Alexis R; Reddy, Ramachandra P

    2015-10-01

    The purposes of this study were to assess the diagnostic performance of 40- and 64-MDCT angiography with digital subtraction angiography as the reference standard in the detection of arterial injuries in patients at high risk after penetrating neck trauma and to perform a separate analysis of injuries to the external carotid artery. In a retrospective evaluation of 53 sets of angiograms from 51 patients with penetrating neck injury, three reviewers unaware of the digital subtraction angiographic findings reviewed the CT angiographic (CTA) images to discern the presence or absence of arterial injuries. Sensitivity and specificity of CTA were calculated per injury, and a separate analysis of external carotid artery injuries was performed. Sensitivity of CTA for detecting arterial injuries ranged from 75.7% (95% CI, 62.3-86.9%) to 82.2% (95% CI, 69.5-92.1%). Specificity ranged from 96.4% (95% CI, 94.0-98.4%) to 98.4% (95% CI, 96.0-100%). CTA was highly sensitive for detection of the subgroup of injuries involving the large-caliber vessels that contribute to cerebral circulation. These sensitivities ranged from 92.8% (95% CI, 66-98.8%) to 100% (95% CI, 76.6-100%) for internal carotid artery injuries and from 88.9% (95% CI, 65.2-98.3%) to 94.4% (95% CI, 72.6-99.0%) for vertebral artery injuries. In contrast, sensitivity of CTA was limited for external carotid artery injuries, ranging from 63.4% (95% CI, 45.5-79.5%) to 70.0% (95% CI, 52.0-85.0%). CTA can be used for initial evaluation and may help guide management decisions if an external carotid artery injury is detected. Negative findings should not preclude close clinical follow-up, repeat CTA evaluation, or, in the presence of high suspicion of arterial injury due to clinical findings or wound trajectory, evaluation with digital subtraction angiography.

  5. Dynamic real-time 4D cardiac MDCT image display using GPU-accelerated volume rendering.

    Science.gov (United States)

    Zhang, Qi; Eagleson, Roy; Peters, Terry M

    2009-09-01

    Intraoperative cardiac monitoring, accurate preoperative diagnosis, and surgical planning are important components of minimally-invasive cardiac therapy. Retrospective, electrocardiographically (ECG) gated, multidetector computed tomographical (MDCT), four-dimensional (3D + time), real-time, cardiac image visualization is an important tool for the surgeon in such procedure, particularly if the dynamic volumetric image can be registered to, and fused with the actual patient anatomy. The addition of stereoscopic imaging provides a more intuitive environment by adding binocular vision and depth cues to structures within the beating heart. In this paper, we describe the design and implementation of a comprehensive stereoscopic 4D cardiac image visualization and manipulation platform, based on the opacity density radiation model, which exploits the power of modern graphics processing units (GPUs) in the rendering pipeline. In addition, we present a new algorithm to synchronize the phases of the dynamic heart to clinical ECG signals, and to calculate and compensate for latencies in the visualization pipeline. A dynamic multiresolution display is implemented to enable the interactive selection and emphasis of volume of interest (VOI) within the entire contextual cardiac volume and to enhance performance, and a novel color and opacity adjustment algorithm is designed to increase the uniformity of the rendered multiresolution image of heart. Our system provides a visualization environment superior to noninteractive software-based implementations, but with a rendering speed that is comparable to traditional, but inferior quality, volume rendering approaches based on texture mapping. This retrospective ECG-gated dynamic cardiac display system can provide real-time feedback regarding the suspected pathology, function, and structural defects, as well as anatomical information such as chamber volume and morphology.

  6. MDCT in the assessment of laryngeal trauma: value of 2D multiplanar and 3D reconstructions.

    Science.gov (United States)

    Becker, Minerva; Duboé, Pier-Olivier; Platon, Alexandra; Kohler, Romain; Tasu, Jean-Pierre; Becker, Christoph D; Poletti, Pierre-Alexandre

    2013-10-01

    The purpose of this study was to analyze fracture patterns and related effects of laryngeal trauma and to assess the value of 2D multiplanar reformation (MPR) and 3D reconstruction. Among 4222 consecutively registered trauma patients who underwent emergency MDCT, 38 patients had presented with laryngeal trauma. Axial, 2D MPR, 3D volume-rendered, and virtual endoscopic images were analyzed retrospectively by two blinded observers according to predefined criteria. Laryngeal fractures, soft-tissue injuries, and airway compromise were evaluated and correlated with clinical, endoscopic, surgical, and follow-up findings. Fifty-nine fractures (37 thyroid, 13 cricoid, nine arytenoid) were present in 38 patients. They were isolated in 21 (55%) patients. The other 17 (45%) patients had additional injuries to the neck, face, brain, chest, or abdomen. Laryngeal fractures were bilateral in 31 (82%) patients and were associated with hyoid bone fractures in nine (24%) patients. Arytenoid luxation was present in eight cartilages. Axial imaging missed 7 of 59 (12%) laryngeal fractures, six of eight (75%) arytenoid luxations, and four of nine (44%) hyoid bone fractures. Additional 2D MPR imaging missed 5 of 59 (8%) laryngeal fractures, five of eight (62.5%) arytenoid luxations, and two of nine (22%) hyoid bone fractures, whereas 3D volume-rendered images depicted them all. Virtual endoscopy and 3D volume rendering added diagnostic accuracy with respect to the length, width, shape, and spatial orientation of fractures in 22 of 38 (58%) patients; arytenoid luxation in six of eight (75%) luxations; and the evaluation of airway narrowing in 19 of 38 (50%) patients. Three-dimensional volume rendering was not of additional value in evaluation of the cricoid cartilage. The use of 2D MPR and 3D volume rendering with or without virtual endoscopy improved assessment of thyroid and hyoid bone fractures, arytenoid luxations, and laryngotracheal narrowing, providing helpful data for optimal

  7. Noninvasive detection of cardiac amyloidosis using delayed enhanced MDCT: a pilot study.

    Science.gov (United States)

    Deux, Jean-François; Mihalache, Cristian-Ionut; Legou, François; Damy, Thibaud; Mayer, Julie; Rappeneau, Stéphane; Planté-Bordeneuve, Violaine; Luciani, Alain; Kobeiter, Hicham; Rahmouni, Alain

    2015-08-01

    To evaluate myocardial enhancement of patients with cardiac amyloidosis (CA) using computed tomography (CT). Thirteen patients with CA and 11 control patients were examined with first-pass and delayed CT acquisition. A qualitative and quantitative analysis of images was performed. Myocardial attenuation, myocardial signal-to-noise ratio (SNRmyoc), blood pool SNR (SNRblood), contrast-to-noise ratio between blood pool and myocardium (CNRblood-myoc) and relative attenuation index (RAI) defined as variation of myocardial attenuation between delayed and first-pass acquisitions were calculated. Two false negative cases (15 %) and three false positive cases (27 %) were detected on qualitative analysis. SNRmyoc of patients with CA was significantly (p < 0.05) lower on first-pass (4.08 ± 1.9) and higher on delayed acquisition (7.10 ± 2.7) than control patients (6.1 ± 2.2 and 5.03 ± 1.8, respectively). Myocardial attenuation was higher in CA (121 ± 39 HU) than control patients (81 ± 17 HU) on delayed acquisition. CNRblood-myoc was significantly (p < 0.05) lower in CA (1.51 ± 0.7) than control patients (2.85 ± 1.2) on delayed acquisition. The RAI was significantly (p < 0.05) higher in CA (0.12 ± 0.25) than in control patients (-0.56 ± 0.21). Dual phase MDCT can detect abnormal myocardial enhancement in patients with CA. • CT can detect abnormal first-pass and delayed enhancement in cardiac amyloidosis. • Measurement of relative myocardial enhancement between acquisitions helps to detect cardiac amyloidosis. • CT may provide useful data to diagnose cardiac amyloidosis.

  8. Noninvasive detection of cardiac amyloidosis using delayed enhanced MDCT: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Deux, Jean-Francois [University Paris Est Creteil, Assistance Publique-Hopitaux de Paris, Cardiac MR Unit, Radiology Department, Henri Mondor Hospital, Creteil (France); University Paris Est Creteil, Assistance Publique-Hopitaux de Paris, CNRS EAC 4396, Centre de Recherches Chirurgicales, Henri Mondor Hospital, Creteil (France); Reseau Amylose Mondorien, Henri Mondor Hospital, Creteil (France); Mihalache, Cristian-Ionut; Legou, Francois; Luciani, Alain; Kobeiter, Hicham; Rahmouni, Alain [University Paris Est Creteil, Assistance Publique-Hopitaux de Paris, Cardiac MR Unit, Radiology Department, Henri Mondor Hospital, Creteil (France); Damy, Thibaud [Reseau Amylose Mondorien, Henri Mondor Hospital, Creteil (France); University Paris Est Creteil, Assistance Publique-Hopitaux de Paris, Cardiology Department, Henri Mondor Hospital, Creteil (France); Mayer, Julie [University Paris Est Creteil, Assistance Publique-Hopitaux de Paris, Cardiac MR Unit, Radiology Department, Henri Mondor Hospital, Creteil (France); Reseau Amylose Mondorien, Henri Mondor Hospital, Creteil (France); Rappeneau, Stephane [Reseau Amylose Mondorien, Henri Mondor Hospital, Creteil (France); Plante-Bordeneuve, Violaine [Reseau Amylose Mondorien, Henri Mondor Hospital, Creteil (France); University Paris Est Creteil, Assistance Publique-Hopitaux de Paris, Department of Neurophysiology of Neurology, Henri Mondor Hospital, Creteil (France)

    2015-08-15

    To evaluate myocardial enhancement of patients with cardiac amyloidosis (CA) using computed tomography (CT). Thirteen patients with CA and 11 control patients were examined with first-pass and delayed CT acquisition. A qualitative and quantitative analysis of images was performed. Myocardial attenuation, myocardial signal-to-noise ratio (SNR{sub myoc}), blood pool SNR (SNR{sub blood}), contrast-to-noise ratio between blood pool and myocardium (CNR{sub blood-myoc}) and relative attenuation index (RAI) defined as variation of myocardial attenuation between delayed and first-pass acquisitions were calculated. Two false negative cases (15 %) and three false positive cases (27 %) were detected on qualitative analysis. SNR{sub myoc} of patients with CA was significantly (p < 0.05) lower on first-pass (4.08 ± 1.9) and higher on delayed acquisition (7.10 ± 2.7) than control patients (6.1 ± 2.2 and 5.03 ± 1.8, respectively). Myocardial attenuation was higher in CA (121 ± 39 HU) than control patients (81 ± 17 HU) on delayed acquisition. CNR{sub blood-myoc} was significantly (p < 0.05) lower in CA (1.51 ± 0.7) than control patients (2.85 ± 1.2) on delayed acquisition. The RAI was significantly (p < 0.05) higher in CA (0.12 ± 0.25) than in control patients (-0.56 ± 0.21). Dual phase MDCT can detect abnormal myocardial enhancement in patients with CA. (orig.)

  9. A multiscale MDCT image-based breathing lung model with time-varying regional ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Yin, Youbing, E-mail: youbing-yin@uiowa.edu [Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA 52242 (United States); IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA 52242 (United States); Department of Radiology, The University of Iowa, Iowa City, IA 52242 (United States); Choi, Jiwoong, E-mail: jiwoong-choi@uiowa.edu [Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA 52242 (United States); IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA 52242 (United States); Hoffman, Eric A., E-mail: eric-hoffman@uiowa.edu [Department of Radiology, The University of Iowa, Iowa City, IA 52242 (United States); Department of Biomedical Engineering, The University of Iowa, Iowa City, IA 52242 (United States); Department of Internal Medicine, The University of Iowa, Iowa City, IA 52242 (United States); Tawhai, Merryn H., E-mail: m.tawhai@auckland.ac.nz [Auckland Bioengineering Institute, The University of Auckland, Auckland (New Zealand); Lin, Ching-Long, E-mail: ching-long-lin@uiowa.edu [Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA 52242 (United States); IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA 52242 (United States)

    2013-07-01

    A novel algorithm is presented that links local structural variables (regional ventilation and deforming central airways) to global function (total lung volume) in the lung over three imaged lung volumes, to derive a breathing lung model for computational fluid dynamics simulation. The algorithm constitutes the core of an integrative, image-based computational framework for subject-specific simulation of the breathing lung. For the first time, the algorithm is applied to three multi-detector row computed tomography (MDCT) volumetric lung images of the same individual. A key technique in linking global and local variables over multiple images is an in-house mass-preserving image registration method. Throughout breathing cycles, cubic interpolation is employed to ensure C{sub 1} continuity in constructing time-varying regional ventilation at the whole lung level, flow rate fractions exiting the terminal airways, and airway deformation. The imaged exit airway flow rate fractions are derived from regional ventilation with the aid of a three-dimensional (3D) and one-dimensional (1D) coupled airway tree that connects the airways to the alveolar tissue. An in-house parallel large-eddy simulation (LES) technique is adopted to capture turbulent-transitional-laminar flows in both normal and deep breathing conditions. The results obtained by the proposed algorithm when using three lung volume images are compared with those using only one or two volume images. The three-volume-based lung model produces physiologically-consistent time-varying pressure and ventilation distribution. The one-volume-based lung model under-predicts pressure drop and yields un-physiological lobar ventilation. The two-volume-based model can account for airway deformation and non-uniform regional ventilation to some extent, but does not capture the non-linear features of the lung.

  10. A Robust Audio Watermarking Technique Operates in MDCT Domain based on Perceptual Measures

    Directory of Open Access Journals (Sweden)

    Maha Bellaaj

    2016-06-01

    Full Text Available the review presents a digital audio watermarking technique operating in the frequency domain with two variants. This technique uses the Modified Discrete Cosine Transform (MDCT to move to the frequency domain. To ensure more inaudibility, we exploited the proprieties of the psychoacoustic model 1 (PMH1 of MPEG1 encoder layer I in the first variant and those of psychoacoustic model 2 (PMH2 of MPEG1 encoder Layer III in the second alternative to search the places for insertion of the watermark. In both variants of the technique, the bits of the mark will be duplicated to increase the capacity of insertion then inserted into the least significant bit (LSB. For more reliability in the detection phase, we use an error correction code (Hamming on the mark. Next, to analyze the performance of the proposed technique, we perform two comparative studies. In the first, we compare the proposed digital audio watermarking technique with her two variants and those achieved by Luigi Rosa and Rolf Brigola, ‘which we download the M-files of each’. The technique developed by Luigi Rosa operates in the frequency domain but using the Discrete Cosine Transform (DCT as transformation and that proposed by Rolf Brigola uses the Fast Fourier Transform (FFT. We studied the robustness of each technique against different types of attacks such as compression / decompression MP3, stirmark audio attack and we evaluated the inaudibility by using an objective approach by calculating the SNR and the ODG notes given by PEAQ. The robustness of this technique is shown against different types of attacks. In the second, we prove the contribution of the proposed technique by comparing the payload data, imperceptibility and robustness against attack MP3 with others existing techniques in the literature.

  11. Effect of abdominal muscle training on respiratory muscle strength and forced expiratory flows in sedentary, healthy adolescents.

    Science.gov (United States)

    Rodríguez-Núñez, Iván; Navarro, Ximena; Gatica, Darwin; Manterola, Carlos

    2016-10-01

    Respiratory muscle training is the most commonly used method to revert respiratory muscle weakness; however, the effect of protocols based on non-respiratory maneuvers has not been adequately studied in the pediatric population. The objective of this study was to establish the effect of abdominal muscle training on respiratory muscle strength and forced expiratory flows in healthy adolescents. This was a quasi-experiment. The sample was made up of healthy adolescents divided into two groups: an experimental group who completed eight weeks of active abdominal muscle training, and an equivalent control group. The following indicators were measured: abdominal muscle strength, maximal inspiratory pressure, maximal expiratory pressure (MEP), peak expiratory flow, and peak cough flow, before and after protocol completion. A value of p training, MEP and peak expiratory flow increased in healthy (sedentary) adolescents. Such effects were associated with intervention-induced increases in cough peak flow. Sociedad Argentina de Pediatría.

  12. Experimental Study of Dispersion and Deposition of Expiratory Aerosols in Aircraft Cabins and Impact on Infectious Disease Transmission

    DEFF Research Database (Denmark)

    To, G.N.S.; Wan, M.P.; Chao, C.Y.H.

    2009-01-01

    The dispersion and deposition characteristics of polydispersed expiratory aerosols were investigated in an aircraft cabin mockup to study the transmission of infectious diseases. The airflow was characterized by particle image velocimetry (PIV) measurements. Aerosol dispersionwas measured...

  13. Cystic Fibrosis: Are Volumetric Ultra-Low-Dose Expiratory CT Scans Sufficient for Monitoring Related Lung Disease?

    DEFF Research Database (Denmark)

    Loeve, Martine; Lequin, Maarten H; Bruijne, Marleen de

    2009-01-01

    that differences in scores were independent of score magnitude. Conclusion: In this pilot study, CT scores from end-expiratory and end-inspiratory CT match closely, suggesting that ultra-low-dose end-expiratory CT alone may be sufficient for monitoring CF-related lung disease. This would help reduce radiation dose......Purpose: To assess whether chest computed tomography (CT) scores from ultra-low-dose end-expiratory scans alone could suffice for assessment of all cystic fibrosis (CF)-related structural lung abnormalities. Materials and Methods: In this institutional review board–approved study, 20 patients...... with CF aged 6–20 years (eight males, 12 females) underwent low-dose end-inspiratory CT and ultra-low-dose end-expiratory CT. Informed consent was obtained. Scans were randomized and scored by using the Brody-II CT scoring system to assess bronchiectasis, airway wall thickening, mucus plugging...

  14. Correlation of 64 row MDCT, echocardiography and cardiac catheterization angiography in assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Chandrashekhar, Guruprasadh, E-mail: cguruprasadh@gmail.com [Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012 (India); Sodhi, Kushaljit Singh, E-mail: sodhiks@gmail.com [Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012 (India); Saxena, Akshay Kumar, E-mail: fatakshay@yahoo.com [Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012 (India); Rohit, Manoj Kumar, E-mail: rohitmanoj@gmail.com [Department of Pediatric Cardiology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012 (India); Khandelwal, Niranjan, E-mail: khandelwaln@hotmail.com [Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012 (India)

    2012-12-15

    Objective: To study the correlation of low-dose 64-row multi-detector computed tomography (MDCT) with echocardiography and cardiac catheterization angiography (CCA) in the assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease (CCHD). Materials and methods: This prospective study included 105 children (74 males, 31 females) with CCHD, in the age group of 2 months to 20 years, who underwent 64-row MDCT examination (low-dose CT protocol), echocardiography and CCA for the assessment of pulmonary arteries, including visualization, presence of confluence, stenosis and collaterals. Statistical analysis was performed using the non-parametric statistical analysis test to evaluate the concordance or discordance between echocardiography, MDCT and CCA. Results: 64-row MDCT detected significantly more main and branch pulmonary arteries, patent pulmonary confluences, and more cases of pulmonary artery stenosis. CCA detected more major aorto-pulmonary collaterals than MDCT, whereas echocardiography failed to identify these major aorto-pulmonary collaterals. The effective CT radiation dose to patients less than 2 years of age was in the range of 0.7–2.5 mSv, where as the dose in patients more than 2 years of age ranged from that of 2.1 to 4.2 mSv, which is much less than the radiation dose reported in cardiac catheterization angiography. Conclusion: In cases where cardiac MRI cannot be performed, or is not sufficiently informative, low-dose 64-row MDCT correlates well with CCA and can provide adequate information about pulmonary arterial anatomy in children with cyanotic congenital heart disease, and can replace invasive cardiac catheterization angiography with markedly reduced radiation dosage to the patient.

  15. Visual vs Fully Automatic Histogram-Based Assessment of Idiopathic Pulmonary Fibrosis (IPF Progression Using Sequential Multidetector Computed Tomography (MDCT.

    Directory of Open Access Journals (Sweden)

    Davide Colombi

    Full Text Available To describe changes over time in extent of idiopathic pulmonary fibrosis (IPF at multidetector computed tomography (MDCT assessed by semi-quantitative visual scores (VSs and fully automatic histogram-based quantitative evaluation and to test the relationship between these two methods of quantification.Forty IPF patients (median age: 70 y, interquartile: 62-75 years; M:F, 33:7 that underwent 2 MDCT at different time points with a median interval of 13 months (interquartile: 10-17 months were retrospectively evaluated. In-house software YACTA quantified automatically lung density histogram (10th-90th percentile in 5th percentile steps. Longitudinal changes in VSs and in the percentiles of attenuation histogram were obtained in 20 untreated patients and 20 patients treated with pirfenidone. Pearson correlation analysis was used to test the relationship between VSs and selected percentiles.In follow-up MDCT, visual overall extent of parenchymal abnormalities (OE increased in median by 5%/year (interquartile: 0%/y; +11%/y. Substantial difference was found between treated and untreated patients in HU changes of the 40th and of the 80th percentiles of density histogram. Correlation analysis between VSs and selected percentiles showed higher correlation between the changes (Δ in OE and Δ 40th percentile (r=0.69; p<0.001 as compared to Δ 80th percentile (r=0.58; p<0.001; closer correlation was found between Δ ground-glass extent and Δ 40th percentile (r=0.66, p<0.001 as compared to Δ 80th percentile (r=0.47, p=0.002, while the Δ reticulations correlated better with the Δ 80th percentile (r=0.56, p<0.001 in comparison to Δ 40th percentile (r=0.43, p=0.003.There is a relevant and fully automatically measurable difference at MDCT in VSs and in histogram analysis at one year follow-up of IPF patients, whether treated or untreated: Δ 40th percentile might reflect the change in overall extent of lung abnormalities, notably of ground-glass pattern

  16. 多层螺旋CT对肠道Crohn病的诊断价值%MDCT diagnosis of Crohn disease

    Institute of Scientific and Technical Information of China (English)

    付峰; 董海波; 张玉琴; 孙勤学; 陈振东

    2011-01-01

    Objective: To evaluate the CT features and diagnostic value of MDCT in the diagnosis of Crohn Disease,Methods: CT findings in 14 patients of Crohn disease confirmed by pathology were retrospectively analyzed. Results: Segmental thickening of the intestinal bowel wall was detected in all 14 patients. Mural thickening and stratification, resulring in the target or double halo appearance were detected in 8 patients, mural thickening without enhancement or mural stratification, and homogeneous attenuation in the thickened wall were observed in 11 patients; bowel wall thickening ranged from 5 to 11 mm. Four patients had perienteric abnormalities including fibrofatty proliferation, phlegmon, and abscess (1case), 7 patients had mesentetic lymph nodes hyperplasia. Comb like pattern was detected in three patients because mesenteric hypervascularity. Target or double halo appearance, comb like pattern suggested high Crohn disease activity. Conclusion : MDCT has the unparalleled ability to depict the abnormalities in the bowel wall, and contrast enhanced CT can distinguish active Crohn disease from quiescent Crohn disease, it can also detect more extra-intestinal lesions. MDCT should be the first imaging examination when Crohn disease is suspected.%目的:探讨多层螺旋CT(MDCT)Crohn病影像特点及诊断价值.方法:对我院经病理证实的14例肠道Crohn病患者的MDCT影像特点进行回顾性分析.结果:所有病例均有跳跃性肠壁增厚,8例表现为肠壁环形增厚,同时伴有粘膜强化和分层形成"靶征"及"双晕征";有11例表现为增厚肠壁分层消失,增强不明显,肠壁厚度多在5~11mm.4例表现为病变段肠管周围肠系膜水肿及增厚,蜂窝织炎,其中并发脓肿1例.7例表现为肠系膜淋巴结肿大.有3例表现为肠系膜血管增多增粗形成"梳征".其中"靶征"、"双晕征"及"梳征",均提示与病变活动度相关.结论:MDCT不但能准确显示Crohn病病变部位、肠外病

  17. Local Control With Reduced-Dose Radiotherapy for Low-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group D9602 Study

    Energy Technology Data Exchange (ETDEWEB)

    Breneman, John, E-mail: john.breneman@uchealth.com [Department of Radiation Oncology, University of Cincinnati and Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Meza, Jane [Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, NE (United States); Donaldson, Sarah S. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA (United States); Raney, R. Beverly [Children' s Cancer Hospital and Division of Pediatrics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Children' s Ambulatory Blood and Cancer Center, Dell Children' s Medical Center of Central Texas, Austin, TX (United States); Wolden, Suzanne [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY (United States); Michalski, Jeff [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Laurie, Fran [Quality Assurance Review Center, Lincoln, RI (United States); Rodeberg, David A. [Department of Surgery, East Carolina University, Greenville, NC (United States); Meyer, William [Section of Pediatric Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States); Walterhouse, David [Division of Hematology/Oncology, Children' s Memorial Medical Center, Chicago, IL (United States); Hawkins, Douglas S. [Department of Pediatrics, Seattle Children' s Hospital, University of Washington, Seattle, WA (United States)

    2012-06-01

    Purpose: To analyze the effect of reduced-dose radiotherapy on local control in children with low-risk rhabdomyosarcoma (RMS) treated in the Children's Oncology Group D9602 study. Methods and Materials: Patients with low-risk RMS were nonrandomly assigned to receive radiotherapy doses dependent on the completeness of surgical resection of the primary tumor (clinical group) and the presence of involved regional lymph nodes. After resection, most patients with microscopic residual and uninvolved nodes received 36 Gy, those with involved nodes received 41.4 to 50.4 Gy, and those with orbital primary tumors received 45 Gy. All patients received vincristine and dactinomycin, with cyclophosphamide added for patient subsets with a higher risk of relapse in Intergroup Rhabdomyosarcoma Study Group III and IV studies. Results: Three hundred forty-two patients were eligible for analysis; 172 received radiotherapy as part of their treatment. The cumulative incidence of local/regional failure was 15% in patients with microscopic involved margins when cyclophosphamide was not part of the treatment regimen and 0% when cyclophosphamide was included. The cumulative incidence of local/regional failure was 14% in patients with orbital tumors. Protocol-specified omission of radiotherapy in girls with Group IIA vaginal tumors (n = 5) resulted in three failures for this group. Conclusions: In comparison with Intergroup Rhabdomyosarcoma Study Group III and IV results, reduced-dose radiotherapy does not compromise local control for patients with microscopic tumor after surgical resection or with orbital primary tumors when cyclophosphamide is added to the treatment program. Girls with unresected nonbladder genitourinary tumors require radiotherapy for postsurgical residual tumor for optimal local control to be achieved.

  18. Synchronous infection of the aorta and the testis: emphysematous epididymo-orchitis, abdominal aortic mycotic aneurysm, and testicular artery pseudoaneurysm diagnosed by use of MDCT.

    Science.gov (United States)

    Hegde, Rahul G; Balani, Ankit; Merchant, Suleman A; Joshi, Anagha R

    2014-07-01

    We report clinical details and imaging findings for a case of emphysematous epididymo-orchitis with co-existing mycotic abdominal aortic aneurysm and a testicular artery pseudoaneurysm in a diabetic 65-year-old male. We report imaging findings from ultrasonography (USG) and contrast-enhanced multidetector computed tomography (MDCT). Use of MDCT to identify, confirm, and define the extent of the disease, and its utility in understanding the pathogenesis of this rare condition are highlighted. For such lethal infections, early diagnosis and intervention can be lifesaving; imaging can be of crucial importance in this.

  19. MDCT quantification is the dominant parameter in decision–making regarding chest tube drainage for stable patients with traumatic pneumothorax

    Science.gov (United States)

    Cai, Wenli; Lee, June-Goo; Fikry, Karim; Yoshida, Hiroyuki; Novelline, Robert; de Moya, Marc

    2013-01-01

    It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate volume of pneumothoraces in the improvement of the performance in decision-making regarding CTD in the management of traumatic pneumothoraces. For this purpose, an occurrence frequency map was calculated for quantitative analysis of the importance of each clinical parameter in the decision-making regarding CTD by a computer simulation of decision-making using a genetic algorithm (GA) and a support vector machine (SVM). A total of 14 clinical parameters, including volume of pneumothorax calculated by our CAV scheme, was collected as parameters available for decision-making. The results showed that volume was the dominant parameter in decision-making regarding CTD, with an occurrence frequency value of 1.00. The results also indicated that the inclusion of volume provided the best performance that was statistically significant compared to the other tests in which volume was excluded from the clinical parameters. This study provides the scientific evidence for the application of CAV scheme in MDCT volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax. PMID:22560899

  20. Preoperative T staging of gastric carcinoma obtained by MDCT vessel probe reconstructions and correlations with histological findings

    Energy Technology Data Exchange (ETDEWEB)

    Moschetta, M.; Stabile Ianora, A.A.; Anglani, A.; Scardapane, A.; Angelelli, G. [University of Bari Medical School, Department of Radiology, Bari (Italy); Marzullo, A. [University of Bari Medical School, Department of Pathological Anatomy, Bari (Italy)

    2010-01-15

    This study aims to evaluate the diagnostic accuracy of 16-row multidetector CT (MDCT) and vessel probe reconstructions in the T staging of gastric carcinoma. Fifty-three patients (39 men, 14 women, mean age 57.5) with an endoscopic diagnosis of gastric adenocarcinoma underwent CT examination. A hypotonic drug was administered, and the gastric walls were distended by the ingestion of 400-600 ml of water. A biphasic technique with 40-s and 70-s delay was used after endovenous contrast material injection. All patients underwent surgery, and preoperative and histological stagings were compared. The diagnostic accuracy of T staging was 68% for axial images and 94% for VP reconstructions. In the T1, T2, T3 and T4 parameter evaluation, diagnostic accuracy values were 87%, 73.5%, 81% and 96%, respectively, for axial images and 96%, 96%, 98% and 100%, respectively for VP reconstructions. MDCT is an accurate technique for the preoperative staging of gastric cancer. The VP reconstructions obtained by isotropic data can evaluate the T parameter with a higher accuracy. (orig.)

  1. The impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT analysis.

    Science.gov (United States)

    Kim, Eun Joong; Choi, Ji Ho; Kim, Kang Woo; Kim, Tae Hoon; Lee, Sang Hag; Lee, Heung Man; Shin, Chol; Lee, Ki Yeol; Lee, Seung Hoon

    2011-04-01

    Open-mouth breathing during sleep is a risk factor for obstructive sleep apnea (OSA) and is associated with increased disease severity and upper airway collapsibility. The aim of this study was to investigate the effect of open-mouth breathing on the upper airway space in patients with OSA using three-dimensional multi-detector computed tomography (3-D MDCT). The study design included a case-control study with planned data collection. The study was performed at a tertiary medical center. 3-D MDCT analysis was conducted on 52 patients with OSA under two experimental conditions: mouth closed and mouth open. Under these conditions, we measured the minimal cross-sectional area of the retropalatal and retroglossal regions (mXSA-RP, mXSA-RG), as well as the upper airway length (UAL), defined as the vertical dimension from hard palate to hyoid. We also computed the volume of the upper airway space by 3-D reconstruction of both conditions. When the mouth was open, mXSA-RP and mXSA-RG significantly decreased and the UAL significantly increased, irrespective of the severity of OSA. However, between the closed- and open-mouth states, there was no significant change in upper airway volume at any severity of OSA. Results suggest that the more elongated and narrow upper airway during open-mouth breathing may aggravate the collapsibility of the upper airway and, thus, negatively affect OSA severity.

  2. 16-slice MDCT arthrography of the shoulder: accuracy for detection of glenoid labral and rotator cuff tears

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gang Deuk; Kim, Huoung Jun; Kim, Hye Won; Oh, Jung Taek; Juhng, Seon Kwan [Wonkwang University Hospital, Iksan (Korea, Republic of); Lee, Sung Ah [Seoul Medical Center, Seoul (Korea, Republic of)

    2007-04-15

    We wanted to determine the diagnostic accuracy of 16-slice MDCT arthrography (CTA) for glenoid labral and rotator cuff tears of the shoulder. We enrolled forty-five patients who underwent arthroscopy after CTA for pain or instability of the shoulder joint. The CTA images were analyzed for the existence, sites and types of glenoid labral tears and the presence and severity of rotator cuff tears. We determined the sensitivity, specificity and accuracy of CTA for detecting glenoid labral and rotator cuff tears on the basis of the arthroscopy findings. At arthroscopy, there were 33 SLAP lesions (9 type I, 23 type II and 1 type III), 6 Bankart lesions and 31 rotator cuff lesions (21 supraspinatus, 9 infraspinatus and 1 subscapularis). On CTA, the sensitivity, specificity and accuracy for detecting 24 SLAP lesions, excluding the type I lesions, were 83%, 100% and 91%, the total rotator cuff tears were 90%, 100% and 98%, the full thickness supraspinatus tendon tears were 100%, 94% and 96%, and the partial thickness supraspinatus tendon tears were 29%, 100% and 89%, respectively. 16-slice MDCT arthrography has high accuracy for the diagnosis of abnormality of the glenoid labrum or rotator cuff tears and it can be a useful alternative to MRI or US.

  3. Low contrast detectability and spatial resolution with model-based iterative reconstructions of MDCT images: a phantom and cadaveric study

    Energy Technology Data Exchange (ETDEWEB)

    Millon, Domitille; Coche, Emmanuel E. [Universite Catholique de Louvain, Department of Radiology and Medical Imaging, Cliniques Universitaires Saint Luc, Brussels (Belgium); Vlassenbroek, Alain [Philips Healthcare, Brussels (Belgium); Maanen, Aline G. van; Cambier, Samantha E. [Universite Catholique de Louvain, Statistics Unit, King Albert II Cancer Institute, Brussels (Belgium)

    2017-03-15

    To compare image quality [low contrast (LC) detectability, noise, contrast-to-noise (CNR) and spatial resolution (SR)] of MDCT images reconstructed with an iterative reconstruction (IR) algorithm and a filtered back projection (FBP) algorithm. The experimental study was performed on a 256-slice MDCT. LC detectability, noise, CNR and SR were measured on a Catphan phantom scanned with decreasing doses (48.8 down to 0.7 mGy) and parameters typical of a chest CT examination. Images were reconstructed with FBP and a model-based IR algorithm. Additionally, human chest cadavers were scanned and reconstructed using the same technical parameters. Images were analyzed to illustrate the phantom results. LC detectability and noise were statistically significantly different between the techniques, supporting model-based IR algorithm (p < 0.0001). At low doses, the noise in FBP images only enabled SR measurements of high contrast objects. The superior CNR of model-based IR algorithm enabled lower dose measurements, which showed that SR was dose and contrast dependent. Cadaver images reconstructed with model-based IR illustrated that visibility and delineation of anatomical structure edges could be deteriorated at low doses. Model-based IR improved LC detectability and enabled dose reduction. At low dose, SR became dose and contrast dependent. (orig.)

  4. Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis.

    Science.gov (United States)

    Takaji, Ryo; Mori, Hiromu; Yamada, Yasunari; Kiyonaga, Maki; Matsumoto, Shunro

    2016-01-01

    To investigate the medial pathways of the right retromesenteric plane by reviewing multidetector CT (MDCT) findings in patients with acute pancreatitis and pyelonephritis. 112 patients with acute pancreatitis and 114 patients with pyelonephritis underwent MDCT scans. 64 of the 112 patients with acute pancreatitis and 34 of the 114 patients with pyelonephritis had right retromesenteric plane thickening because of inflammatory extensions. The medial pathways of the right retromesenteric plane were evaluated by two radiologists in consensus. In 18 (28%) of the 64 patients with acute pancreatitis and 10 (29%) of the 34 patients with pyelonephritis, the right retromesenteric plane continued to the central retroperitoneum behind the descending duodenum and pancreatic head (Type 1 pathway). The right retromesenteric plane extended to the right wall of the descending duodenum (Type 2 pathway) in 46 patients (72%) with acute pancreatitis and 24 patients (71%) with pyelonephritis. There was no significant difference in the pathway patterns of the right retromesenteric plane between the acute pancreatitis group and the pyelonephritis group (Type 1 pathway, p = 0.89; Type 2 pathway, p = 0.76). Two patterns were confirmed regarding the medial pathways of the right retromesenteric plane; this anatomical knowledge is important for evaluating the extension of retroperitoneal diseases. Medial aspect of the right retromesenteric plane is thought to have two pathways. The right retromesenteric plane continuing to the right duodenal wall is a common type. Knowledge of these variations is important when evaluating the retroperitoneal diseases.

  5. Effects of bronchomotor tone and gas density on time dependence of forced expiratory vital capacity maneuver.

    Science.gov (United States)

    D'Angelo, E; Milic-Emili, J; Marazzini, L

    1996-11-01

    It has been shown that in normal subjects and chronic obstructive pulmonary disease (COPD) patients the maximal expiratory flows and FEV1 are significantly higher if the FVC maneuver is preceded by a rapid inspiration without an end-inspiratory pause (maneuver 1) compared with a slow inspiration with an end-inspiratory pause of approximately 5 s (maneuver 2). This time dependency of FVC was attributed primarily to loss of lung recoil (stress relaxation) during breath-holding at TLC, in association with time constant inequality within the lungs, and changes in bronchomotor tone. To examine the role of bronchomotor tone on time dependency of FVC, 11 COPD and 10 asthmatic patients performed FVC maneuvers 1 and 2 before and after administration of a bronchodilator drug (salbutamol). In addition, using the same approach, the effects of changing airway resistance per se were assessed in another group of 10 COPD patients and 10 normal subjects, while breathing air and after equilibration with 80% helium in oxygen. Main findings were: peak expiratory flow (PEF), FEV1, and maximal midexpiratory flow rate (MMF) were significantly larger with maneuver 1 than 2; after salbutamol administration and during helium-oxygen breathing, all indices increased significantly with both maneuvers but the relative differences between maneuvers 1 and 2 were unchanged. We conclude that time dependency of maximal expiratory flow-volume (MEFV) curves, as indexed by PEF, FEV1, and MMF, is largely independent of bronchomotor tone and gas density, and probably reflects mainly stress relaxation of the respiratory tissues. The relevance of time dependency of FVC maneuver in the assessment of bronchodilator response and density dependence is discussed.

  6. Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway.

    Directory of Open Access Journals (Sweden)

    Samantha Torres Grams

    Full Text Available Maximal Inspiratory Pressure (MIP is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway.This study aimed to compare the MIP values assessed by standard method (MIPsta and by unidirectional expiratory valve method (MIPuni in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated.This was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B at two moments (Tests 1 and 2 to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1] was used to determine intraobserver and interobserver reproducibility.The mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O than the mean values for MIPsta (-102.5 ± 23.9 cmH2O (p<0.001. Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91, and high correlation for Test 2 (ICC[2,1] = 0.88. The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86 and evaluator B (ICC[2,1] = 0.77.MIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway.

  7. Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway

    Science.gov (United States)

    Grams, Samantha Torres; Kimoto, Karen Yumi Mota; Azevedo, Elen Moda de Oliveira; Lança, Marina; de Albuquerque, André Luis Pereira; de Brito, Christina May Moran; Yamaguti, Wellington Pereira

    2015-01-01

    Introduction Maximal Inspiratory Pressure (MIP) is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway. Objectives This study aimed to compare the MIP values assessed by standard method (MIPsta) and by unidirectional expiratory valve method (MIPuni) in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated. Methods This was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B) at two moments (Tests 1 and 2) to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1]) was used to determine intraobserver and interobserver reproducibility. Results The mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O) than the mean values for MIPsta (-102.5 ± 23.9 cmH2O) (p<0.001). Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91), and high correlation for Test 2 (ICC[2,1] = 0.88). The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86) and evaluator B (ICC[2,1] = 0.77). Conclusions MIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway. PMID:26360255

  8. Maximal expiratory and inspiratory flow-volume curves in Parkinson's disease.

    Science.gov (United States)

    Bogaard, J M; Hovestadt, A; Meerwaldt, J; vd Meché, F G; Stigt, J

    1989-03-01

    In order to investigate the type and degree of upper airway obstruction (UAO) in a group of patients with Parkinson's disease in different stages of the disease, we obtained maximal expiratory and inspiratory flow-volume (MEFV and MIFV) curves and maximal static mouth pressures. The clinical disability was indicated by a Hoehn-Yahr (H-Y) scale, ranging from III to V, and a more continuous Northwestern University Disability Scale (NUDS), ranging from zero to 50. Twelve patients were in H-Y Group III, and eleven and eight were in Groups IV and V, respectively. The pattern of the flow-volume curves was classified as either normal, or with superimposed regular or irregular oscillations (A), or with rounded-off and delayed expiratory peak appearance (B). Mean MEFV curves in Groups III and IV were not appreciably different from reference. In Group V, the mean curve showed a lower peak expiratory flow (PEF) and a more convex tail. Only the effort-dependent variables PEF, peak inspiratory flow (PIF), and maximal mouth pressures at RV and TLC (PmTLC and PmRV) appeared to be significantly correlated with the NUDS index and decreased with increasing clinical disability. The mean values of those variables were also significantly different between the H-Y groups. The number of normal curves decreased from H-Y Group III to Group V. The contribution of A and B curves was relatively equal in the groups, with only a small number of A curves.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Influence of radiation dose and reconstruction algorithm in MDCT assessment of airway wall thickness: A phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Gomez-Cardona, Daniel [Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, 1111 Highland Avenue, Madison, Wisconsin 53705 (United States); Nagle, Scott K. [Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, 1111 Highland Avenue, Madison, Wisconsin 53705 (United States); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, Wisconsin 53792 (United States); Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, Wisconsin 53792 (United States); Li, Ke; Chen, Guang-Hong, E-mail: gchen7@wisc.edu [Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, 1111 Highland Avenue, Madison, Wisconsin 53705 (United States); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, Wisconsin 53792 (United States); Robinson, Terry E. [Department of Pediatrics, Stanford School of Medicine, 770 Welch Road, Palo Alto, California 94304 (United States)

    2015-10-15

    Purpose: Wall thickness (WT) is an airway feature of great interest for the assessment of morphological changes in the lung parenchyma. Multidetector computed tomography (MDCT) has recently been used to evaluate airway WT, but the potential risk of radiation-induced carcinogenesis—particularly in younger patients—might limit a wider use of this imaging method in clinical practice. The recent commercial implementation of the statistical model-based iterative reconstruction (MBIR) algorithm, instead of the conventional filtered back projection (FBP) algorithm, has enabled considerable radiation dose reduction in many other clinical applications of MDCT. The purpose of this work was to study the impact of radiation dose and MBIR in the MDCT assessment of airway WT. Methods: An airway phantom was scanned using a clinical MDCT system (Discovery CT750 HD, GE Healthcare) at 4 kV levels and 5 mAs levels. Both FBP and a commercial implementation of MBIR (Veo{sup TM}, GE Healthcare) were used to reconstruct CT images of the airways. For each kV–mAs combination and each reconstruction algorithm, the contrast-to-noise ratio (CNR) of the airways was measured, and the WT of each airway was measured and compared with the nominal value; the relative bias and the angular standard deviation in the measured WT were calculated. For each airway and reconstruction algorithm, the overall performance of WT quantification across all of the 20 kV–mAs combinations was quantified by the sum of squares (SSQs) of the difference between the measured and nominal WT values. Finally, the particular kV–mAs combination and reconstruction algorithm that minimized radiation dose while still achieving a reference WT quantification accuracy level was chosen as the optimal acquisition and reconstruction settings. Results: The wall thicknesses of seven airways of different sizes were analyzed in the study. Compared with FBP, MBIR improved the CNR of the airways, particularly at low radiation dose

  10. Automated logging of inspiratory and expiratory non-synchronized breathing (ALIEN) for mechanical ventilation.

    Science.gov (United States)

    Chiew, Yeong Shiong; Pretty, Christopher G; Beatson, Alex; Glassenbury, Daniel; Major, Vincent; Corbett, Simon; Redmond, Daniel; Szlavecz, Akos; Shaw, Geoffrey M; Chase, J Geoffrey

    2015-01-01

    Asynchronous Events (AEs) during mechanical ventilation (MV) result in increased work of breathing and potential poor patient outcomes. Thus, it is important to automate AE detection. In this study, an AE detection method, Automated Logging of Inspiratory and Expiratory Non-synchronized breathing (ALIEN) was developed and compared between standard manual detection in 11 MV patients. A total of 5701 breaths were analyzed (median [IQR]: 500 [469-573] per patient). The Asynchrony Index (AI) was 51% [28-78]%. The AE detection yielded sensitivity of 90.3% and specificity of 88.3%. Automated AE detection methods can potentially provide clinicians with real-time information on patient-ventilator interaction.

  11. The effects of positive end-expiratory pressure in alveolar recruitment during mechanical ventilation in pigs

    OpenAIRE

    Madke,Gabriel Ribeiro; Pilla,Eduardo Sperb; Sanchez,Pablo Geraldo; Foernges, Rafael; Grün, Gustavo; Vendrami,Giovani; Fontena,Eduardo; Andrade, Cristiano Feijó; Cardoso, Paulo Francisco Guerreiro

    2008-01-01

    PURPOSE: To evaluate the effects of alveolar recruitment based on mean airway pressure (MAP) on pig lungs submitted to thoracotomy through blood gas exchange and hemodynamic parameters. METHODS: Twelve pigs weighting approximately 25Kg were intubated and ventilated on volume controlled ventilation (tidal volume 10ml/Kg, respiratory rate 16min, FiO2 1.0, inspiratory:expiratory ratio 1:2, PEEP 5cmH2O). The animals were then randomized into two groups: control and left lateral thoracotomy. The P...

  12. CORRELATION OF PEAK EXPIRATORY FLOW RATE WITH PULMONARY FUNCTION TEST IN CHILDHOOD ASTHMA

    Directory of Open Access Journals (Sweden)

    Antony Jenifer

    2014-08-01

    Full Text Available AIM: To ascertain whether the severity of childhood asthma as assessed by peak expiratory flow rate correlated with assessment by spirometry. MATERIALS AND METHODS: All patient between 6-18 years of age attending the asthma clinic during the non-exacerbation phase were included, those in whom PFT, PEFR could not be performed and those with diagnosis other than asthma were excluded. A total of 102 patients were enrolled in the study. CONCLUSION: The present study demonstrated that PEFR measurement alone had poor predictive value for abnormal spirometry. In the absence of PFTs, PEFR often overestimated how well a patient's asthma was controlled.

  13. Effects of chest wall compression on expiratory flow rates in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Masafumi Nozoe

    2016-01-01

    Full Text Available Background: Manual chest wall compression (CWC during expiration is a technique for removing airway secretions in patients with respiratory disorders. However, there have been no reports about the physiological effects of CWC in patients with chronic obstructive pulmonary disease (COPD. Objective: To compare the effects of CWC on expiratory flow rates in patients with COPD and asymptomatic controls. Method: Fourteen subjects were recruited from among patients with COPD who were receiving pulmonary rehabilitation at the University Hospital (COPD group. Fourteen age-matched healthy subjects were also consecutively recruited from the local community (Healthy control group. Airflow and lung volume changes were measured continuously with the subjects lying in supine position during 1 minute of quiet breathing (QB and during 1 minute of CWC by a physical therapist. Results: During CWC, both the COPD group and the healthy control group showed significantly higher peak expiratory flow rates (PEFRs than during QB (mean difference for COPD group 0.14 L/sec, 95% confidence interval (CI 0.04 to 0.24, p<0.01, mean difference for healthy control group 0.39 L/sec, 95% CI 0.25 to 0.57, p<0.01. In the between-group comparisons, PEFR was significantly higher in the healthy control group than in the COPD group (-0.25 L/sec, 95% CI -0.43 to -0.07, p<0.01. However, the expiratory flow rates at the lung volume at the PEFR during QB and at 50% and 25% of tidal volume during QB increased in the healthy control group (mean difference for healthy control group 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.27 L/sec, 95% CI 0.13 to 0.41, p<0.01, respectively but not in the COPD group (0.05 L/sec, 95% CI -0.01 to 0.12: -0.01 L/sec, 95% CI -0.11 to 0.08: 0.02 L/sec, 95% CI -0.05 to 0.90 with the application of CWC. Conclusion: The effects of chest wall compression on expiratory flow rates was different between COPD patients and

  14. TU-G-204-09: The Effects of Reduced- Dose Lung Cancer Screening CT On Lung Nodule Detection Using a CAD Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Young, S; Lo, P; Kim, G; Hsu, W; Hoffman, J; Brown, M; McNitt-Gray, M [UCLA School of Medicine, Los Angeles, CA (United States)

    2015-06-15

    Purpose: While Lung Cancer Screening CT is being performed at low doses, the purpose of this study was to investigate the effects of further reducing dose on the performance of a CAD nodule-detection algorithm. Methods: We selected 50 cases from our local database of National Lung Screening Trial (NLST) patients for which we had both the image series and the raw CT data from the original scans. All scans were acquired with fixed mAs (25 for standard-sized patients, 40 for large patients) on a 64-slice scanner (Sensation 64, Siemens Healthcare). All images were reconstructed with 1-mm slice thickness, B50 kernel. 10 of the cases had at least one nodule reported on the NLST reader forms. Based on a previously-published technique, we added noise to the raw data to simulate reduced-dose versions of each case at 50% and 25% of the original NLST dose (i.e. approximately 1.0 and 0.5 mGy CTDIvol). For each case at each dose level, the CAD detection algorithm was run and nodules greater than 4 mm in diameter were reported. These CAD results were compared to “truth”, defined as the approximate nodule centroids from the NLST reports. Subject-level mean sensitivities and false-positive rates were calculated for each dose level. Results: The mean sensitivities of the CAD algorithm were 35% at the original dose, 20% at 50% dose, and 42.5% at 25% dose. The false-positive rates, in decreasing-dose order, were 3.7, 2.9, and 10 per case. In certain cases, particularly in larger patients, there were severe photon-starvation artifacts, especially in the apical region due to the high-attenuating shoulders. Conclusion: The detection task was challenging for the CAD algorithm at all dose levels, including the original NLST dose. However, the false-positive rate at 25% dose approximately tripled, suggesting a loss of CAD robustness somewhere between 0.5 and 1.0 mGy. NCI grant U01 CA181156 (Quantitative Imaging Network); Tobacco Related Disease Research Project grant 22RT-0131.

  15. Automated 3D Analysis of Pre-Procedural MDCT to Predict Annulus Plane Angulation and C-Arm Positioning Benefit on Procedural Outcome in Patients Referred for TAVR

    NARCIS (Netherlands)

    Samim, Mariam; Stella, Pieter R.; Agostoni, Pierfrancesco; Kluin, Jolanda; Ramjankhan, Faiez; Budde, Ricardo P. J.; Sieswerda, Gertjan; Algeri, Emanuela; van Belle, Camille; Elkalioubie, Ahmed; Juthier, Francis; Belkacemi, Anouar; Bertrand, Michel E.; Doevendans, Pieter A.; Van Belle, Eric

    2013-01-01

    OBJECTIVES The aim of this study was to determine whether pre-procedural analysis of multidetector row computed tomography (MDCT) scans could accurately predict the "line of perpendicularity" (LP) of the aortic annulus and corresponding C-arm angulations required for prosthesis delivery and impact t

  16. Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation

    Energy Technology Data Exchange (ETDEWEB)

    Scharitzer, M.; Ba-Ssalamah, A.; Ringl, H.; Koelblinger, C.; Weber, M. [Medical University of Vienna, Department of Radiology, Vienna (Austria); Gruenberger, T. [Medical University of Vienna, Department of Surgery, Vienna (Austria); Schima, W. [Department of Radiology, KH Goettlicher Heiland, KH der Barmherzigen Schwestern and St Josef-Krankenhaus, Vienna (Austria)

    2013-08-15

    The aim of this prospective study was to compare the diagnostic performance of 64-row MDCT and gadoxetic-acid-enhanced MRI at 3.0 T in patients with colorectal liver metastases in correlation with histopathological findings. Lesions detected at MDCT and MRI were interpreted by three blinded readers and compared with histopathological workup as the term of reference. Two subgroups of lesions were additionally evaluated: (1) metastases smaller than 10 mm and (2) lesions in patients with and without steatosis of the liver, assessed histopathologically. Surgery and histopathological workup revealed 81 colorectal liver metastases in 35 patients and diffuse metastatic involvement in 3 patients. In a lesion-by-lesion analysis, significant sensitivity differences could only be found for reader 1 (P = 0.035) and reader 3 (P = 0.003). For segment-based evaluation, MRI was more sensitive only for reader 3 (P = 0.012). The number of false-positive results ranged from 3 to 12 for MDCT and 8 to 11 for MRI evaluation. In the group of small lesions, the sensitivity differed significantly between both methods (P = 0.003). In patients with hepatic steatosis, MRI showed a trend toward better performance than MDCT, but without statistical performance. The 3.0-T MRI with liver-specific contrast agents is the preferred investigation in the preoperative setting, especially for the assessment of small colorectal liver metastases. (orig.)

  17. High-pitch computed tomography of the lung in pediatric patients. An intraindividual comparison of image quality and radiation dose to conventional 64-MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Tsiflikas, I.; Thomas, C.; Ketelsen, D.; Claussen, C.D.; Schaefer, J.F. [University Hospital of Tuebingen (Germany). Diagnostic and Interventional Radiology; Seitz, G.; Warmann, S. [University Hospital of Tuebingen (Germany). Pediatric Surgery

    2014-06-15

    Purpose: The aim of this study was to investigate frequencies of typical artifacts in low-dose pediatric lung examinations using high-pitch computed tomography (HPCT) compared to MDCT, and to estimate the effective radiation dose (E{sub eff}). Materials and Methods: Institutional review board approval for this retrospective study was obtained. 35 patients (17 boys, 18 girls; mean age 112 ± 69 months) were included and underwent MDCT and follow-up scan by HPCT or vice versa (mean follow-up time 87 days), using the same tube voltage and current. The total artifact score (0-8) was defined as the sum of artifacts arising from movement, breathing or pulsation of the heart or pulmonary vessels (0 - no; 1 - moderate; 2 - severe artifacts). E{sub eff} was estimated according to the European Guidelines on Quality Criteria for Multislice Computed Tomography. The Mann-Whitney U test was used to analyze differences between the patient groups. The Spearman's rank correlation coefficient was used for correlation of ordinal variables. Results: The scan time was significantly lower for HPCT compared to MDCT (0.72 ± 0.13 s vs. 3.65 ± 0.81s; p < 0.0001). In 28 of 35 (80 %) HPCT examinations no artifacts were visible, whereas in MDCT artifacts occurred in all examinations. The frequency of pulsation artifacts and breathing artifacts was higher in MDCT compared to HPCT (100% vs. 17% and 31% vs. 6%). The total artifact score significantly correlated with the patient's age in MDCT (r=-0.42; p=0.01), but not in HPCT (r=-0.32; p=0.07). The estimated E{sub eff} was significantly lower in HPCT than in MDCT (1.29±0.31 vs. 1.47±0.37 mSv; p < 0.0001). Conclusion: Our study indicates that the use of HPCT has advantages for pediatric lung imaging with a reduction of breathing and pulsation artifacts. Moreover, the estimated E{sub eff} was lower. In addition, examinations can be performed without sedation or breath-hold without losing image quality. (orig.)

  18. 音频压缩中3种整数型MDCT变换的比较%Comparison of three IntMDCT algorithms in audio compression

    Institute of Scientific and Technical Information of China (English)

    王膂; 伍家松; Senhadji Lotfi; 舒华忠

    2012-01-01

    为了快速计算整数型改进的离散余弦变换(IntMDCT),构造了基于提升变换、模变换以及无穷范数旋转变换的3种计算12点IntMDCT的算法.首先将12点MDCT转化为6点Ⅳ型离散余弦变换(DCT-Ⅳ),并将后者分解为7个Givens旋转变换的乘积;然后分别利用提升变换算法、模变换算法和无穷范数旋转变换算法实现Givens旋转变换的整数型近似计算;最后,对这3种算法在语音信号无损和有损压缩中的运行速度和计算精确度进行比较.实验结果表明,在这3种算法中,基于模变换的IntMDCT算法的运行速度最快;基于无穷范数旋转变换的IntMDCT算法的计算精度最高,并在有损音频压缩中获得的信噪比最高.%In order to improve the computation efficiency of the integer modified discrete cosine transform (IntMDCT), three algorithms based on the lifting scheme, modulo transform and infinity norm rotation transform are formulated respectively for computing the 12-point IntMDCT. First, the 12-point IntMDCT is converted into the 6-point type-]V discrete cosine transform (DCT-IV) , which is then factorized into a product of 7 Givens rotation matrices. The integer type Givens rotation matrices are approximated by lifting scheme, modulo transform and infinity norm rotation transform, respectively. Finally, the speed and accuracy of these three IntMDCT algorithms are compared in both lossless and lossy audio compression. The experimental results show that in the three algorithms , the IntMDCT algorithm based on the modulo transform has the highest computation speed. The IntMDCT algorithm based on the infinity norm rotation transform has the highest accuracy, and can achieve the highest signal to noise ratio (SNR) in lossy audio compression.

  19. Benefit of educational feedback for the use of positive expiratory pressure device

    Science.gov (United States)

    Reychler, Gregory; Jacquemart, Manon; Poncin, William; Aubriot, Anne-Sophie; Liistro, Giuseppe

    2015-01-01

    BACKGROUND: Positive expiratory pressure (PEP) is regularly used as a self-administered airway clearance technique. OBJECTIVE: The aim of this study was to evaluate the need to teach the correct use of the PEP device and to measure the progress of the success rate of the maneuver after training. METHOD: A PEP system (PariPEP-S Sytem) was used to generate PEP in 30 healthy volunteers. They were instructed by a qualified physical therapist to breathe correctly through the PEP device. Then they were evaluated during a set of ten expirations. Two other evaluations were performed at day 2 and day 8 (before and after feedback). The mean PEP and the success rate were calculated for each set of expirations. The number of maneuvers needed to obtain a correct use was calculated on the first session. RESULTS: An optimal PEP was reached after 7.5 SD 2.7 attempts by all subjects. Success rates and mean pressures were similar between the different sets of expirations (p=0.720 and p=0.326, respectively). Pressure variability was around 10%. After one week, 30% of subjects generated more than two non-optimal pressures in the set of ten expirations. No difference in success rate was observed depending on the evaluations. CONCLUSION: This study demonstrates that good initial training on the use of the PEP device and regular follow-up are required for the subject to reach optimal expiratory pressure. PMID:26647746

  20. Effects of concurrent inspiratory and expiratory muscle training on respiratory and exercise performance in competitive swimmers.

    Science.gov (United States)

    Wells, Gregory D; Plyley, Michael; Thomas, Scott; Goodman, Len; Duffin, James

    2005-08-01

    The efficiency of the respiratory system presents significant limitations on the body's ability to perform exercise due to the effects of the increased work of breathing, respiratory muscle fatigue, and dyspnoea. Respiratory muscle training is an intervention that may be able to address these limitations, but the impact of respiratory muscle training on exercise performance remains controversial. Therefore, in this study we evaluated the effects of a 12-week (10 sessions week(-1)) concurrent inspiratory and expiratory muscle training (CRMT) program in 34 adolescent competitive swimmers. The CRMT program consisted of 6 weeks during which the experimental group (E, n = 17) performed CRMT and the sham group (S, n = 17) performed sham CRMT, followed by 6 weeks when the E and S groups performed CRMT of differing intensities. CRMT training resulted in a significant improvement in forced inspiratory volume in 1 s (FIV1.0) (P = 0.050) and forced expiratory volume in 1 s (FEV1.0) (P = 0.045) in the E group, which exceeded the S group's results. Significant improvements in pulmonary function, breathing power, and chemoreflex ventilation threshold were observed in both groups, and there was a trend toward an improvement in swimming critical speed after 12 weeks of training (P = 0.08). We concluded that although swim training results in attenuation of the ventilatory response to hypercapnia and in improvements in pulmonary function and sustainable breathing power, supplemental respiratory muscle training has no additional effect except on dynamic pulmonary function variables.

  1. Low positive end-expiratory pressure does not exacerbate nebulized-acid lung injury in dogs.

    Science.gov (United States)

    Pellett, Andrew A; Welsh, David A; deBoisblanc, Bennett P; Lipscomb, Gary; Johnson, Royce W; Lord, Kevin C; Levitzky, Michael G

    2005-03-01

    It is not clear if low end-expiratory pressures contribute to ventilator-induced lung injury in large animals. We sought to determine whether ventilation with a low level of positive end-expiratory pressure (PEEP) worsens preexisting permeability lung injury in dogs. Lung injury was initiated in 20 mongrel dogs by ventilating with nebulized 3N hydrochloric acid until a lower inflection point (LIP) appeared on the respiratory system pressure-volume loop. One group of 10 dogs was then ventilated for 4 hours with PEEP set below the LIP (low PEEP), whereas the remaining group of dogs was ventilated for the same time period with similar tidal volumes but with PEEP set above the LIP (high PEEP). We found histologic evidence of reduced alveolar volumes in the low-PEEP animals. However, there were no differences in neutrophil infiltration, lung lobe weights, pulmonary capillary hemorrhage or congestion, or arterial endothelin-1 concentration between the 2 protocol groups. In conclusion, we were unable to demonstrate that ventilation with PEEP set below the LIP exacerbates hydrochloric acid-induced lung injury in dogs.

  2. Use of model-based iterative reconstruction (MBIR) in reduced-dose CT for routine follow-up of patients with malignant lymphoma: dose savings, image quality and phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Herin, Edouard; Chiaradia, Melanie; Cavet, Madeleine; Deux, Jean-Francois; Rahmouni, Alain [AP-HP, Hopitaux Universitaires Henri Mondor, Imagerie Medicale, Creteil (France); Universite Paris Est Creteil, Faculte de Medecine, Creteil (France); Gardavaud, Francois; Beaussart, Pauline [AP-HP, Hopitaux Universitaires Henri Mondor, Imagerie Medicale, Creteil (France); Richard, Philippe [GE Healthcare France, Buc (France); Haioun, Corinne [Universite Paris Est Creteil, Faculte de Medecine, Creteil (France); AP-HP, Hopitaux Universitaires Henri Mondor, Hemopathies Lymphoides, Creteil (France); Itti, Emmanuel [Universite Paris Est Creteil, Faculte de Medecine, Creteil (France); AP-HP, Hopitaux Universitaires Henri Mondor, Medecine Nucleaire, Creteil (France); Luciani, Alain [AP-HP, Hopitaux Universitaires Henri Mondor, Imagerie Medicale, Creteil (France); Universite Paris Est Creteil, Faculte de Medecine, Creteil (France); INSERM Unite U 955, Creteil (France); AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, CHU Henri Mondor, Creteil Cedex (France)

    2015-08-15

    To evaluate both in vivo and in phantom studies, dose reduction, and image quality of body CT reconstructed with model-based iterative reconstruction (MBIR), performed during patient follow-ups for lymphoma. This study included 40 patients (mean age 49 years) with lymphoma. All underwent reduced-dose CT during follow-up, reconstructed using MBIR or 50 % advanced statistical iterative reconstruction (ASIR). All had previously undergone a standard dose CT with filtered back projection (FBP) reconstruction. The volume CT dose index (CTDIvol), the density measures in liver, spleen, fat, air, and muscle, and the image quality (noise and signal to noise ratio, SNR) (ANOVA) observed using standard or reduced-dose CT were compared both in patients and a phantom study (Catphan 600) (Kruskal Wallis). The CTDIvol was decreased on reduced-dose body CT (4.06 mGy vs. 15.64 mGy p < 0.0001). SNR was higher in reduced-dose CT reconstructed with MBIR than in 50 % ASIR or than standard dose CT with FBP (patients, p ≤ 0.01; phantoms, p = 0.003). Low contrast detectability and spatial resolution in phantoms were not altered on MBIR-reconstructed CT (p ≥ 0.11). Reduced-dose CT with MBIR reconstruction can decrease radiation dose delivered to patients with lymphoma, while keeping an image quality similar to that obtained on standard-dose CT. (orig.)

  3. An experimental study on the impacts of inspiratory and expiratory muscles activities during mechanical ventilation in ARDS animal model

    Science.gov (United States)

    Zhang, Xianming; Du, Juan; Wu, Weiliang; Zhu, Yongcheng; Jiang, Ying; Chen, Rongchang

    2017-01-01

    In spite of intensive investigations, the role of spontaneous breathing (SB) activity in ARDS has not been well defined yet and little has been known about the different contribution of inspiratory or expiratory muscles activities during mechanical ventilation in patients with ARDS. In present study, oleic acid-induced beagle dogs’ ARDS models were employed and ventilated with the same level of mean airway pressure. Respiratory mechanics, lung volume, gas exchange and inflammatory cytokines were measured during mechanical ventilation, and lung injury was determined histologically. As a result, for the comparable ventilator setting, preserved inspiratory muscles activity groups resulted in higher end-expiratory lung volume (EELV) and oxygenation index. In addition, less lung damage scores and lower levels of system inflammatory cytokines were revealed after 8 h of ventilation. In comparison, preserved expiratory muscles activity groups resulted in lower EELV and oxygenation index. Moreover, higher lung injury scores and inflammatory cytokines levels were observed after 8 h of ventilation. Our findings suggest that the activity of inspiratory muscles has beneficial effects, whereas that of expiratory muscles exerts adverse effects during mechanical ventilation in ARDS animal model. Therefore, for mechanically ventilated patients with ARDS, the demands for deep sedation or paralysis might be replaced by the strategy of expiratory muscles paralysis through epidural anesthesia. PMID:28230150

  4. Aortic and hepatic contrast enhancement with abdominal 64-MDCT in pediatric patients: effect of body weight and iodine dose.

    Science.gov (United States)

    Bae, Kyongtae T; Shah, Amisha J; Shang, Sherry S; Wang, Jin Hong; Chang, Samuel; Kanematsu, Masayuki; Hildebolt, Charles F

    2008-11-01

    The purpose of our study was to retrospectively evaluate the effect of body weight and iodine dose on aortic and hepatic contrast enhancement in pediatric patients who underwent 64-MDCT of the abdomen and pelvis. Eighty-seven consecutive pediatric patients (50 boys and 37 girls; median age, 12.1 years; age range, 3.8-17.6 years) underwent standard abdominopelvic CT with a 64-MDCT scanner. Contrast medium (350 mg I/mL) was injected using a power injector at 2 mL/s followed by 15-20 mL of saline flush. According to our CT protocol, the volume of administered contrast medium was approximately 1.8 mL/kg of body weight, up to the maximum volume of 80 mL. CT scanning was initiated 60 seconds after the start of the contrast medium injection. CT attenuations of the aorta and liver were measured. For each patient, the injected contrast medium iodine mass per body weight index (g I/kg) (hereafter, iodine mass body index) was calculated. Linear regression analysis was performed between iodine mass body index and aortic and hepatic attenuations. A wide range of patient weights (19-82 kg; mean, 48.6 kg [95% CI, 45.3-51.9 kg]) and contrast volumes (30-80 mL; median, 80.0 mL) were observed. The median attenuations were 149.0 HU (141.0-160.0 HU) for the aorta and 113.5 HU (109.5-120.0 HU) for the liver. Moderately high correlations were observed between iodine mass body index and aortic (Spearman's rho [r(s)] = 0.60 [0.45-0.72]; p mass body index [p mass body index [p abdominal 64-MDCT in pediatric patients, we found that approximately 1.5 mL/kg, or 0.525 g I/kg, yields 116 HU of hepatic attenuation or 50-55 HU of hepatic enhancement.

  5. Effect of simultaneous application of postural techniques and expiratory muscle strength training on the enhancement of the swallowing function of patients with dysphagia caused by parkinson's disease.

    Science.gov (United States)

    Byeon, Haewon

    2016-06-01

    [Purpose] This study aimed to investigate the effect of simultaneous application of postural techniques and expiratory muscle strength training on the enhancement of the swallowing function of patients with dysphagia caused by Parkinson's disease. [Subjects and Methods] The subjects of this study were 18 patients who received simultaneous application of postural techniques and expiratory muscle strength training and 15 patients who received expiratory muscle strength training only. Postural techniques were conducted in the order of chin tucking, head rotation, head tilting, bending head back, and lying down, while expiratory muscle strength training was conducted at a resistance level of about 70% of the maximal expiratory pressure. Swallowing recovery was assessed by using the Functional Dysphagia Scale based on videofluoroscopic studies. [Results] The mean value obtained in the videofluoroscopic studies for both groups decreased after the treatment. In the postural techniques plus expiratory muscle strength training group, the decrease was significantly greater than that in the expiratory muscle strength training-only group. [Conclusion] The results imply that simultaneous performance of postural techniques and expiratory muscle strength training is more effective than expiratory muscle strength training alone when applied in the swallowing rehabilitation for patients with dysphagia caused by Parkinson's disease.

  6. Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lubner, Meghan G.; Pooler, B.D.; Kitchin, Douglas R.; Kim, David H.; Munoz del Rio, Alejandro; Pickhardt, Perry J. [University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, Departments of Radiology, Madison, WI (United States); Tang, Jie [University of Wisconsin School of Medicine and Public Health, Medical Physics, Madison, WI (United States); Li, Ke; Chen, Guang-Hong [University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, Departments of Radiology, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, Medical Physics, Madison, WI (United States)

    2015-07-15

    To prospectively compare reduced-dose (RD) CT colonography (CTC) with standard-dose (SD) imaging using several reconstruction algorithms. Following SD supine CTC, 40 patients (mean age, 57.3 years; 17 M/23 F; mean BMI, 27.2) underwent an additional RD supine examination (targeted dose reduction, 70-90 %). DLP, CTDI{sub vol}, effective dose, and SSDE were compared. Several reconstruction algorithms were applied to RD series. SD-FBP served as reference standard. Objective image noise, subjective image quality and polyp conspicuity were assessed. Mean CTDI{sub vol} and effective dose for RD series was 0.89 mGy (median 0.65) and 0.6 mSv (median 0.44), compared with 3.8 mGy (median 3.1) and 2.8 mSv (median 2.3) for SD series, respectively. Mean dose reduction was 78 %. Mean image noise was significantly reduced on RD-PICCS (24.3 ± 19HU) and RD-MBIR (19 ± 18HU) compared with RD-FBP (90 ± 33), RD-ASIR (72 ± 27) and SD-FBP (47 ± 14 HU). 2D image quality score was higher with RD-PICCS, RD-MBIR, and SD-FBP (2.7 ± 0.4/2.8 ± 0.4/2.9 ± 0.6) compared with RD-FBP (1.5 ± 0.4) and RD-ASIR (1.8 ± 0.44). A similar trend was seen with 3D image quality scores. Polyp conspicuity scores were similar between SD-FBP/RD-PICCS/RD-MBIR (3.5 ± 0.6/3.2 ± 0.8/3.3 ± 0.6). Sub-milliSievert CTC performed with iterative reconstruction techniques demonstrate decreased image quality compared to SD, but improved image quality compared to RD images reconstructed with FBP. (orig.)

  7. Acute inflammatory bowel disease of the small intestine in adult: MDCT findings and criteria for differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Stefania [Department of Diagnostic Imaging, A.Cardarelli Hospital, Naples (Italy)], E-mail: stefromano@libero.it; Russo, Anna [Institute of Radiology, Second University of Naples, Naples (Italy); Daniele, Stefania; Tortora, Giovanni [Department of Diagnostic Imaging, A.Cardarelli Hospital, Naples (Italy); Maisto, Francesco [Institute of Radiology, Second University of Naples, Naples (Italy); Romano, Luigia

    2009-03-15

    Inflammatory changes of the intestine leading to acute abdomen could represent a frequent diagnostic challenge for radiologists actively involved in the emergency area. MDCT imaging findings needs to be evaluated considering the clinical history and symptoms and other abdominal findings that could be of help in differential diagnosis. Several protocols have been suggested and indicated in the imaging of patient with acute intestine. However, a CT protocol in which the precontrast scanning of the abdomen is followed by i.v. administration of contrast medium using the 45-55 s delay could be effective for an optimal visualization of the bowel wall. It is important to learn to recognize how the intestine reacts to the injury and how it 'talks', in order to become aware of the different patterns of disease manifestation related to an acute intestinal condition, for an effective diagnosis of active and acute inflammatory bowel disease.

  8. Using an expiratory resistor, arterial pulse pressure variations predict fluid responsiveness during spontaneous breathing: an experimental porcine study.

    Science.gov (United States)

    Dahl, Michael K; Vistisen, Simon T; Koefoed-Nielsen, Jacob; Larsson, Anders

    2009-01-01

    Fluid responsiveness prediction is difficult in spontaneously breathing patients. Because the swings in intrathoracic pressure are minor during spontaneous breathing, dynamic parameters like pulse pressure variation (PPV) and systolic pressure variation (SPV) are usually small. We hypothesized that during spontaneous breathing, inspiratory and/or expiratory resistors could induce high arterial pressure variations at hypovolemia and low variations at normovolemia and hypervolemia. Furthermore, we hypothesized that SPV and PPV could predict fluid responsiveness under these conditions. Eight prone, anesthetized and spontaneously breathing pigs (20 to 25 kg) were subjected to a sequence of 30% hypovolemia, normovolemia, and 20% and 40% hypervolemia. At each volemic level, the pigs breathed in a randomized order either through an inspiratory and/or an expiratory threshold resistor (7.5 cmH2O) or only through the tracheal tube without any resistor. Hemodynamic and respiratory variables were measured during the breathing modes. Fluid responsiveness was defined as a 15% increase in stroke volume (DeltaSV) following fluid loading. Stroke volume was significantly lower at hypovolemia compared with normovolemia, but no differences were found between normovolemia and 20% or 40% hypervolemia. Compared with breathing through no resistor, SPV was magnified by all resistors at hypovolemia whereas there were no changes at normovolemia and hypervolemia. PPV was magnified by the inspiratory resistor and the combined inspiratory and expiratory resistor. Regression analysis of SPV or PPV versus DeltaSV showed the highest R2 (0.83 for SPV and 0.52 for PPV) when the expiratory resistor was applied. The corresponding sensitivity and specificity for prediction of fluid responsiveness were 100% and 100%, respectively, for SPV and 100% and 81%, respectively, for PPV. Inspiratory and/or expiratory threshold resistors magnified SPV and PPV in spontaneously breathing pigs during hypovolemia

  9. TU-CD-BRA-11: Application of Bone Suppression Technique to Inspiratory/expiratory Chest Radiography

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, R; Sanada, S [Kanazawa University, Kanazawa, Ishikawa (Japan); Sakuta, K; Kawashima, H [Kanazawa University Hospital, Kanazawa, Ishikawa (Japan); Kishitani, Y [TOYO Corporation, Chuoh-ku, Tokyo (Japan)

    2015-06-15

    Purpose: The bone suppression technique based on advanced image processing can suppress the conspicuity of bones on chest radiographs, creating soft tissue images normally obtained by the dual-energy subtraction technique. This study was performed to investigate the usefulness of bone suppression technique in quantitative analysis of pulmonary function in inspiratory/expiratory chest radiography. Methods: Commercial bone suppression image processing software (ClearRead; Riverain Technologies) was applied to paired inspiratory/expiratory chest radiographs of 107 patients (normal, 33; abnormal, 74) to create corresponding bone suppression images. The abnormal subjects had been diagnosed with pulmonary diseases, such as pneumothorax, pneumonia, emphysema, asthma, and lung cancer. After recognition of the lung area, the vectors of respiratory displacement were measured in all local lung areas using a cross-correlation technique. The measured displacement in each area was visualized as displacement color maps. The distribution pattern of respiratory displacement was assessed by comparison with the findings of lung scintigraphy. Results: Respiratory displacement of pulmonary markings (soft tissues) was able to be quantified separately from the rib movements on bone suppression images. The resulting displacement map showed a left-right symmetric distribution increasing from the lung apex to the bottom region of the lung in many cases. However, patients with ventilatory impairments showed a nonuniform distribution caused by decreased displacement of pulmonary markings, which were confirmed to correspond to area with ventilatory impairments found on the lung scintigrams. Conclusion: The bone suppression technique was useful for quantitative analysis of respiratory displacement of pulmonary markings without any interruption of the rib shadows. Abnormal areas could be detected as decreased displacement of pulmonary markings. Inspiratory/expiratory chest radiography combined

  10. Survey of pediatric MDCT radiation dose from university hospitals in Thailand. A preliminary for national dose survey

    Energy Technology Data Exchange (ETDEWEB)

    Kritsaneepaiboon, Supika [Dept. of Radiology, Faculty of Medicine, Prince of Songkla Univ., Hat Yai (Thailand)], e-mail: supikak@yahoo.com; Trinavarat, Panruethai [Dept. of Radiology, Faculty of Medicine, Chulalongkorn Univ., Bangkok (Thailand); Visrutaratna, Pannee [Dept. of Radiology, Faculty of Medicine, Chiang Mai Univ., Chiang Mai (Thailand)

    2012-09-15

    Background: Increasing pediatric CT usage worldwide needs the optimization of CT protocol examination. Although there are previous published dose reference level (DRL) values, the local DRLs should be established to guide for clinical practice and monitor the CT radiation. Purpose: To determine the multidetector CT (MDCT) radiation dose in children in three university hospitals in Thailand in four age groups using the CT dose index (CTDI) and dose length product (DLP). Material and Methods: A retrospective review of CT dosimetry in pediatric patients (<15 years of age) who had undergone head, chest, and abdominal MDCT in three major university hospitals in Thailand was performed. Volume CTDI (CTDIvol) and DLP were recorded, categorized into four age groups: <1 year, 1- < 5 years, 5- <10 years, and 10- <15 years in each scanner. Range, mean, and third quartile values were compared with the national reference dose levels for CT in pediatric patients from the UK and Switzerland according to International Commission on Radiological Protection (ICRP) recommendation. Results: Per age group, the third quartile values for brain, chest, and abdominal CTs were, respectively, in terms of CTDIvol: 25, 30, 40, and 45 mGy; 4.5, 5.7, 10, and 15.6 mGy; 8.5, 9, 14, and 17 mGy; and in terms of DLP: 400, 570, 610, and 800 mGy cm; 80, 140, 305, and 470 mGy cm; and 190, 275, 560,765 mGy cm. Conclusion: This preliminary national dose survey for pediatric CT in Thailand found that the majority of CTDIvol and DLP values in brain, chest, and abdominal CTs were still below the diagnostic reference levels (DRLs) from the UK and Switzerland regarding to ICRP recommendation.

  11. 3-T contrast-enhanced MR angiography in evaluation of suspected intracranial aneurysm: comparison with MDCT angiography.

    Science.gov (United States)

    Nael, Kambiz; Villablanca, J Pablo; Mossaz, Léonard; Pope, Whitney; Juncosa, Alex; Laub, Gerhard; Finn, J Paul

    2008-02-01

    The purpose of this study was to prospectively evaluate a high-spatial-resolution contrast-enhanced 3-T MR angiography protocol for detection and characterization of intracranial aneurysms and to compare the results with those of MDCT angiography. Forty-one patients with suspected intracranial aneurysm underwent high-spatial-resolution 3D contrast-enhanced MR angiography and CT angiography (CTA). With a generalized autocalibrating partially parallel acquisition algorithm with an acceleration factor of 4 at 3 T, contrast-enhanced MR angiographic images were acquired over 20 seconds with a spatial-resolution of 0.7 x 0.7 x 0.8 mm. CTA images were acquired with a spatial resolution of 0.35 x 0.35 x 0.8 mm on a 16-MDCT scanner in 17 seconds. The images from the two studies were evaluated independently by two neuroradiologists for image quality, presence of aneurysm, and characterization of aneurysm. The dimensions of the aneurysm were measured independently with both techniques. A total of 25 aneurysms were identified with both contrast-enhanced MR angiography and CTA. A comparative analysis of detection and depiction of aneurysms showed excellent interobserver agreement for both contrast-enhanced MR angiography (kappa = 0.81) and CTA (kappa = 0.91) images. There was significant correlation between the techniques for both qualitative assessment of aneurysm depiction (rho = 0.92; 95% CI, 0.88-0.95) and quantitative dimensional measurement of aneurysm size (r = 0.94; 95% CI, 0.92-0.97). Contrast-enhanced MR angiography at 3 T is reliable for evaluation and characterization of intracranial aneurysms. The results are comparable with those of MDCTA.

  12. Effects of computing parameters and measurement locations on the estimation of 3D NPS in non-stationary MDCT images.

    Science.gov (United States)

    Miéville, Frédéric A; Bolard, Gregory; Bulling, Shelley; Gudinchet, François; Bochud, François O; Verdun, François R

    2013-11-01

    The goal of this study was to investigate the impact of computing parameters and the location of volumes of interest (VOI) on the calculation of 3D noise power spectrum (NPS) in order to determine an optimal set of computing parameters and propose a robust method for evaluating the noise properties of imaging systems. Noise stationarity in noise volumes acquired with a water phantom on a 128-MDCT and a 320-MDCT scanner were analyzed in the spatial domain in order to define locally stationary VOIs. The influence of the computing parameters in the 3D NPS measurement: the sampling distances bx,y,z and the VOI lengths Lx,y,z, the number of VOIs NVOI and the structured noise were investigated to minimize measurement errors. The effect of the VOI locations on the NPS was also investigated. Results showed that the noise (standard deviation) varies more in the r-direction (phantom radius) than z-direction plane. A 25 × 25 × 40 mm(3) VOI associated with DFOV = 200 mm (Lx,y,z = 64, bx,y = 0.391 mm with 512 × 512 matrix) and a first-order detrending method to reduce structured noise led to an accurate NPS estimation. NPS estimated from off centered small VOIs had a directional dependency contrary to NPS obtained from large VOIs located in the center of the volume or from small VOIs located on a concentric circle. This showed that the VOI size and location play a major role in the determination of NPS when images are not stationary. This study emphasizes the need for consistent measurement methods to assess and compare image quality in CT.

  13. Depiction of normal gastrointestinal anatomy with MDCT: Comparison of low- and high-attenuation oral contrast media

    Energy Technology Data Exchange (ETDEWEB)

    Erturk, Sukru Mehmet [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States)], E-mail: mehmeterturk@superonline.com; Mortele, Koenraad J.; Oliva, Maria-Raquel; Ichikawa, Tomoaki; Silverman, Stuart G. [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States); Cantisani, Vito; Pagliara, Elisa [Department of Radiological Sciences, Policlinico Umberto I, University La Sapienza, Rome (Italy); Ros, Pablo R. [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States)

    2008-04-15

    Purpose: To compare low- and high-attenuation oral contrast media for depiction of normal gastrointestinal anatomy with multidetector-row computed tomography (MDCT). Materials and methods: A prospective, randomized study of 90 consecutive patients without known or suspected gastrointestinal disease was conducted after the approval of our Institutional Review Board. All patients underwent IV contrast-enhanced abdominal and pelvic CT scans after oral administration of 900 ml of either low- or high-attenuation barium sulphate suspension. Using a five-point scale, two radiologists independently graded distention and wall visualization of stomach, duodenum, jejunum, and ileum. The degree of distention and wall visualization was compared using Mann-Whitney U-test. Results: Duodenal, jejunal and ileal distention (p < 0.05, <0.001, <0.001, respectively) and wall visualization (p < 0.05, <0.01, <0.05, respectively) scores with low-attenuation contrast medium were significantly higher than those with high-attenuation barium sulphate preparation, for reader 1. Duodenal and jejunal wall visualization scores with low-attenuation contrast medium (p < 0.05, <0.01, respectively) were significantly higher than those with high-attenuation contrast medium, for reader 2. Interobserver agreement was fair to good for both distention ({kappa}-range: 0.41-0.74) and wall visualization ({kappa}-range: 0.48-0.71). Conclusion: MDCT with low-attenuation contrast medium provides distention and wall visualization of the GI tract that is equal or better than high-attenuation contrast medium.

  14. Peak expiratory flow rates in healthy Turkish children living in Istanbul, Turkey.

    Science.gov (United States)

    Oneş, Ulker; Somer, Ayper; Sapan, Nihat; Dişçi, Rian; Güler, Nermin

    2004-01-01

    In the evaluation and management of bronchial asthma, simple instruments for measurements of the peak expiratory flow (PEF) rate are needed. The aim of this study was to determine normal PEF values of Turkish children living in Istanbul. This is the largest study conducted in Turkey. In a cross-sectional study, we measured PEF in 2791 healthy schoolchildren (1468 boys and 1323 girls) aged 7-14 years, with a Mini Wright peak flow meter. We entered height, age, and sex into the regression equation. The equation for prediction of PEF in boys was calculated as (3.5 x height [cm]) + (9.2 x age [years]) - 256.5, (p 7 millions inhabitants) can reflect more reliably real PEF values of Turkish children. We concluded that our findings would serve as an important basis for preparing centile curves for normal PEF values for Turkish children.

  15. The steady expiratory pressure-flow relation in a model pulmonary bifurcation.

    Science.gov (United States)

    Collins, J M; Shapiro, A H; Kimmel, E; Kamm, R D

    1993-08-01

    Experiments were conducted over a range of Reynolds numbers from 50 to 8000 to study the pressure-flow relationship for a single bifurcation in a multi-generation model during steady expiratory flow. Using the energy equation, the measured static pressure drop was decomposed into separate components due to fluid acceleration and viscous energy dissipation. The frictional pressure drop was found to closely approximate that for an equivalent length of curved tube with the same curvature ratio as in the model bifurcation. The sensitivity of these results to changes in airway cross-sectional shape, non-planar configuration, and flow regime (laminar-turbulent) was investigated. In separate experiments using dye visualization and hot-wire anemometry, a transition to turbulent flow was observed at Reynolds numbers between 1000 and 1500. Transition had very little effect on the pressure-flow relation.

  16. Inspiratory and expiratory steady flow analysis in a model symmetrically bifurcating airway.

    Science.gov (United States)

    Zhao, Y; Brunskill, C T; Lieber, B B

    1997-02-01

    Steady inspiratory and expiratory flow in a symmetrically bifurcating airway model was studied numerically using the finite element method (FIDAP). Flows of Reynolds number of 500 and 1000 during inspiration and a flow of Reynolds number of 500 during expiration were analyzed. Since the geometry of the bifurcation model used in this study is exactly the same as the model used in the experimental studies, the computed results were compared to the experimental findings. Results show that most of the important flow features that were observed in the experiment, such as the skewed velocity profiles in the daughter branches during inspiration and velocity peak in the parent tube during expiration, were captured in the numerical simulation. Quantitatively, the computed velocity profiles are in good agreement with the measured profiles. This comparison validates the computational simulations.

  17. Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks.

    Science.gov (United States)

    Perchiazzi, Gaetano; Rylander, Christian; Pellegrini, Mariangela; Larsson, Anders; Hedenstierna, Göran

    2016-04-11

    Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPapp and intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEPtot from flow and pressure tracings during ongoing mechanical ventilation. Ten pigs were mechanically ventilated, and the time constant of their respiratory system (τRS) was measured. We shortened their expiratory time (TE) according to multiples of τRS, obtaining different respiratory patterns (Rpat). Pressure (PAW) and flow (V'AW) at the airway opening during ongoing mechanical ventilation were simultaneously recorded, with and without the addition of external resistance. The last breath of each Rpat included an EEHM, which was used to compute the reference PEEPtot. The entire protocol was repeated after the induction of ALI with i.v. injection of oleic acid, and 382 tracings were obtained. The ANN had to extract the PEEPtot, from the tracings without an EEHM. ANN agreement with reference PEEPtot was assessed with the Bland-Altman method. Bland Altman analysis of estimation error by ANN showed -0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmH2O). The ANNs estimated the PEEPtot well at different levels of PEEPapp under dynamic conditions, opening up new possibilities in monitoring PEEPi in critically ill patients who require ventilator treatment.

  18. Positive End-expiratory Pressure Titration after Alveolar Recruitment Directed by Electrical Impedance Tomography

    Institute of Scientific and Technical Information of China (English)

    Yun Long; Da-Wei Liu; Huai-Wu He; Zhan-Qi Zhao

    2015-01-01

    Background:Electrical impedance tomography (EIT) is a real-time bedside monitoring tool,which can reflect dynamic regional lung ventilation.The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome (ARDS) during positive-end-expiratory pressure (PEEP) titration using EIT.Methods:Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study.After recruitment maneuvers (RMs),decremental PEEP titration was performed from 20 cmH2O to 5 cmH2O in steps of 3 cmH2O every 5-10 min.Regional over-distension and recruitment were monitored with EIT.Results:After RMs,patient with arterial blood oxygen partial pressure (PaO2) + carbon dioxide partial pressure (PaCO2) >400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders.Thirteen ARDS patients was diagnosed as responders whose PaO2 + PaCO2 were higher than nonresponders (419 ± 44 mmHg vs.170 ± 73 mmHg,P < 0.0001).In responders,PEEP mainly increased recruited pixels in dependent regions and over-distended pixels in nondependent regions.PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume.PEEP levels without significant alveolar derecruitment and over-distension were identified individually.Conclusions:After RMs,PEEP titration significantly affected regional gas distribution in lung,which could be monitored with EIT.EIT has the potential to optimize PEEP titration.

  19. End expiratory oxygen concentrations to predict central venous oxygen saturation: an observational pilot study

    Directory of Open Access Journals (Sweden)

    Steuerwald Michael

    2006-09-01

    Full Text Available Abstract Background A non-invasive surrogate measurement for central venous oxygen saturation (ScVO2 would be useful in the ED for assessing therapeutic interventions in critically ill patients. We hypothesized that either linear or nonlinear mathematical manipulation of the partial pressure of oxygen in breath at end expiration (EtO2 would accurately predict ScVO2. Methods Prospective observational study of a convenience sample of hemodialysis patients age > 17 years with existing upper extremity central venous catheters were enrolled. Using a portable respiratory device, we collected both tidal breathing and end expiratory oxygen and carbon dioxide concentrations, volume and flow on each patient. Simultaneous ScVO2 measurements were obtained via blood samples collected from the hemodialysis catheter. Two models were used to predict ScVO2: 1 Best-fit multivariate linear regression equation incorporating all respiratory variables; 2 MathCAD to model the decay curve of EtO2 versus expiratory volume using the least squares method to estimate the pO2 that would occur at Results From 21 patients, the correlation between EtO2 and measured ScVO2 yielded R2 = 0.11. The best fit multivariate equation included EtCO2 and EtO2 and when solved for ScVO2, the equation yielded a mean absolute difference from the measured ScVO2 of 8 ± 6% (range -18 to +17%. The predicted ScVO2 value was within 10% of the actual value for 57% of the patients. Modeling of the EtO2 curve did not accurately predict ScVO2 at any lung volume. Conclusion We found no significant correlation between EtO2 and ScVO2. A linear equation incorporating EtCO2 and EtO2 had at best modest predictive accuracy for ScVO2.

  20. Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques.

    Science.gov (United States)

    Bach, J R

    1993-11-01

    Pulmonary complications are major causes of morbidity and mortality for patients with severe expiratory muscle weakness. The purpose of this study was to compare peak cough expiratory flows (PCEFs) during unassisted and assisted coughing and review the long-term use of mechanical insufflation-exsufflation (MI-E) for 46 neuromuscular ventilator users. These individuals used noninvasive methods of ventilatory support for a mean of 21.1 h/d for 17.3 +/- 15.5 years. They relied on manually assisted coughing and/or MI-E during periods of productive airway secretion. They reported a mean of 0.7 +/- 1.2 cases of pneumonia and other serious pulmonary complications and 2.8 +/- 5.6 hospitalizations during the 16.4-year period and no complications of MI-E. A sample of 21 of these patients with a mean forced vital capacity of 490 +/- 370 ml had a mean maximum insufflation capacity (MIC) achieved by a combination of air stacking of ventilator insufflations and glossopharyngeal breathing of 1,670 +/- 540 ml. The PCEFs for this sample were: following an unassisted inspiration, 1.81 +/- 1.03 L/s; following a MIC maneuver, 3.37 +/- 1.07 L/s; with manual assistance by abdominal compression following a MIC maneuver, 4.27 +/- 1.29 L/s; and with MI-E, 7.47 +/- 1.02 L/s. Each PCEF was significantly greater than the preceding, respectively (p < 0.01). We conclude that manually assisted coughing and MI-E are effective and safe methods for facilitating airway secretion clearance for neuromuscular ventilator users who would otherwise be managed by endotracheal suctioning. Severely decreased MIC, but not necessarily vital capacity, is an indication for tracheostomy.

  1. Associations between air pollution and peak expiratory flow among patients with persistent asthma.

    Science.gov (United States)

    Qian, Zhengmin; Lin, Hung-Mo; Chinchilli, Vernon M; Lehman, Erik B; Stewart, Walter F; Shah, Nirav; Duan, Yinkang; Craig, Timothy J; Wilson, William E; Liao, Duanping; Lazarus, Stephen C; Bascom, Rebecca

    2009-01-01

    Responses of patients with persistent asthma to ambient air pollution may be different from those of general populations. For example, asthma medications may modify the effects of ambient air pollutants on peak expiratory flow (PEF). Few studies examined the association between air pollution and PEF in patients with persistent asthma on well-defined medication regimens using asthma clinical trial data. Airway obstruction effects of ambient air pollutants, using 14,919 person-days of daily self-measured peak expiratory flow (PEF), were assessed from 154 patients with persistent asthma during the 16 wk of active treatment in the Salmeterol Off Corticosteroids Study trial. The three therapies were an inhaled corticosteroid, an inhaled long-acting beta-agonist, and placebo. The participants were nonsmokers aged 12 through 63 yr, recruited from 6 university-based ambulatory care centers from February 1997 to January 1999. Air pollution data were derived from the U.S. Environmental Protection Agency Aerometric Information Retrieval System. An increase of 10 ppb of ambient daily mean concentrations of NO2 was associated with a decrease in PEF of 1.53 L/min (95% confidence interval [CI] -2.93 to -0.14) in models adjusted for age, gender, race/ethnicity, asthma clinical center, season, week, daily average temperature, and daily average relative humidity. The strongest association between NO2 and PEF was observed among the patients treated with salmeterol. Negative associations were also found between PEF and SO2 and between PEF and PM(10), respectively. The results show that the two medication regimens protected against the effects of PM(10). However, salmeterol increased the sensitivity to NO2 and triamcinalone enhanced the sensitivity to SO2.

  2. SU-D-12A-01: An Inter-Projection Interpolation (IPI) Approach for the Synchronized Moving Grid (SMOG) to Reduce Dose in Cone Beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, H; Kong, V; Jin, J [Georgia Regents University, Augusta, GA (Georgia); Ren, L [Duke University Medical Center, Durham, NC (United States)

    2014-06-01

    Purpose: Synchronized moving grid is a promising technique to reduce scatter and ghost artifacts in cone beam computed tomography (CBCT). However, it requires 2 projections in the same gantry angle to obtain full information due to signal blockage by the grid. We proposed an inter-projection interpolation (IPI) method to estimate blocked signals, which may reduce the scan time and the dose. This study aims to provide a framework to achieve a balance between speed, dose and image quality. Methods: The IPI method is based on the hypothesis that an abrupt signal in a projection can be well predicted by the information in the two immediate neighboring projections if the gantry angle step is small. The study was performed on a Catphan and a head phantom. The SMOG was simulated by erasing the information (filling with “0”) of the areas in each projection corresponding to the grid. An IPI algorithm was applied on each projection to recover the erased information. FDK algorithm was used to reconstruct CBCT images for the IPI-processed projections, and compared with the original image in term of signal to noise ratio (SNR) measured in the whole reconstruction image range. The effect of gantry angle step was investigated by comparing the CBCT images from projection sets of various gantry intervals, with IPI-predicted projections to fill the missing projection in the interval. Results: The IPI procession time was 1.79s±0.53s for each projection. SNR after IPI was 29.0db and 28.1db for the Catphan and head phantom, respectively, comparing to 15.3db and 22.7db for an inpainting based interpolation technique. SNR was 28.3, 28.3, 21.8, 19.3 and 17.3 db for gantry angle intervals of 1, 1.5, 2, 2.5 and 3 degrees, respectively. Conclusion: IPI is feasible to estimate the missing information, and achieve an reasonable CBCT image quality with reduced dose and scan time. This study is supported by NIH/NCI grant 1R01CA166948-01.

  3. Prospective evaluation of reduced dose computed tomography for the detection of low-contrast liver lesions. Direct comparison with concurrent standard dose imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pooler, B.D.; Lubner, Meghan G.; Kim, David H.; Chen, Oliver T. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); Li, Ke; Chen, Guang-Hong [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, Department of Medical Physics, Madison, WI (United States); Pickhardt, Perry J. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, Department of Radiology, Madison, WI (United States)

    2017-05-15

    To prospectively compare the diagnostic performance of reduced-dose (RD) contrast-enhanced CT (CECT) with standard-dose (SD) CECT for detection of low-contrast liver lesions. Seventy adults with non-liver primary malignancies underwent abdominal SD-CECT immediately followed by RD-CECT, aggressively targeted at 60-70 % dose reduction. SD series were reconstructed using FBP. RD series were reconstructed with FBP, ASIR, and MBIR (Veo). Three readers - blinded to clinical history and comparison studies - reviewed all series, identifying liver lesions ≥4 mm. Non-blinded review by two experienced abdominal radiologists - assessing SD against available clinical and radiologic information - established the reference standard. RD-CECT mean effective dose was 2.01 ± 1.36 mSv (median, 1.71), a 64.1 ± 8.8 % reduction. Pooled per-patient performance data were (sensitivity/specificity/PPV/NPV/accuracy) 0.91/0.78/0.60/0.96/0.81 for SD-FBP compared with RD-FBP 0.79/0.75/0.54/0.91/0.76; RD-ASIR 0.84/0.75/0.56/0.93/0.78; and RD-MBIR 0.84/0.68/0.49/0.92/0.72. ROC AUC values were 0.896/0.834/0.858/0.854 for SD-FBP/RD-FBP/RD-ASIR/RD-MBIR, respectively. RD-FBP (P = 0.002) and RD-MBIR (P = 0.032) AUCs were significantly lower than those of SD-FBP; RD-ASIR was not (P = 0.052). Reader confidence was lower for all RD series (P < 0.001) compared with SD-FBP, especially when calling patients entirely negative. Aggressive CT dose reduction resulted in inferior diagnostic performance and reader confidence for detection of low-contrast liver lesions compared to SD. Relative to RD-ASIR, RD-FBP showed decreased sensitivity and RD-MBIR showed decreased specificity. (orig.)

  4. Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study.

    Science.gov (United States)

    Chen, Allen M; Felix, Carol; Wang, Pin-Chieh; Hsu, Sophia; Basehart, Vincent; Garst, Jordan; Beron, Phillip; Wong, Deborah; Rosove, Michael H; Rao, Shyam; Melanson, Heather; Kim, Edward; Palmer, Daphne; Qi, Lihong; Kelly, Karen; Steinberg, Michael L; Kupelian, Patrick A; Daly, Megan E

    2017-06-01

    Head and neck cancers positive for human papillomavirus (HPV) are exquisitely radiosensitive. We investigated whether chemoradiotherapy with reduced-dose radiation would maintain survival outcomes while improving tolerability for patients with HPV-positive oropharyngeal carcinoma. We did a single-arm, phase 2 trial at two academic hospitals in the USA, enrolling patients with newly diagnosed, biopsy-proven stage III or IV squamous-cell carcinoma of the oropharynx, positive for HPV by p16 testing, and with Zubrod performance status scores of 0 or 1. Patients received two cycles of induction chemotherapy with 175 mg/m(2) paclitaxel and carboplatin (target area under the curve of 6) given 21 days apart, followed by intensity-modulated radiotherapy with daily image guidance plus 30 mg/m(2) paclitaxel per week concomitantly. Complete or partial responders to induction chemotherapy received 54 Gy in 27 fractions, and those with less than partial or no responses received 60 Gy in 30 fractions. The primary endpoint was progression-free survival at 2 years, assessed in all eligible patients who completed protocol treatment. This study is registered with ClinicalTrials.gov, numbers NCT02048020 and NCT01716195. Between Oct 4, 2012, and March 3, 2015, 45 patients were enrolled with a median age of 60 years (IQR 54-67). One patient did not receive treatment and 44 were included in the analysis. 24 (55%) patients with complete or partial responses to induction chemotherapy received 54 Gy radiation, and 20 (45%) with less than partial responses received 60 Gy. Median follow-up was 30 months (IQR 26-37). Three (7%) patients had locoregional recurrence and one (2%) had distant metastasis; 2-year progression-free survival was 92% (95% CI 77-97). 26 (39%) of 44 patients had grade 3 adverse events, but no grade 4 events were reported. The most common grade 3 events during induction chemotherapy were leucopenia (17 [39%]) and neutropenia (five [11%]), and during chemoradiotherapy were

  5. Does phase 2 of the expiratory PCO2 versus volume curve have diagnostic value in emphysema patients?

    NARCIS (Netherlands)

    A.H. Kars (Alice); G. Goorden; Th. Stijnen (Theo); J.M. Bogaard (Jan); A.F.M. Verbraak (Anton); C. Hilvering

    1995-01-01

    textabstractIt has been postulated that serial inhomogeneity of ventilation in the peripheral airways in emphysema is represented by the shape of expiratory carbon dioxide tension versus volume curve. We examined the diagnostic value of this test in patients with various degrees of

  6. Does phase 2 of the expiratory PCO2 versus volume curve have diagnostic value in emphysema patients?

    NARCIS (Netherlands)

    A.H. Kars (Alice); G. Goorden; Th. Stijnen (Theo); J.M. Bogaard (Jan); A.F.M. Verbraak (Anton); C. Hilvering

    1995-01-01

    textabstractIt has been postulated that serial inhomogeneity of ventilation in the peripheral airways in emphysema is represented by the shape of expiratory carbon dioxide tension versus volume curve. We examined the diagnostic value of this test in patients with various degrees of emphysema. The vo

  7. Nebulized hypertonic saline via positive expiratory pressure versus via jet nebulizer in patients with severe cystic fibrosis.

    LENUS (Irish Health Repository)

    O'Connell, Oisin J

    2011-06-01

    Nebulized hypertonic saline is a highly effective therapy for patients with cystic fibrosis (CF), yet 10% of patients are intolerant of hypertonic saline administered via jet nebulizer. Positive expiratory pressure (PEP) nebulizers splint open the airways and offers a more controlled rate of nebulization.

  8. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    LENUS (Irish Health Repository)

    McCaul, Conán

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

  9. Improvement of lung mechanics by exogenous surfactant: effect of prior application of high positive end-expiratory pressure

    NARCIS (Netherlands)

    A. Hartog (Anneke); D.A.M.P.J. Gommers (Diederik); J.J. Haitsma (Jack); B.F. Lachmann (Burkhard)

    2000-01-01

    textabstractThe use of a ventilation strategy with high positive end-expiratory pressure (PEEP) that is intended to recruit collapsed alveoli and to prevent recurrent collapse can reduce alveolar protein influx in experimental acute lung injury (ALI). This could affect

  10. Submental sEMG and Hyoid Movement during Mendelsohn Maneuver, Effortful Swallow, and Expiratory Muscle Strength Training

    Science.gov (United States)

    Wheeler-Hegland, Karen M.; Rosenbek, John C.; Sapienza, Christine M.

    2008-01-01

    Purpose: This study investigated the concurrent biomechanical and electromyographic properties of 2 swallow-specific tasks (effortful swallow and Mendelsohn maneuver) and 1 swallow-nonspecific (expiratory muscle strength training [EMST]) swallow therapy task in order to examine the differential effects of each on hyoid motion and associated…

  11. Visualization of subtle temporal bone structures. Comparison of cone beam CT and MDCT; Darstellung subtiler Schlaefenbeinstrukturen. In-vivo-Vergleich digitale Volumentomographie vs. Multidetektor-CT

    Energy Technology Data Exchange (ETDEWEB)

    Pein, M.K.; Plontke, S.K. [Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer HNO-Heilkunde, Kopf- und Halschirurgie, Halle (Saale) (Germany); Brandt, S.; Koesling, S. [Universitaetsklinikum Halle (Saale), Universitaetsklinik und Poliklinik fuer Diagnostische Radiologie, Halle (Saale) (Germany)

    2014-03-15

    The purpose of this study was to compare the visualization of subtle, non-pathological temporal bone structures on cone beam computed tomography (CBCT) and multi-detector computed tomography (MDCT) in vivo. Temporal bone studies of images from 38 patients archived in the picture archiving and communication system (PACS) were analyzed (slice thickness MDCT 0.6 mm and CBCT 0.125 mm) of which 23 were imaged by MDCT and 15 by CBCT using optimized standard protocols. Inclusion criteria were normal radiological findings, absence of previous surgery and anatomical variants. Images were evaluated blind by three trained observers. Using a five-point scale the visualization of ten subtle structures of the temporal bone was analyzed. Subtle middle ear structures showed a tendency to be more easily distinguishable by CBCT with significantly better visualization of the tendon of the stapedius muscle and the crura of the stapes on CBCT (p = 0.003 and p = 0.033, respectively). In contrast, inner ear components, such as the osseus spiral lamina and the modiolus tended to be better detectable on MDCT, showing significant differences for the osseous spiral lamina (p = 0.001). The interrater reliability was 0.73 (Cohen's kappa coefficient) and intraobserver reliability was 0.89. The use of CBCT and MDCT allows equivalent and excellent imaging results if optimized protocols are chosen. With both imaging techniques subtle temporal bone structures could be visualized with a similar degree of definition. In vivo differences do not seem to be as large as suggested in several previous studies. (orig.) [German] Vergleich der Identifizierbarkeit subtiler Schlaefenbeinstrukturen in der digitalen Volumentomographie (DVT) und Multidetektor-CT (MDCT) in vivo. Analysiert wurden 38 im PACS (Picture Archiving and Communication System) duennschichtig gespeicherte Schlaefenbeinuntersuchungen (23 MDCTs, Schichtdicke 0,6 mm sowie 15 DVTs, Schichtdicke 0,125 mm). Einschlusskriterium war eine

  12. Is the lung scan alive and well? Facts and controversies in defining the role of lung scintigraphy for the diagnosis of pulmonary embolism in the era of MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Reid, John H. [Borders General Hospital, Department of Radiology, Melrose, Scotland (United Kingdom); Coche, Emmanuel E. [Cliniques Universitaires St-Luc, Department of Medical Imaging, Brussels (Belgium); Inoue, Tomio [Yokohama City University Hospital, Department of Radiology, Yokohama (Japan); Kim, Edmund E. [MD Anderson Cancer Center, Nuclear Medicine Service, Houston, TX (United States); Dondi, Maurizio; Watanabe, Naoyuki [International Atomic Energy Agency, Vienna (Austria); Mariani, Giuliano [University of Pisa Medical School, Regional Centre of Nuclear Medicine, Pisa (Italy)

    2009-03-15

    The last decade has seen a changing pattern of utilization of multidetector CT (MDCT) versus lung perfusion scintigraphy in the investigation of pulmonary venous thromboembolism (VTE). In response to this the International Atomic Energy Agency (IAEA) determined that the subject required an overview. The IAEA has invited a group of five specialists in the relevant fields to review the current status and optimum role of scintigraphy, to explore some of the facts and controversies surrounding the use of both modalities and to make recommendations about the continued role of nuclear medicine for the investigation of pulmonary embolism. This paper identifies the relative merits of each technique, highlights benefits, focuses on complementary roles and seeks a nonadversarial symbiosis. The consultants reached a consensus that the continued use of scintigraphy for diagnosis of thromboembolic disease is recommended, particularly in scenarios where scintigraphy confers specific benefits and is complementary to MDCT. (orig.)

  13. Editorial to: Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes by Sucha et al

    Energy Technology Data Exchange (ETDEWEB)

    Peeters, F.E.C.M. [Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Kietselaer, B.L.J.H. [Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands)

    2016-04-15

    Over the last years a growing number of prosthetic heart valve (PHV) implantation procedures have been performed in sequence with the aging of the population and improving surgical techniques. Currently, echocardiography is the most important tool in the follow-up and evaluation of complications associated with the PHV (pannus, thrombus, endocarditis). However, echocardiographic examination of PHV associated disease may be hampered by poor acoustic window or scatter artefacts caused by the PHV. PHV related disease such as endocarditis is related with a poor prognosis, especially when complications such as periannular abscess formation occurs. Early treatment of PHV associated disease improves prognosis. Therefore, an unmet clinical need for early detection of complications exists. In the evaluation of PHV (dys)function, multidetector-row computed tomography (MDCT) has shown to be of additive value. A necessity for MDCT to be implemented in daily practice is to be able to distinguish between normal and pathological features. (orig.)

  14. Dangerous Pressurization and Inappropriate Alarms during Water Occlusion of the Expiratory Circuit of Commonly Used Infant Ventilators.

    Directory of Open Access Journals (Sweden)

    Murray Hinder

    Full Text Available Non-invasive continuous positive airways pressure is commonly a primary respiratory therapy delivered via multi-purpose ventilators in premature newborns. Expiratory limb occlusion due to water accumulation or 'rainout' from gas humidification is a frequent issue. A case of expiratory limb occlusion due to rainout causing unexpected and excessive repetitive airway pressurisation in a Draeger VN500 prompted a systematic bench test examination of currently available ventilators.To assess neonatal ventilator response to partial or complete expiratory limb occlusion when set to non-invasive continuous positive airway pressure mode.Seven commercially available neonatal ventilators connected to a test lung using a standard infant humidifier circuit with partial and/or complete expiratory limb occlusion were examined in a bench test study. Each ventilator was set to deliver 6 cmH2O in non-invasive mode and respiratory mechanics data for 75%, 80% and 100% occlusion were collected.Several ventilators responded inappropriately with complete occlusion by cyclical pressurisation/depressurisation to peak pressures of between 19·4 and 64·6 cm H2O at rates varying between 2 to 77 inflations per minute. Tidal volumes varied between 10·1 and 24·3mL. Alarm responses varied from 'specific' (tube occluded to 'ambiguous' (Safety valve open. Carefusion Avea responded by continuing to provide the set distending pressure and displaying an appropriate alarm message. Draeger Babylog 8000 did not alarm with partial occlusions and incorrectly displayed airways pressure at 6·1cmH2O compared to the measured values of 13cmH2O.This study found a potential for significant adverse ventilator response due to complete or near complete expiratory limb occlusion in CPAP mode.

  15. Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation

    OpenAIRE

    Chanplakorn, Pongsthorn; Kraiwattanapong, Chaiwat; Aroonjarattham, Kitti; Leelapattana, Pittavat; Keorochana, Gun; Jaovisidha, Suphaneewan; Wajanavisit, Wiwat

    2014-01-01

    Background Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) sca...

  16. Fractal Dimension Analysis of MDCT Images for Quantifying the Morphological Changes of the Pulmonary Artery Tree in Patients with Pulmonary Hypertension

    OpenAIRE

    2011-01-01

    Objective The aim of this study was to use fractal dimension (FD) analysis on multidetector CT (MDCT) images for quantifying the morphological changes of the pulmonary artery tree in patients with pulmonary hypertension (PH). Materials and Methods Fourteen patients with PH and 17 patients without PH as controls were studied. All of the patients underwent contrast-enhanced helical CT and transthoracic echocardiography. The pulmonary artery trees were generated using post-processing software, a...

  17. Pulmonary 64-MDCT angiography with 50 mL of iodinated contrast material in an unselected patient population: a feasible protocol

    Energy Technology Data Exchange (ETDEWEB)

    Trad, Henrique Simao; Boasquevisque, Gustavo Santos; Giacometti, Tiago Rangon; Trad, Catherine Yang; Zoghbi Neto, Orlando Salomao; Trad, Clovis Simao, E-mail: hsimtrad@gmail.com [Central de Diagnostico Ribeirao Preto (CEDIRP), Ribeirao Preto, SP (Brazil)

    2016-03-15

    Objective: To propose a protocol for pulmonary angiography using 64-slice multidetector computed tomography (64-MDCT) with 50 mL of iodinated contrast material, in an unselected patient population, as well as to evaluate vascular enhancement and image quality. Materials and methods: We evaluated 29 patients (22-86 years of age). The body mass index ranged from 19.0 kg/m{sup 2} to 41.8 kg/m{sup 2}. Patients underwent pulmonary CT angiography in a 64-MDCT scanner, receiving 50 mL of iodinated contrast material via venous access at a rate of 4.5 mL/s. Bolus tracking was applied in the superior vena cava. Two experienced radiologists assessed image quality and vascular enhancement. Results: The mean density was 382 Hounsfield units (HU) for the pulmonary trunk; 379 and 377 HU for the right and left main pulmonary arteries, respectively; and 346 and 364 HU for the right and left inferior pulmonary arteries, respectively. In all patients, subsegmental arteries were analyzed. There were streak artifacts from contrast material in the superior vena cava in all patients. However, those artifacts did not impair the image analysis. Conclusion: Our findings suggest that pulmonary angiography using 64-MDCT with 50 mL of iodinated contrast can produce high quality images in unselected patient populations. (author)

  18. Pancreatic neuroendocrine tumour (PNET): Staging accuracy of MDCT and its diagnostic performance for the differentiation of PNET with uncommon CT findings from pancreatic adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hoon; Lee, Jeong Min; Han, Joon Koo; Choi, Byung-Ihn [Seoul National University Hospital, Department of Radiology, 101 Daehangno, Jongno-gu, Seoul (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul (Korea, Republic of); Eun, Hyo Won [Yonsei University College of Medicine, Department of Radiology, Severance Hospital, Seodaemun-ku, Seoul (Korea, Republic of); Kim, Young Jae [Soonchunhyang University Hospital, Department of Radiology, 657 Hannam-Dong, Youngsan-Ku, Seoul (Korea, Republic of)

    2016-05-15

    To investigate staging accuracy of multidetector CT (MDCT) for pancreatic neuroendocrine tumour (PNET) and diagnostic performance for differentiation of PNET from pancreatic adenocarcinoma. We included 109 patients with surgically proven PNET (NETG1 = 66, NETG2 = 31, NEC = 12) who underwent MDCT. Two reviewers assessed stage and presence of predefined CT findings. We analysed the relationship between CT findings and tumour grade. Using PNETs with uncommon findings, we also estimated the possibility of PNET or adenocarcinoma. Accuracy for T stage was 85-88 % and N-metastasis was 83-89 %. Common findings included well circumscribed, homogeneously enhanced, hypervascular mass, common in lower grade tumours (p < 0.05). Uncommon findings included ill-defined, heterogeneously enhanced, hypovascular mass and duct dilation, common in higher grade tumours (p < 0.05). Using 31 PNETs with uncommon findings, diagnostic performance for differentiation from adenocarcinoma was 0.760-0.806. Duct dilatation was an independent predictor for adenocarcinoma (Exp(B) = 4.569). PNETs with uncommon findings were associated with significantly worse survival versus PNET with common findings (62.7 vs. 95.7 months, p < 0.001). MDCT is useful for preoperative evaluation of PNET; it not only accurately depicts the tumour stage but also prediction of tumour grade, because uncommon findings were more common in higher grade tumours. (orig.)

  19. Pulmonary 64-MDCT angiography with 50 mL of iodinated contrast material in an unselected patient population: a feasible protocol*

    Science.gov (United States)

    Trad, Henrique Simão; Boasquevisque, Gustavo Santos; Giacometti, Tiago Rangon; Trad, Catherine Yang; Zoghbi Neto, Orlando Salomão; Trad, Clovis Simão

    2016-01-01

    Objective To propose a protocol for pulmonary angiography using 64-slice multidetector computed tomography (64-MDCT) with 50 mL of iodinated contrast material, in an unselected patient population, as well as to evaluate vascular enhancement and image quality. Materials and Methods We evaluated 29 patients (22-86 years of age). The body mass index ranged from 19.0 kg/m2 to 41.8 kg/m2. Patients underwent pulmonary CT angiography in a 64-MDCT scanner, receiving 50 mL of iodinated contrast material via venous access at a rate of 4.5 mL/s. Bolus tracking was applied in the superior vena cava. Two experienced radiologists assessed image quality and vascular enhancement. Results The mean density was 382 Hounsfield units (HU) for the pulmonary trunk; 379 and 377 HU for the right and left main pulmonary arteries, respectively; and 346 and 364 HU for the right and left inferior pulmonary arteries, respectively. In all patients, subsegmental arteries were analyzed. There were streak artifacts from contrast material in the superior vena cava in all patients. However, those artifacts did not impair the image analysis. Conclusion Our findings suggest that pulmonary angiography using 64-MDCT with 50 mL of iodinated contrast can produce high quality images in unselected patient populations. PMID:27141128

  20. Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

    Energy Technology Data Exchange (ETDEWEB)

    Tresoldi, Silvia; Flor, Nicola [Azienda Ospedaliera San Paolo, Dipartimento di Radiologia Diagnostica ed Interventistica, Milano (Italy); Luciani, Andrea [Azienda Ospedaliera San Paolo, Oncologia, Dipartimento di Medicina, Milano (Italy); Lombardi, Maria Antonietta; Colombo, Bernardo [Universita degli Studi di Milano, Scuola di Specializzazione in Radiodiagnostica, Facolta di Medicina e Chirurgia, Milano (Italy); Cornalba, Gianpaolo [Azienda Ospedaliera San Paolo, Dipartimento di Radiologia Diagnostica ed Interventistica, Milano (Italy); Universita degli Studi di Milano, Dipartimento di Scienze della Salute, Milano (Italy)

    2015-11-15

    To prospectively assess prevalence/characteristics of clinically unsuspected pulmonary embolism (PE) in cancer patients undergoing follow-up chest MDCT and investigate MDCT protocol. We evaluated 1013 oncologic patients. MDCT images at 5 and 1.25 mm thickness were independently evaluated. Pulmonary artery opacification degree was assessed. Presence, level, and site of PE were reported. Type of malignancy and metastases were reported for PE-positive patients. After excluding 1.4 % (14/1013) of examinations due to inadequate vessel opacification, 999 patients (572 male; mean age:68 ± 12 years; range:26-93 years) entered the study. Prevalence of PE was 5 %. There was significant improvement in the sensitivity for both readers in the evaluation of 1.25 mm compared to 5 mm images (46-50 % to 82-92 %). 30 % (15/51) PE were not described by the radiologist in the prospectively issued report; 53 % (27/51) of PE were segmental, 72.5 % (37/51) unilateral. The right lower lobe was the most involved (59 %). 27 % patients had colon cancer, 18 % lung cancer. Among PE-positive patients (25 male; mean age 70 ± 10 years; range:44-87 years), 25 % (13/51) had lung cancer, 15 % (8/51) colon cancer. Thin reconstructions are essential for PE diagnosis, regardless of reader experience. Regarding oncologic patients, incidental PE diagnosis influences anticoagulation therapy. (orig.)

  1. Quantitative right and left ventricular functional analysis during gated whole-chest MDCT: A feasibility study comparing automatic segmentation to semi-manual contouring

    Energy Technology Data Exchange (ETDEWEB)

    Coche, Emmanuel, E-mail: Emmanuel.coche@uclouvain.b [Department of Medical Imaging, Universite Catholique de Louvain, Cliniques Universitaires St-Luc (UCL), Avenue Hippocrate, 10, 1200 Brussels (Belgium); Walker, Matthew J. [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States); Zech, Francis [Department of Internal Medicine, Universite Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels (Belgium); Crombrugghe, Rodolphe de [Department of Medical Imaging, Universite Catholique de Louvain, Cliniques Universitaires St-Luc (UCL), Avenue Hippocrate, 10, 1200 Brussels (Belgium); Vlassenbroek, Alain [Philips Healthcare, Brussels (Belgium)

    2010-06-15

    Purpose: To evaluate the feasibility of an automatic, whole-heart segmentation algorithm for measuring global heart function from gated, whole-chest MDCT images. Material and methods: 15 patients with suspicion of PE underwent whole-chest contrast-enhanced MDCT with retrospective ECG synchronization. Two observers computed right and left ventricular functional indices using a semi-manual and an automatic whole-heart segmentation algorithm. The two techniques were compared using Bland-Altman analysis and paired Student's t-test. Measurement reproducibility was calculated using intraclass correlation coefficient. Results: Ventricular analysis with automatic segmentation was successful in 13/15 (86%) and in 15/15 (100%) patients for the right ventricle and left ventricle, respectively. Reproducibility of measurements for both ventricles was perfect (ICC: 1.00) and very good for automatic and semi-manual measurements, respectively. Ventricular volumes and functional indices except right ventricular ejection fraction obtained from the automatic method were significantly higher for the RV compared to the semi-manual methods. Conclusions: The automatic, whole-heart segmentation algorithm enabled highly reproducible global heart function to be rapidly obtained in patients undergoing gated whole-chest MDCT for assessment of acute chest pain with suspicion of pulmonary embolism.

  2. Pressures and Oscillation Frequencies Generated by Bubble-Positive Expiratory Pressure Devices.

    Science.gov (United States)

    Santos, Mary D; Milross, Maree A; Eisenhuth, John P; Alison, Jennifer A

    2017-04-01

    Positive expiratory pressure (PEP) devices are used to assist with airway clearance. Little is known about the therapist-made or commercially available bubble-PEP devices. The aim of this study was to determine the end-expiratory pressures (cm H2O) and oscillation frequencies (Hz) generated when a range of flows were applied to the therapist-made bubble-PEP devices (Bubble-PEP-3cm and Bubble-PEP-0cm) and commercial bubble-PEP devices (AguaPEP, Hydrapep, and Therabubble). This was a bench-top experimental study using a compressed air source, flow rotameter (flows of 5, 10, 15, 20, and 25 L/min), and pressure transducer. Data were collected using a data acquisition device with PhysioDAQxs software and analyzed with Breathalyser software to determine the pressures and oscillation frequencies generated by 5 bubble-PEP devices. Each flow was constant for a 30-s measurement period, and measurements were repeated in triplicate. The 5 devices were: a therapist-made Bubble-PEP-3cm device (filled with 13 cm of water, tubing resting 3 cm from the base of the container); the therapist-made Bubble-PEP-0cm (filled with 10 cm of water, tubing resting at the base of the container); and the AguaPEP, Hydrapep, and Therabubble devices with water to the 10 cm mark on the containers. Flows of 5-25 L/min produced the following mean ± SD PEP and oscillation frequencies (Hz): the Bubble-PEP-3cm produced PEP of 10.4 ± 0.14 to 10.8 ± 0.24 cm H2O, oscillations between 13 and 17 Hz; the Bubble-PEP-0cm produced PEP of 10.9 ± 0.01 to 12.9 ± 0.08 cm H2O, oscillations between 12 and 14 Hz; the AguaPEP produced PEP from 9.7 ± 0.02 to 11.5 ± 0.02 cm H2O, oscillations between 11 and 17 Hz; the Hydrapep produced PEP of 9.6 ± 0.35 to 10.7 ± 0.39 cm H2O, oscillations between 14 and 17 Hz; and the Therabubble produced PEP from 8.6 ± 0.01 to 12.8 ± 0.03 cm H2O, oscillations between 14 and 17 Hz. Bubble-PEP-3cm maintained the most stable pressure throughout the range of flows tested. All

  3. 64排螺旋 CT 及三维容积测量系统对肺叶容积的定量研究%The quantitative measurement of pulmonary lobar volume using 3-dimensional volumetric diagnosis system and 64 row MDCT

    Institute of Scientific and Technical Information of China (English)

    刘斋; 何丽; 贾立镯; 任庆云

    2016-01-01

    Objective To explore the value of 3‐dimensional volumetric diagnosis system in quantitative measurement of pulmona‐ry lobar volumetry using a 64 row MDCT .Methods Seventy‐seven adult volunteers were scanned twice on a 64 row MDCT at the end of the maximum inspiratory and maximum expiratory end respectively .On a volumetric computer‐aided diagnosis system ,the en‐tire lung was semiautomatically separated into 5 anatomy lobes including the right upper lobe ,right middle lobe ,right lower lobe ,left upper lobe ,and left lower lobe .Each lobar volume was measured .Results The lung volume of left upper lobe ,right lower lobe ,left lower lobe ,right upper lobe ,right middle lobe in male volunteers were 1 303 .90 mL and 938 .31 mL ,1 276 .90 mL and 737 .69 mL , 1 204 .47 mL and 678 .67 mL ,1 048 .49 mL and 754 .83 mL ,519 .53 mL and 407 .86 mL at the end of the inspiratory and expiratory respectively .The lung volume of left upper lobe ,right lower lobe ,left lower lobe ,right upper lobe ,right middle lobe in female volun‐teers were 915 .78 mL and 666 .23 mL ,913 .87 mL and 576 .62 mL ,822 .17 mL and 509 .30 mL ,734 .20 mL and 530 .23 mL ,389 .13 mL and 316 .70 mL at the end of the inspiratory and expiratory respectively .The values of each lobe volume between the full inspiration phase and expiration phase group showed significant difference the same sex group (P<0 .05) .The values of each lobe volume in the man group were significantly larger than those of female group in both respiratory phase (P<0 .05) .Of the D‐value in the each lobe volume in 5 anatomy lobe at full inspiration phase and expiration phase in both sex group ,both of the lower lobes were the largest , followed by the left upper lobe ,right upper lobe and right middle lobe .The D‐value in the each lobe volume at full inspiration phase and expiration phase in the man group were significantly larger than those of female group .Conclusion Three‐dimensional volumet‐ric diagnosis system

  4. THE RELATIONSHIP BETWEEN PEAK EXPIRATORY FLOW RATE BEFORE BRONCHOSCOPY AND ARTERIAL OXYGEN DESATURATION DURING BRONCHOSCOPY

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    D. Attaran

    2008-05-01

    Full Text Available A significant reduction in arterial blood oxygen saturation during fiberoptic bronchoscopy has been proved but it is not yet known whether all patients need supplemental oxygen during this procedure. The aim of study is to examine the relationship between peak expiratory flow rate (PEFR before bronchoscopy and oxygen desaturation during bronchoscopy. Measurement of PEFR (% predicted performed before bronchoscopy and arterial O2 desaturation was assessed with a pulse oximeter during bronchoscopy. Study performed in 66 patients with a median age 53 years, who had been referred to our bronchoscopy unit. None of the patients received supplemental oxygen before the procedure. Thirty nine cases (59% had an episode of O2 desaturation during bronchoscopy. Of them 25 cases (38% had sustained O2 desaturation, requiring oxygen therapy while 14 cases (21% had momentary desaturation (< 20s not requiring O2 therapy. Oxygen therapy was administered in 58% of cases with PEFR % < 60 and in 83% of cases with PEFR % less than 45 (P, 0.008 and 0.001, respectively. We also observed a significant fall in mean O2 saturation during bronchoscopy (88 ± 4 % compared to prebronchoscopy levels (95 ± 2 % (P < 0.0001. It is concluded that PEFR < 60% and especially < 45% is a reliable predictor of hypoxemia and the need to O2 therapy during bronchoscopy.

  5. Peak expiratory flow rate; the effect of smoking on younger AND middle aged males

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    B. Satyanarayana

    2013-08-01

    Full Text Available A total of 80 male subjects in age group of 20-50 years were selected for the purpose of the study. They were divided in two groups, smokers and non smokers. Each group subdivided into age groups of 20-35 and 36-50 yrs. The criteria for smoking was about 5-10 cigarettes per day since 6-12 months. Peak Expiratory Flow Rate (P.E.F.R. was determined by using Wright’s peak flow meter. The results showed that in Non-Smoker of age group 20-35 years, (n= 30 the mean PEFR value was 535±50 L/min, whereas in age group 36-50 years, (n=15 the mean P.E.F.R value was 515±50 L/min. In Smokers of age group 20-35 years, (n=10 mean P.E.F.R. value was 374±128 L/min whereas in age group 36-50 years, (n=25 mean P.E.F.R. value was 357±86 L/min. This shows that in smokers P.E.F.R. value is lower compared to Non-smokers in both age groups and that P.E.F.R. is lower in the elder age group in comparison to younger age group. [Int J Res Med Sci 2013; 1(4.000: 441-442

  6. Acu-TENS and Postexercise Expiratory Flow Volume in Healthy Subjects

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    Shirley P. C. Ngai

    2011-01-01

    Full Text Available Transcutaneous Electrical Nerve Stimulation over acupoints (Acu-TENS facilitates recovery of resting heart rate after treadmill exercise in healthy subjects. Its effect on postexercise respiratory indices has not been reported. This study investigates the effect of Acu-TENS on forced expiratory volume in 1 second (FEV1 and forced vital capacity (FVC in healthy subjects after a submaximal exercise. Eleven male subjects were invited to the laboratory twice, two weeks apart, to receive in random order either Acu-TENS or Placebo-TENS (no electrical output from the TENS unit over bilateral Lieque (LU7 and Dingchuan (EX-B1 for 45 minutes, before undergoing exercise following the Bruce protocol. Exercise duration, rate of perceived exertion (RPE, and peak heart rate (PHR were recorded. Between-group FEV1 and FVC, before, immediately after, at 15, 30, and 45minutes postexercise, were compared. While no between-group differences in PHR, RPE, and FVC were found, Acu-TENS was associated with a longer exercise duration (0.9 min (P=.026 and a higher percentage increase in FEV1 at 15 and 45 minutes postexercise (3.3 ± 3.7% (P=.013 and 5.1 ± 7.5% (P=.047, resp. compared to Placebo-TENS. We concluded that Acu-TENS was associated with a higher postexercise FEV1 and a prolongation of submaximal exercise.

  7. Expiratory flow limitation and operating lung volumes during exercise in older and younger adults.

    Science.gov (United States)

    Smith, Joshua R; Kurti, Stephanie P; Meskimen, Kayla; Harms, Craig A

    2017-02-20

    We determined the effect of aging on expiratory flow limitation (EFL) and operating lung volumes when matched for lung size. We hypothesized that older adults will exhibit greater EFL and increases in EELV during exercise compared to younger controls. Ten older (5M/5W; >60years old) and nineteen height-matched young adults (10M/9W) were recruited. Young adults were matched for%predicted forced vital capacity (FVC) (Y-matched%Pred FVC; n=10) and absolute FVC (Y-matched FVC; n=10). Tidal flow-volume loops were recorded during the incremental exercise test with maximal flow-volume loops measured pre- and post-exercise. Compared to younger controls, older adults exhibited more EFL at ventilations of 26, 35, 51, and 80L/min. The older group had higher end-inspiratory lung volume compared to Y-matched%Pred FVC group during submaximal ventilations. The older group increased EELV during exercise, while EELV stayed below resting in the Y-matched%Pred FVC group. These data suggest older adults exhibit more EFL and increase EELV earlier during exercise compared to younger adults.

  8. Los Angeles phonospirometry technique: creating a normogram that correlates with peak expiratory flow measurements in children.

    Science.gov (United States)

    Ochoa, Kelly; Nunez, Jeranil; Wang, Vincent J

    2015-09-01

    Measurement of peak expiratory flow (PEF) is recommended in the assessment of patients with asthma. However, the use of PEF involves multiple barriers, which have limited its use. Phonospirometry, as assessed by a novel Los Angeles phonospirometry technique, has shown good correlation to standard PEF measurements in a pilot study on symptomatic patients with asthma. We sought to develop a normogram for phonospirometry, and to validate the PEF normogram. A convenience sample of asymptomatic children ages 3-17 years old was approached for participation in the Emergency Department. Sample size calculations determined that at least 30 children per age group (n = 450) were needed. Children were asked to perform PEF measurements and phonospirometry, measured as the length of time (in s) the child was able to chant "lalala" in a single breath. 510 children were enrolled. Spearman's rho between PEF and phonospirometry was 0.722. Phonospirometry correlated with both age and height, with a Spearman rho of 0.697 and 0.696, respectively. This was slightly lower than the correlation of PEF with age and height with Spearman rhos of 0.877 and 0.902, respectively. A normogram was developed for phonospirometry based on age and height. This study determined normal value ranges for the Los Angeles phonospirometry technique for age and height, and also showed that the technique has good correlation with PEF. This technique may be used to assess a pediatric patient with an acute asthma exacerbation.

  9. Disodium cromoglycate attenuates hypoxia induced enlargement of end-expiratory lung volume in rats.

    Science.gov (United States)

    Maxová, H; Hezinová, A; Vízek, M

    2011-01-01

    Mechanism responsible for the enlargement of end-expiratory lung volume (EELV) induced by chronic hypoxia remains unclear. The fact that the increase in EELV persists after return to normoxia suggests involvement of morphological changes. Because hypoxia has been also shown to activate lung mast cells, we speculated that they could play in the mechanism increasing EELV similar role as in vessel remodeling in hypoxic pulmonary hypertension (HPH). We, therefore, tested an effect of mast cells degranulation blocker disodium cromoglycate (DSCG) on hypoxia induced EELV enlargement. Ventilatory parameters, EELV and right to left heart weight ratio (RV/LV+S) were measured in male Wistar rats. The experimental group (H+DSCG) was exposed to 3 weeks of normobaric hypoxia and treated with DSCG during the first four days of hypoxia, control group was exposed to hypoxia only (H), two others were kept in normoxia as non-treated (N) and treated (N+DSCG) groups. DSCG treatment significantly attenuated the EELV enlargement (H+DSCG = 6.1+/-0.8; H = 9.2+/-0.9; ml +/-SE) together with the increase in minute ventilation (H + DSCG = 190+/-8; H = 273 +/- 10; ml/min +/- SE) and RV/LV + S (H + DSCG = 0.39 +/- 0.03; H = 0.50 +/- 0.06).

  10. PROGRESSIVE MUSCLE RELAXATION INCREASE PEAK EXPIRATORY FLOW RATE ON CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

    Directory of Open Access Journals (Sweden)

    Tintin Sukartini

    2017-07-01

    Full Text Available Introduction: Limited progressive air flow in Chronic Obstructive Pulmonary Disease (COPD can caused by small airway disease (bronchiolitis obstructive and loss of elasticity of the lung (emphysema. Further it can be decreasing the quality of life in COPD patients because dyspnea and uncomfortable in activity. Progressive muscle relaxation (PMR is one of the relaxation technique that can repair pulmonary ventilation by decreasing chronic constriction of the respiratory muscles. The objective of this study was to analyze the effect of progressive muscle relaxation on raised peak expiratory flow rate (PEFR. Method: A pre-experimental one group pre-post test design was used in this study. Population was all of the COPD patients at Pulmonary Specialist Polyclinic Dr Mohamad Soewandhie Surabaya. There were 8 respondents taken by using purposive sampling. PEFR was counted by using peak flow meter every six day. Data were analyzed by using Paired t-Test with significance level  p≤0.05. Result: The result showed that PMR had significance level on increasing of PEFR (p=0.012. Discussion: It can be concluded that PMR has an effect on raise PEFR. Further studies are recommended to measure the effect of PMR on respiratory rate (RR, heart rate (HR subjective dyspnoe symptoms, forced expiration volume on the first minute (FEV1 and mid maximum flow rate (MMFR in COPD patients.

  11. The longitudinal relationship of work stress with peak expiratory flow: a cohort study.

    Science.gov (United States)

    Loerbroks, Adrian; Karrasch, Stefan; Lunau, Thorsten

    2017-05-29

    Research has suggested that psychological stress is associated with reduced lung function and with the development of respiratory disease. Among the major potential sources of stress in adulthood are working conditions. We aimed to examine the relationship of work stress with lung function. We drew on 4-year prospective data from the Survey of Health, Ageing and Retirement in Europe. The analyzed sample comprised 2627 workers aged 50 years or older who were anamnestically free of respiratory disease. Work stress at baseline was operationalized by abbreviated instruments measuring the well-established effort-reward imbalance model (seven items) and the control component of the job-demand control (two items). Peak expiratory flow (PEF) was determined at baseline and at follow-up. Continuous and categorized (i.e., by the tertile) work stress variables were employed in multivariable linear regression models to predict PEF change. Work stress did not show statistically significant associations with PEF change. For instance, the unstandardized regression coefficient for PEF decline according to high versus low effort-reward imbalance was -1.41 (95% confidence interval = -3.75, 0.94). Our study is the first to examine prospective relationships between work stress and PEF. Overall, we did not observe meaningful associations. Future studies should consider a broader spectrum of spirometric parameters and should expand research to younger and possibly less-selected working populations (i.e., aged <50 years).

  12. Pancreatic tuberculosis: MDCT features and differential diagnosis%胰腺结核九例的MDCT特征和误诊分析

    Institute of Scientific and Technical Information of China (English)

    梁宗辉; 窦娅芳; 唐颖; 汤伟军; 冯晓源

    2011-01-01

    Objective To study the multi-detector spiral CT (MDCT) features of pancreatic tuberculosis to improve the awareness and correct diagnosis. Methods Imaging features of MDCT were retrospectively reviewed on 9 cases with pancreatic tuberculosis that were diagnosed from 2003 to 2009, among them two patients underwent MDCT angiography, the features were compared with those of operative and pathological findings. Results One case of pancreatic cancer, 2 cases of cystadenocarcinoma and 1 case of pseudocyst, 2 cases of pancreatic cancer with retroperitoneal lymph node metastasis, 2 cases of lymphoma were diagnosed by MDCT, and all the lesions were diagnosed as pancreatic tuberculosis pathologically, and the misdiagnosis rate was 100%. Pancreatic tuberculosis often presented as pancreatic head mass, sometimes pancreatic body and tail were involved. MDCT showed isopycnic or low density solid-cyst mass, occasionally calcification was present, with slightly or moderate ring-like enhancement after contrast injection. There was no enlargement of the pancreatic duct. The retroperitoneal and adjacent lymph nodes were always enlarged with ring-like enhancement. Sometimes there was evidence of tuberculosis of other abdominal organs. Conclusions Ring-like enhanced lesions with ring-like enhanced lymph nodes without enlargement of pancreatic duct are characteristic MDCT features of pancreatic tuberculosis.%目的 分析胰腺结核(pancreatic tuberculoses,PT)的多层螺旋CT(MDCT)征象,以期提高对该病的认识和诊断正确率.方法 收集2003年至2009年行MDCT检查并最终确诊为PT的9例患者,其中2例行MDCT血管成像.分析PT的MDCT特征性表现,并与手术及病理结果进行比较.结果 MDCT诊断为胰腺癌1例、囊腺癌1例、囊腺瘤2例、假性囊肿1例、胰腺癌伴后腹膜淋巴结转移2例、淋巴瘤2例.通过病理证实,9例均为PT,误诊率达100%.PT常表现为胰头肿块,亦可累及体尾部或整个胰腺.MDCT呈现等或略

  13. Volume-monitored chest CT: a simplified method for obtaining motion-free images near full inspiratory and end expiratory lung volumes

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Kathryn S. [The Ohio State University College of Medicine, Columbus, OH (United States); Long, Frederick R. [Nationwide Children' s Hospital, The Children' s Radiological Institute, Columbus, OH (United States); Flucke, Robert L. [Nationwide Children' s Hospital, Department of Pulmonary Medicine, Columbus, OH (United States); Castile, Robert G. [The Research Institute at Nationwide Children' s Hospital, Center for Perinatal Research, Columbus, OH (United States)

    2010-10-15

    Lung inflation and respiratory motion during chest CT affect diagnostic accuracy and reproducibility. To describe a simple volume-monitored (VM) method for performing reproducible, motion-free full inspiratory and end expiratory chest CT examinations in children. Fifty-two children with cystic fibrosis (mean age 8.8 {+-} 2.2 years) underwent pulmonary function tests and inspiratory and expiratory VM-CT scans (1.25-mm slices, 80-120 kVp, 16-40 mAs) according to an IRB-approved protocol. The VM-CT technique utilizes instruction from a respiratory therapist, a portable spirometer and real-time documentation of lung volume on a computer. CT image quality was evaluated for achievement of targeted lung-volume levels and for respiratory motion. Children achieved 95% of vital capacity during full inspiratory imaging. For end expiratory scans, 92% were at or below the child's end expiratory level. Two expiratory exams were judged to be at suboptimal volumes. Two inspiratory (4%) and three expiratory (6%) exams showed respiratory motion. Overall, 94% of scans were performed at optimal volumes without respiratory motion. The VM-CT technique is a simple, feasible method in children as young as 4 years to achieve reproducible high-quality full inspiratory and end expiratory lung CT images. (orig.)

  14. Effect of preceding inspiratory speed and end-inspiratory pause on forced expiratory manoeuvre in healthy subjects and chronic obstructive pulmonary disease patients.

    Science.gov (United States)

    Boni, Enrico; Chiari, Stefania; Trigiani, Marco; Gatta, Diego; Pini, Laura; Tantucci, Claudio

    2009-01-01

    Lower peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV(1)) have been consistently found after slow inspiration with end-inspiratory pause (EIP). It was the aim of this study to establish the respective influence of the speed of preceding inspiration (SPI) and EIP on the parameters obtained from the following expiratory forced vital capacity (FVC) manoeuvre. In 8 healthy subjects and 12 patients with chronic obstructive pulmonary disease (COPD), a number of inspirations with different SPI and EIP were performed. In the subsequent FVC manoeuvre, maximal expiratory flows, including PEF, and maximal expired volumes at different times, including FEV(1), were measured. For each FVC manoeuvre, peak expiratory time, expired volume at PEF (as % of FVC), flow limitation by the negative expiratory pressure technique and FVC were checked to be sure of achieving a similar expiratory effort and starting inflation lung volume. The highest values of PEF and FEV(1) were found in normal subjects and COPD patients after fastest SPI without EIP (p 2 s) without EIP were followed by lower PEF in COPD patients (p COPD patients (p COPD patients, unless SPI is too slow (inspiratory time >2 s), while any EIP decreases these indices in all individuals. (c) 2009 S. Karger AG, Basel.

  15. Adenocarcinoma of the uncinate process of the pancreas: MDCT patterns of local invasion and clinical features at presentation

    Energy Technology Data Exchange (ETDEWEB)

    Padilla-Thornton, Amie E.; Willmann, Juergen K.; Jeffrey, R.B. [Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States)

    2012-05-15

    To compare the multidetector CT (MDCT) patterns of local invasion and clinical findings at presentation in patients with adenocarcinoma of the uncinate process of the pancreas to patients with adenocarcinomas in the non-uncinate head of the pancreas. We evaluated the two cohorts for common duct and pancreatic duct dilatation, mesenteric vascular encasement, root of mesentery invasion, perineural invasion and duodenal invasion. In addition, we compared the clinical findings at presentation in both groups. Common duct (P < 0.001) and pancreatic duct dilatation (P = 0.001) were significantly less common in uncinate process adenocarcinomas than in the non-uncinate head of the pancreas. Clinical findings of jaundice (P = 0.01) and pruritis (P = 0.004) were significantly more common in patients with lesions in the non-uncinate head of the pancreas. Superior mesenteric artery encasement (P = 0.02) and perineural invasion (P = 0.001) were significantly more common with uncinate process adenocarcinomas. Owing to its unique anatomic location, adenocarcinomas within the uncinate process of the pancreas have significantly different patterns of both local invasion and clinical presentation compared to patients with carcinomas in the non-uncinate head of the pancreas. (orig.)

  16. Determination of breath isoprene allows the identification of the expiratory fraction of the propofol breath signal during real-time propofol breath monitoring.

    Science.gov (United States)

    Hornuss, Cyrill; Dolch, Michael E; Janitza, Silke; Souza, Kimberly; Praun, Siegfried; Apfel, Christian C; Schelling, Gustav

    2013-10-01

    Real-time measurement of propofol in the breath may be used for routine clinical monitoring. However, this requires unequivocal identification of the expiratory phase of the respiratory propofol signal as only expiratory propofol reflects propofol blood concentrations. Determination of CO2 breath concentrations is the current gold standard for the identification of expiratory gas but usually requires additional equipment. Human breath also contains isoprene, a volatile organic compound with low inspiratory breath concentration and an expiratory concentration plateau. We investigated whether breath isoprene could be used similarly to CO2 to identify the expiratory fraction of the propofol breath signal. We investigated real-time breath data obtained from 40 study subjects during routine anesthesia. Propofol, isoprene, and CO2 breath concentrations were determined by a combined ion molecule reaction/electron impact mass spectrometry system. The expiratory propofol signal was identified according to breath CO2 and isoprene concentrations and presented as median of intervals of 30 s duration. Bland-Altman analysis was applied to detect differences (bias) in the expiratory propofol signal extracted by the two identification methods. We investigated propofol signals in a total of 3,590 observation intervals of 30 s duration in the 40 study subjects. In 51.4 % of the intervals (1,844/3,590) both methods extracted the same results for expiratory propofol signal. Overall bias between the two data extraction methods was -0.12 ppb. The lower and the upper limits of the 95 % CI were -0.69 and 0.45 ppb. Determination of isoprene breath concentrations allows the identification of the expiratory propofol signal during real-time breath monitoring.

  17. Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure

    DEFF Research Database (Denmark)

    Møller, Tom; Moser, Claus; Adamsen, Lis

    2016-01-01

    of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty-five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between...... fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient-performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness...... intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80-76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients...

  18. Functional electrical stimulation to the abdominal wall muscles synchronized with the expiratory flow does not induce muscle fatigue.

    Science.gov (United States)

    Okuno, Yukako; Takahashi, Ryoichi; Sewa, Yoko; Ohse, Hirotaka; Imura, Shigeyuki; Tomita, Kazuhide

    2017-03-01

    [Purpose] Continuous electrical stimulation of abdominal wall muscles is known to induce mild muscle fatigue. However, it is not clear whether this is also true for functional electrical stimulation delivered only during the expiratory phase of breathing. This study aimed to examine whether or not intermittent electrical stimulation delivered to abdominal wall muscles induces muscle fatigue. [Subjects and Methods] The subjects were nine healthy adults. Abdominal electrical stimulation was applied for 1.5 seconds from the start of expiration and then turned off during inspiration. The electrodes were attached to both sides of the abdomen at the lower margin of the 12th rib. Abdominal electrical stimulation was delivered for 15 minutes with the subject in a seated position. Expiratory flow was measured during stimulus. Trunk flexor torque and electromyography activity were measured to evaluate abdominal muscle fatigue. [Results] The mean stimulation on/off ratio was 1:2.3. The declining rate of abdominal muscle torque was 61.1 ± 19.1% before stimulus and 56.5 ± 20.9% after stimulus, not significantly different. The declining rate of mean power frequency was 47.8 ± 11.7% before stimulus and 47.9 ± 10.2% after stimulus, not significantly different. [Conclusion] It was found that intermittent electrical stimulation to abdominal muscles synchronized with the expiratory would not induce muscle fatigue.

  19. Functional electrical stimulation to the abdominal wall muscles synchronized with the expiratory flow does not induce muscle fatigue

    Science.gov (United States)

    Okuno, Yukako; Takahashi, Ryoichi; Sewa, Yoko; Ohse, Hirotaka; Imura, Shigeyuki; Tomita, Kazuhide

    2017-01-01

    [Purpose] Continuous electrical stimulation of abdominal wall muscles is known to induce mild muscle fatigue. However, it is not clear whether this is also true for functional electrical stimulation delivered only during the expiratory phase of breathing. This study aimed to examine whether or not intermittent electrical stimulation delivered to abdominal wall muscles induces muscle fatigue. [Subjects and Methods] The subjects were nine healthy adults. Abdominal electrical stimulation was applied for 1.5 seconds from the start of expiration and then turned off during inspiration. The electrodes were attached to both sides of the abdomen at the lower margin of the 12th rib. Abdominal electrical stimulation was delivered for 15 minutes with the subject in a seated position. Expiratory flow was measured during stimulus. Trunk flexor torque and electromyography activity were measured to evaluate abdominal muscle fatigue. [Results] The mean stimulation on/off ratio was 1:2.3. The declining rate of abdominal muscle torque was 61.1 ± 19.1% before stimulus and 56.5 ± 20.9% after stimulus, not significantly different. The declining rate of mean power frequency was 47.8 ± 11.7% before stimulus and 47.9 ± 10.2% after stimulus, not significantly different. [Conclusion] It was found that intermittent electrical stimulation to abdominal muscles synchronized with the expiratory would not induce muscle fatigue. PMID:28356636

  20. Nasal Expiratory Positive Airway Pressure Devices (Provent for OSA: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Muhammad Riaz

    2015-01-01

    Full Text Available Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP devices or Provent as treatment for obstructive sleep apnea (OSA. Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD for apnea-hypopnea index (AHI in 345 patients decreased from 27.32±22.24 to 12.78±16.89 events/hr (relative reduction = 53.2%. Random effects modeling mean difference (MD was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI in 247 patients decreased from 21.2±19.3 to 12.4±14.1 events/hr (relative reduction = 41.5%, p value < 0.00001. Lowest oxygen saturation (LSAT M ± SD improved in 146 patients from 83.2±6.8% to 86.2±11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS M ± SD improved (359 patients from 9.9±5.3 to 7.4±5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent.

  1. Synchronized fast rhythms in inspiratory and expiratory nerve discharges during fictive vocalization.

    Science.gov (United States)

    Nakazawa, K; Granata, A R; Cohen, M I

    2000-03-01

    In precollicular decerebrate and paralyzed cats, respiratory nerve activities were recorded during fictive vocalization (FV), which consisted of a distinctive pattern of 1) decreased inspiratory (I) and expiratory (E) phase durations, 2) marked increase of phrenic activity and moderate changes of recurrent laryngeal (RL) and superior laryngeal (SL) I activities, and 3) massive recruitment of laryngeal and abdominal (ABD; lumbar) E activities. FV was produced by electrical stimulation (100 Hz) in the midbrain periaqueductal gray (PAG) or its putative descending pathways in the ventrolateral pons (VLP). Spectral and correlation analyses revealed three types of effect on fast rhythms during FV. 1) I activities: the coherent high-frequency oscillations in I (I-HFO, 60-90 Hz) present in phrenic and RL discharges during the control state did not change qualitatively, but there was an increase of power and a moderate increase (4-10 Hz) of frequency. Sometimes a distinct relatively weak stimulus-locked rhythm appeared. 2) RL and SL activities during E: in recruited discharges, a prominent intrinsic rhythm (coherent E-HFOs at 50-70 Hz) appeared; sometimes a distinct relatively strong stimulus-locked rhythm appeared. 3) ABD activities during E: this recruited activity had no intrinsic rhythm but had an evoked oscillation locked to the stimulus frequency. Thus FV is characterized by 1) appearance of prominent coherent intrinsic rhythms in RL and SL E discharges, which presumably arise as a result of excitation and increased interactions in laryngeal networks; 2) modification of intrinsic rhythmic interactions in inspiratory networks; and 3) evoked rhythms in augmenting-E neuron networks without occurrence of intrinsic rhythms.

  2. Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Riaz, Muhammad; Certal, Victor; Nigam, Gaurav; Abdullatif, Jose; Zaghi, Soroush; Kushida, Clete A.; Camacho, Macario

    2015-01-01

    Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent). PMID:26798519

  3. Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial.

    Science.gov (United States)

    Wheeler, Natalie C; Wing, Jeffrey J; O'Brien, Louise M; Hughes, Rebecca; Jacobs, Teresa; Claflin, Edward; Chervin, Ronald D; Brown, Devin L

    2016-09-15

    Obstructive sleep apnea (OSA) is common after stroke and predicts poor outcomes. Continuous positive airway pressure (CPAP) treats OSA but is generally poorly tolerated by stroke patients. We assessed whether nasal expiratory positive airway pressure (EPAP), an alternative to CPAP, may be an effective option after acute stroke. We conducted a randomized, controlled, two-period crossover study in which each acute ischemic stroke patient received 1 night of EPAP and 1 night without EPAP while OSA was monitored with a validated device, the Watch-PAT 200. Linear repeated- measures analyses were conducted. Sample size calculations indicated that 18 subjects would be required to detect a 10-point or larger average reduction in the apnea-hypopnea index (AHI, the primary outcome), with use of EPAP, with power ≥ 80% and α = 0.05. Among the 19 subjects who completed the protocol, nasal EPAP treatment was associated with a nonsignificant absolute difference in AHI of -5.73 events/h in the primary analysis (p = 0.183, 95% confidence interval -14.4, 2.97) and a nonsignificant absolute difference in AHI of -5.43 events/h in the subgroup of patients who used nasal EPAP for ≥ 3 h (p = 0.314, 95% confidence interval -16.6, 5.76). This study suggests that EPAP is not an effective alternative to CPAP in acute stroke patients with OSA. Further work is needed to identify other more effective alternatives. ClinicalTrials.gov, ID: NCT01703663. © 2016 American Academy of Sleep Medicine.

  4. Daily changes of peak expiratory flow and respiratory symptom occurrence around a soy processing factory.

    Science.gov (United States)

    Heederik, Dick; Doekes, Gert; van Strien, Rob; Brunekreef, Bert

    2014-01-01

    To evaluate sensitization and acute respiratory health effects in inhabitants living in the vicinity of a factory producing soy oil. Two panels of potential responders were created on the basis of a response to a short screening questionnaire sent to random samples of 1,000 exposed and 1,000 non-exposed individuals living around the factory and a control area. Individuals responding to the questionnaire were invited for a medical evaluation, including a respiratory symptom questionnaire and skin prick testing, for a panel of common allergens and a soy allergen extract. This resulted in 53 atopic and/or asthmatic inhabitants from the area surrounding the factory and 30 comparable control subjects. In these subjects, morning and evening Peak Expiratory Flow (PEF), respiratory symptoms and medication use were recorded daily during a 10-week period in the autumn. At the same time, soy allergen and endotoxin concentrations were determined in airborne dust in the exposed and the control area. The wind direction relative to the location of a subjects' house and the factory was used to determine whether an individual was exposed on a particular day. Only few of the atopic subjects were sensitized to soy. PEF showed a decrease, respiratory symptoms and bronchodilator use, an increase among soy sensitized subjects after having been downwind from the factory. Airborne soy allergen was found more frequently in the area surrounding the factory and levels were higher than in the control area. Highest levels were found on the factory premises. Only a weak association was found with wind direction. Airborne endotoxin concentrations did not show a consistent pattern with distance, but levels were clearly higher on the factory premises. Sensitization to soy allergen was not increased among the population sample living in the vicinity of the factory. Soy sensitized individuals living in the surroundings of the factory reported more respiratory symptoms, used bronchodilators more

  5. Positive end-expiratory pressure and variable ventilation in lung-healthy rats under general anesthesia.

    Directory of Open Access Journals (Sweden)

    Luciana M Camilo

    Full Text Available OBJECTIVES: Variable ventilation (VV seems to improve respiratory function in acute lung injury and may be combined with positive end-expiratory pressure (PEEP in order to protect the lungs even in healthy subjects. We hypothesized that VV in combination with moderate levels of PEEP reduce the deterioration of pulmonary function related to general anesthesia. Hence, we aimed at evaluating the alveolar stability and lung protection of the combination of VV at different PEEP levels. DESIGN: Randomized experimental study. SETTING: Animal research facility. SUBJECTS: Forty-nine male Wistar rats (200-270 g. INTERVENTIONS: Animals were ventilated during 2 hours with protective low tidal volume (VT in volume control ventilation (VCV or VV and PEEP adjusted at the level of minimum respiratory system elastance (Ers, obtained during a decremental PEEP trial subsequent to a recruitment maneuver, and 2 cmH2O above or below of this level. MEASUREMENTS AND MAIN RESULTS: Ers, gas exchange and hemodynamic variables were measured. Cytokines were determined in lung homogenate and plasma samples and left lung was used for histologic analysis and diffuse alveolar damage scoring. A progressive time-dependent increase in Ers was observed independent on ventilatory mode or PEEP level. Despite of that, the rate of increase of Ers and lung tissue IL-1 beta concentration were significantly lower in VV than in VCV at the level of the PEEP of minimum Ers. A significant increase in lung tissue cytokines (IL-6, IL-1 beta, CINC-1 and TNF-alpha as well as a ventral to dorsal and cranial to caudal reduction in aeration was observed in all ventilated rats with no significant differences among groups. CONCLUSIONS: VV combined with PEEP adjusted at the level of the PEEP of minimal Ers seemed to better prevent anesthesia-induced atelectasis and might improve lung protection throughout general anesthesia.

  6. New parachute cuff and positive end-expiratory pressure to minimize tracheal injury and prevent aspiration.

    Science.gov (United States)

    Nordin, U; Lyttkens, L

    1979-01-01

    A new parachute cuff has been tested in combination with a positive end-expiratory pressure (PEEP) on mongrel dogs. During positive-pressure ventilation the intracuff and intratracheal pressures showed synchronous, identical pressure variations, and therefore theoretically with this type of cuff the pressure against the tracheal wall would be minimal. The cuff provided a seal against gas leakage from the lungs throughout the entire test period, i.e., for up to 7 h. To avoid aspiration of mouth contents during the passive exhalation phase, different amounts of PEEP were tested. A PEEP of 4.0--8.0 cm H2O always produced a seal against a column of fluid in the mouth exerting a hydrostatic pressure of 5.4--8.8 cm H2O against the cuff. This seal was maintained during the whole test period. No difference in sealing capacity was found when the cuff was used with a normal respiratory frequency (20/min) and with high-frequency positive-pressure ventilation (60/min). When the PEEP is eliminated, e.g., when the respirator is disconnected for suction of the endotracheal tube, the sealing effect will be abolished. As the cuff extends up into the larynx there will be no pooling of fluid above the cuff. The risk of aspiration can therefore be diminished by suction of oral cavity before disconnecting the respirator. With the use of the pneumatic valve principle together with high-frequency positive-pressure ventilation, an open respirator system can produce a continuous PEEP, thereby preventing aspiration even during suctioning of the tracheal tube.

  7. A comprehensive breath plume model for disease transmission via expiratory aerosols.

    Directory of Open Access Journals (Sweden)

    Siobhan K Halloran

    Full Text Available The peak in influenza incidence during wintertime in temperate regions represents a longstanding, unresolved scientific question. One hypothesis is that the efficacy of airborne transmission via aerosols is increased at lower humidities and temperatures, conditions that prevail in wintertime. Recent work with a guinea pig model by Lowen et al. indicated that humidity and temperature do modulate airborne influenza virus transmission, and several investigators have interpreted the observed humidity dependence in terms of airborne virus survivability. This interpretation, however, neglects two key observations: the effect of ambient temperature on the viral growth kinetics within the animals, and the strong influence of the background airflow on transmission. Here we provide a comprehensive theoretical framework for assessing the probability of disease transmission via expiratory aerosols between test animals in laboratory conditions. The spread of aerosols emitted from an infected animal is modeled using dispersion theory for a homogeneous turbulent airflow. The concentration and size distribution of the evaporating droplets in the resulting "Gaussian breath plume" are calculated as functions of position, humidity, and temperature. The overall transmission probability is modeled with a combination of the time-dependent viral concentration in the infected animal and the probability of droplet inhalation by the exposed animal downstream. We demonstrate that the breath plume model is broadly consistent with the results of Lowen et al., without invoking airborne virus survivability. The results also suggest that, at least for guinea pigs, variation in viral kinetics within the infected animals is the dominant factor explaining the increased transmission probability observed at lower temperatures.

  8. Repeated thermo-sterilisation further affects the reliability of positive end-expiratory pressure valves.

    Science.gov (United States)

    Hartung, Julia Christine; Schmölzer, Georg; Schmalisch, Gerd; Roehr, Charles Christoph

    2013-09-01

    Positive end-expiratory pressure (PEEP) valves are used together with self-inflating bags (SIB) to provide a preset PEEP during manual ventilation. It has recently been shown that these valves deliver highly variable levels of PEEP. We hypothesised that material fatigue due to repeated thermo-sterilisation (TS) may contribute to varying reliability of PEEP valves. In a laboratory study 10 new PEEP valves were tested before and after 10, 20 and 30 cycles of routine TS (7 min at 134°C) by using a neonatal lung model (compliance 0.2 mL/kPa). Settings were positive inflation pressure = 20 and 40 cm H(2)O, PEEP = 5 and 10 cm H(2)O, respiratory rate = 40 and 60/min, flow = 8l/min. PEEP was recorded using a respiratory function monitor. Before TS, a mean (standard deviation) PEEP of 4.0 (0.9) and 7.7 (1.0) cm H(2)O was delivered by the 10 valves when the PEEP was set to 5 and 10 cm H(2)O, respectively. One new valve only delivered 2.0 (0.0) and 5.0 (0.0) cm H(2)O when the PEEP was adjusted to 5 and 10 cm H(2)O, respectively. Four of the 10 investigated valves showed significant variations in PEEP (coefficient of variation >10%) throughout the autoclaving process. One valve completely lost its function after the 20th TS. Common defects were tears in the softer materials or displacement of the rubber seal. Six of the 10 valves continued to provide PEEP in spite of repeated TS. The reliability of PEEP valves is affected by repeated TS. Multi-use PEEP valves should be tested for reliable PEEP provision following TS. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  9. Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis.

    Science.gov (United States)

    McIlwaine, Maggie; Button, Brenda; Dwan, Kerry

    2015-06-17

    Chest physiotherapy is widely prescribed to assist the clearance of airway secretions in people with cystic fibrosis. Positive expiratory pressure (PEP) devices provide back pressure to the airways during expiration. This may improve clearance by building up gas behind mucus via collateral ventilation and by temporarily increasing functional residual capacity. Given the widespread use of PEP devices, there is a need to determine the evidence for their effect. This is an update of a previously published review. To determine the effectiveness and acceptability of PEP devices compared to other forms of physiotherapy as a means of improving mucus clearance and other outcomes in people with cystic fibrosis. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. The electronic database CINAHL was also searched from 1982 to 2013.Most recent search of the Group's Cystic Fibrosis Trial Register: 02 December 2014. Randomised controlled studies in which PEP was compared with any other form of physiotherapy in people with cystic fibrosis. This included, postural drainage and percussion, active cycle of breathing techniques, oscillating PEP devices, thoracic oscillating devices, bilevel positive airway pressure (BiPaP) and exercise. Studies also had to include one or more of the following outcomes: change in forced expiratory volume in one second; number of respiratory exacerbations; a direct measure of mucus clearance; weight of expectorated secretions; other pulmonary function parameters; a measure of exercise tolerance; ventilation scans; cost of intervention; and adherence to treatment. Three authors independently applied the inclusion and exclusion criteria to publications and assessed the risk of bias of the included studies. A total of 26 studies (involving 733 participants

  10. The correlation between the paired inspiratory and expiratory three-dimensional quantitative CT and pulmonary function test in chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    隋昕

    2013-01-01

    Objective To investigate the correlation between the paired inspiratory and expiratory quantitative CT and pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD) .Methods A total of 84 patients with COPD were enrolled.For each

  11. Effects of Positive End-Expiratory Pressure on Oscillated Volume during High-Frequency Chest Compression in Children with Cystic Fibrosis

    OpenAIRE

    Dosman, Cara F; Peter C Zuberbuhler; Tabk, Joan I; Jones, Richard L

    2003-01-01

    OBJECTIVE: To investigate the effects of positive end-expiratory pressure (PEEP) on end-expiratory lung volume (EELV) and mean oscillated volume (Vosc) during high frequency chest compression (HFCC).DESIGN: A clinic-based prospective intervention study.SETTING: Pulmonary function laboratory, University of Alberta, Edmonton, Alberta.POPULATION: Nine children with cystic fibrosis with little or no obstructive airway disease who were selected from the outpatient Cystic Fibrosis and Pediatric Pul...

  12. Evaluation of multiple trauma victims with 16-row multidetector CT (MDCT): a time analysis; Anwendung der 16-Zeilen-Mehrdetektor-CT in der Initialdiagnostik beim Polytrauma: Eine Zeitanalyse

    Energy Technology Data Exchange (ETDEWEB)

    Heyer, C.M.; Nicolas, V. [Bochum Univ. (Germany). Inst. fuer Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin; Rduch, G.J. [Bochum Univ. (Germany). Klinik fuer Chirurgie; Wick, M.; Muhr, G. [Bochum Univ. (Germany). Medizinische Klinik III, Pneumologie, Allergologie und Schlafmedizin; Bauer, T.T. [Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Univ. Bochum (Germany)

    2005-12-15

    Purpose: Description and time analysis of a 16-row MDCT protocol in the evaluation of multiple trauma patients considering transport, time of scanning, patient positioning, image reconstruction, and image interpretation. Materials and methods: Between May and December 2004, 60 multiple trauma patients underwent 16-row MDCT (Sensation, Siemens, Erlangen, Germany). The protocol included serial scanning of the head, spiral scanning of the cervical spine and contrast-enhanced spiral scanning of the thorax/abdomen with multiplanar reformations (MPR) of the thoracic/lumbar spine and the pelvis. All time intervals including transport, patient positioning, scanning, duration of MPR, total time in the examination room, and time to first and final image interpretation were prospectively evaluated. Furthermore, patient characteristics, trauma profiles, and mortality rates were recorded. Results: 46 male and 14 female patients (mean age 43.6 years) were enrolled in the study. Time analysis of 16-row MDCT revealed the following results (mean time standard deviation): Emergency room treatment and transport 19.2{+-}6.7 min, patient positioning 16.5{+-}6.5 min, scan duration 8.0{+-}3.3 min, total time in examination room 24.5{+-}7.2 min, image reconstruction including MPR 32.0{+-}16.4 min, and time of first (16.4{+-}4.7 min) and final image interpretation (82.5{+-}30.4 min). Trauma profiles revealed thoracic injuries in 35/60 patients (58.3%), head injuries in 23/60 patients (38.3%), abdominal injuries in 15/60 patients (25.0%), injuries of the cervical (9/60 patients, 15.0%), thoracic (12/60 patients, 20.0%), and lumbar spine (19/60 patients, 31.7%), pelvic injuries in 13/60 patients (21.7%), and injuries of extremities in 39/60 patients (65.0%). The mortality rate was 21.7%. (orig.)

  13. Development of a voxel-matching technique for substantial reduction of subtraction artifacts in temporal subtraction images obtained from thoracic MDCT.

    Science.gov (United States)

    Itai, Yoshinori; Kim, Hyoungseop; Ishikawa, Seiji; Katsuragawa, Shigehiko; Doi, Kunio

    2010-02-01

    A temporal subtraction image, which is obtained by subtraction of a previous image from a current one, can be used for enhancing interval changes (such as formation of new lesions and changes in existing abnormalities) on medical images by removing most of the normal structures. However, subtraction artifacts are commonly included in temporal subtraction images obtained from thoracic computed tomography and thus tend to reduce its effectiveness in the detection of pulmonary nodules. In this study, we developed a new method for substantially removing the artifacts on temporal subtraction images of lungs obtained from multiple-detector computed tomography (MDCT) by using a voxel-matching technique. Our new method was examined on 20 clinical cases with MDCT images. With this technique, the voxel value in a warped (or nonwarped) previous image is replaced by a voxel value within a kernel, such as a small cube centered at a given location, which would be closest (identical or nearly equal) to the voxel value in the corresponding location in the current image. With the voxel-matching technique, the correspondence not only between the structures but also between the voxel values in the current and the previous images is determined. To evaluate the usefulness of the voxel-matching technique for removal of subtraction artifacts, the magnitude of artifacts remaining in the temporal subtraction images was examined by use of the full width at half maximum and the sum of a histogram of voxel values, which may indicate the average contrast and the total amount, respectively, of subtraction artifacts. With our new method, subtraction artifacts due to normal structures such as blood vessels were substantially removed on temporal subtraction images. This computerized method can enhance lung nodules on chest MDCT images without disturbing misregistration artifacts.

  14. Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT - A pooled analysis of two randomized trials

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, Henrik S. [University of Copenhagen, Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, and Department of Diagnostic Sciences, Faculty of Health Sciences, Herlev (Denmark); Morcos, Sameh K. [University of Sheffield, Department of Diagnostic Imaging, Northern General Hospital, Sheffield (United Kingdom)

    2009-04-15

    The incidence of contrast-medium-induced nephropathy (CIN) following intravenous (IV) CM administration of contrast media to renally impaired patients undergoing multidetector computed tomography (MDCT) is not well characterized. Our objective was to investigate the incidence of CIN in patients with glomerular filtration rate (GFR) <60 ml/min undergoing contrast-enhanced MDCT examinations and to compare the rates of CIN following the IV administration of low-osmolar contrast media (LOCM, iopamidol and iomeprol) and an iso-osmolar contrast medium (IOCM, iodixanol). A total of 301 adult patients with moderate-to-severe renal failure received a similar IV contrast dose (40 gI). Serum creatinine (SCr) was measured at screening, baseline and 48-72 {+-} 6 h after the MDCT examination. Primary CIN outcome was an increase in SCr {>=}0.5 mg/dl ({>=}44.2 {mu}mol/l) from baseline. The CIN rates were 2.3% in the total population, 0.6% when GFR >40 ml/min, 4.6% when GFR <40 ml/min and 7.8% in patients with GFR <30 ml/min. The incidence of CIN was significantly higher after iodixanol than after LOCM (seven patients, 4.7% following IOCM, no CIN cases following the LOCM; p = 0.007). Significant differences in favor of the LOCM were also observed in patients with GFR <40 ml/min and GFR <30 ml/min. Following the IV administration of nonionic contrast agents in patients with moderate-to-severe renal insufficiency, the risk of significant CIN seems to be low. The IOCM iodixanol caused a higher rate of CIN than the LOCM iopamidol and iomeprol, especially in high-risk patients. Differences in osmolality between these LOCM and iodixanol do not play a role in the genesis of CIN. (orig.)

  15. C-arm cone beam CT perfusion imaging in the angiographic suite: a comparison with MDCT perfusion imaging

    Science.gov (United States)

    Niu, Kai; Yang, Pengfei; Wu, Yijing; Struffert, Tobias; Doerfler, Arnd; Schafer, Sebastian; Royalty, Kevin; Strother, Charles; Chen, Guang-Hong

    2015-01-01

    Purpose and background Perfusion imaging in the angiography suite may provide a way to reduce time from stroke onset to endovascular revascularization of patients with a large vessel occlusion. Our purpose was to compare CBCTP with MDCTP. Materials and Methods Data from seven subjects with both MDCTP and CBCTP were retrospectively processed and analyzed. Two algorithms were used to enhance temporal resolution, temporal sampling density and reduce noise of CBCT data before generating perfusion maps. Two readers performed qualitative image quality evaluation on maps using a 5-point scale. ROIs indicating CBF/CBV abnormalities were drawn. Quantitative analyses were performed using the Sørensen–Dice coefficients to quantify the similarity of abnormalities. A non-inferiority hypothesis was tested to compare CBCTP against CBCTP. Results Averaged image quality score for MDCTP and CBCTP images was 2.4 and 2.3 respectively. Averaged confidence scores in diagnosis were both 1.4 for MDCT and CBCT; averaged confidence scores on presence of a CBV/CBF mismatch was 1.7 (κ = 0.50) and 1.5 (κ = 0.64). For MDCTP and CBCTP maps the average score of confidence in making treatment decision was 1.4 (κ = 0.79) and 1.3 (κ = 0.90). Area under visual grading characteristic (AVGC) for the above four qualitative quality score showed an average AVGC of 0.50 with 95% confidence level cover centered at the mean for both readers. Sørensen–Dice coefficient for CBF maps is 0.81 and for CBV maps is 0.55. Conclusions After post-processing methods were applied to enhance image quality for CBCTP maps, the CBCTP maps were not inferior to those generated from MDCTP. PMID:26892987

  16. MDCT in the Differentiation of Adrenal Masses: Comparison between Different Scan Delays for the Evaluation of Intralesional Washout

    Directory of Open Access Journals (Sweden)

    Giuseppe Angelelli

    2013-01-01

    Full Text Available Purpose. To evaluate the accuracy of the washout in the differential diagnosis between adenomas and nonadenomas and to compare the obtained results in delayed CT scans at 5, 10 and 15 minutes. Methods. Fifty patients with adrenal masses were prospectively evaluated. CT scans were performed by using a 320-row MDCT device, before and after injection of contrast material. In 25 cases, delayed scans were performed at 5′ and 10′ (group 1, while in the remaining 25, at 5′ and 15′ (group 2. Absolute and relative wash-out percentage values (APW and RPW were calculated. Results. Differential diagnosis between adenomas and nonadenomas was obtained in 48/50 (96% cases, with sensitivity, specificity, and accuracy values of 96%, 95%, and 96%, respectively. In group 1, APW and RPW values were, respectively, 69.8% and 67.2% at 5′ and 75.9% and 73.5% at 10′ for adenomas and 25.1% and 15.8% at 5′ and 33.5% and 20.5% at 10′ for nonadenomas. In group 2, APW and RPW values were 63% and 54.6% at 5′ and 73.8% and 65.5% at 15′ for adenomas and 22% and 12.5% at 5′ and 35.5% and 19.9% at 15′ for nonadenomas. Conclusions. The evaluation of the wash-out values in CT scans performed at 5′, 10′, and 15′ provides comparable diagnostic results. CT scans performed at 5′ are, therefore, to be preferred, since they reduce the examination time and patient discomfort.

  17. 成人肠套叠的MDCT诊断价值%The Diagnostic Value of MDCT for Adult Intussusception

    Institute of Scientific and Technical Information of China (English)

    曾莎莎; 徐嵩; 郭建东; 李春高; 李景雷

    2013-01-01

    目的 分析成人肠套叠的的MDCT影像特征.方法 回顾分析手术证实为成人肠套叠的CT影像资料共48例.观察内容主要包括肠套叠部位、数目、套叠类型及CT征象、套叠处肠壁是否增厚或肿块形成、肠壁是否水肿与坏死等.结果 本组48例50处肠套叠均为顺行套入,单处肠套叠46例(位于回盲部22例、回肠10例、空肠8例、升结肠4例、十二指肠空肠交界处、降结肠型及直肠各2例),多处肠套叠2例.MDCT示肠套叠3层肠壁结构及肠管内脂肪48例50处、杯口征及靶形征4 2例44处,彗星尾征32例34处,漩涡征24例26处.肠壁均匀增厚并水肿12例,其中考虑合并肠壁坏死4例;肠壁不均匀增厚或和肿块形成、不均匀强化14例;肠壁均匀增厚并轻中度均匀强化6例.套叠处见多发囊状低密度灶并囊壁均匀强化4例;套入远端圆形脂肪瘤合并肠壁坏死2例;小肠冗长2例;肠壁正常8例;其中合并肠梗阻12例,合并腹壁疝2例.结论 成人肠套叠MDCT影像表现有一定特征,三期增强扫描结合多平面重组技术,对其诊断及选择治疗方法具有重要价值.%Objective To analyze the imaging features of MDCT for adult intussusception.Methods A retrospective analysis was performed to assess the MDCT imaging appearances of 48 cases of adult intussusception confirmed by operation.Evaluative content contains the intussusceptions' site,number,type and direct CT signs,bowel wall thickening or mass formation,bowel wall edema and necrosis and so on.Results CT demonstrated all 50 intussusceptions in 48 cases were anterograde,of which single lesion in 46 cases (22cases located in ileocecal junction,10 cases in ileum,8 cases in jejunum,4 cases in ascending colon,2 case in duodenum-jejunum junction,descending colon and rectum respectively),multiple intussusceptions in 2 case.CT showed three bowel walls structure and intralumihal fat sign in all 50 intussusceptions of 48 cases

  18. Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): Assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images

    Energy Technology Data Exchange (ETDEWEB)

    Woodhams, Reiko, E-mail: reikow@hotmail.co.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Nishimaki, Hiroshi, E-mail: emgrad@yhb.att.ne.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Emergency Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228-8555 (Japan); Fujii, Kaoru, E-mail: kaorufujii@yahoo.co.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Kakita, Satoko, E-mail: skakita@kitasato-u.ac.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan); Hayakawa, Kazushige, E-mail: hayakazu@med.kitasato-u.ac.j [Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555 (Japan)

    2010-10-15

    Objective: The purpose of this study was to assess the efficacy of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI) by analyzing morphology and diameter of superior mesenteric artery (SMA). We assessed whether MDCT was as useful as angiography for the diagnosis of NOMI. Materials and methods: Four patients who were diagnosed with NOMI were retrospectively analyzed. All patients had 8-row MDCT followed by laparotomy. Two of them underwent angiography after MDCT. The morphology and diameter of SMA of these cases was analyzed on multi-planar reconstructed (MPR) images. The mean diameter of SMA of NOMI cases was compared to that of 13 control cases. Results: MPR images of all NOMI cases showed irregular narrowing of the SMA, spasm of the arcades of SMA, and poor demonstration of intramural vessels. MPR images of two patients who had angiography were concordant with their angiograms. The mean diameter of SMA of NOMI patients was 3.4 {+-} 1.1 mm, which was statistically smaller than that of 13 control patients, 6.0 {+-} 1.5 mm (P < 0.05, Wilcoxon rank sum tests). Conclusion: Angiography has been recognized essential for the diagnosis of NOMI. This study shows the possibility of MDCT to be an equivalently useful modality compared to angiography for the diagnosis of NOMI by interpreting morphologic appearance and diameter of SMA. Introduction of MDCT in the decision tree of NOMI treatment may bring the benefit of prompt diagnosis and subsequent early and efficient initiation of therapy, which may improve the mortality.

  19. In-vivo assessment of femoral bone strength using Finite Element Analysis (FEA based on routine MDCT imaging: a preliminary study on patients with vertebral fractures.

    Directory of Open Access Journals (Sweden)

    Hans Liebl

    Full Text Available To experimentally validate a non-linear finite element analysis (FEA modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD measurements as gold standard.One fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects.In-vitro simulations showed good correlation with the experimentally measured strains both in stance (R2 = 0.963 and fall configuration (R2 = 0.976. The simulated maximum stress overestimated the experimental failure load (4743 N by 14.7% (5440 N while the simulated maximum strain overestimated by 4.7% (4968 N. The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366, but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028.FEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our data suggests, that MDCT

  20. Prediction of bone strength by μCT and MDCT-based finite-element-models: How much spatial resolution is needed?

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, Jan S., E-mail: jsb@tum.de [Department of Radiology, Technische Universität München, Munich (Germany); Department of Radiology, University of California, San Francisco, CA (United States); Max Planck Institute for Extraterrestrial Physics, Garching (Germany); Sidorenko, Irina [Max Planck Institute for Extraterrestrial Physics, Garching (Germany); Mueller, Dirk [Department of Radiology, Universität Köln (Germany); Baum, Thomas [Department of Radiology, Technische Universität München, Munich (Germany); Department of Radiology, University of California, San Francisco, CA (United States); Max Planck Institute for Extraterrestrial Physics, Garching (Germany); Issever, Ahi Sema [Department of Radiology, University of California, San Francisco, CA (United States); Department of Radiology, Charite, Berlin (Germany); Eckstein, Felix [Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg (Austria); Rummeny, Ernst J. [Department of Radiology, Technische Universität München, Munich (Germany); Link, Thomas M. [Department of Radiology, University of California, San Francisco, CA (United States); Raeth, Christoph W. [Max Planck Institute for Extraterrestrial Physics, Garching (Germany)

    2014-01-15

    Objectives: Finite-element-models (FEM) are a promising technology to predict bone strength and fracture risk. Usually, the highest spatial resolution technically available is used, but this requires excessive computation time and memory in numerical simulations of large volumes. Thus, FEM were compared at decreasing resolutions with respect to local strain distribution and prediction of failure load to (1) validate MDCT-based FEM and to (2) optimize spatial resolution to save computation time. Materials and methods: 20 cylindrical trabecular bone specimens (diameter 12 mm, length 15–20 mm) were harvested from elderly formalin-fixed human thoracic spines. All specimens were examined by micro-CT (isotropic resolution 30 μm) and whole-body multi-row-detector computed tomography (MDCT, 250 μm × 250 μm × 500 μm). The resolution of all datasets was lowered in eight steps to ∼2000 μm × 2000 μm × 500 μm and FEM were calculated at all resolutions. Failure load was determined by biomechanical testing. Probability density functions of local micro-strains were compared in all datasets and correlations between FEM-based and biomechanically measured failure loads were determined. Results: The distribution of local micro-strains was similar for micro-CT and MDCT at comparable resolutions and showed a shift toward higher average values with decreasing resolution, corresponding to the increasing apparent trabecular thickness. Small micro-strains (ε{sub eff} < 0.005) could be calculated down to 250 μm × 250 μm × 500 μm. Biomechanically determined failure load showed significant correlations with all FEM, up to r = 0.85 and did not significantly change with lower resolution but decreased with high thresholds, due to loss of trabecular connectivity. Conclusion: When choosing connectivity-preserving thresholds, both micro-CT- and MDCT-based finite-element-models well predicted failure load and still accurately revealed the distribution of local micro-strains in

  1. 心脏瓣膜病的多层螺旋CT、MR研究进展%Research Advances of MDCT-MR in Valvular Heart Disease

    Institute of Scientific and Technical Information of China (English)

    张笑春; 杨志刚

    2008-01-01

    分析多层螺旋CT(Multi-detector computed tomography, MDCT)、MR(Magnetic resonance imaging, MRI)检查技术在心脏瓣膜病中的应用,并探讨常规CT、电影CT(Cine CT)、最大密度投影(Maximum intensity projection, MIP)、多平面重组(Multiple planar reconstruction, MPR)、容积再现(Volume rendering technique, VRT)及黑血序列、电影MRI(Cine MRI)等CT、MRI技术对心脏瓣膜病的诊断价值.

  2. High-inflation pressure and positive end-expiratory pressure. Injurious to the lung? No.

    Science.gov (United States)

    Nelson, L D

    1996-07-01

    during ARDS) and limiting exposure to toxic concentrations of oxygen minimize ventilator-induced secondary lung injury and maximize chances for survival. Arbitrary limitations of peak inspiratory or end-expiratory airway pressure or mandatory tidal volume in patients with severe ARDS seem to be unfounded. Failure to achieve adequate physiologic end-points in these patients may increase morbidity and mortality rates.

  3. Effects of the concurrent use of a reduced dose of propofol with divided supplemental remifentanil and moderate hyperventilation on duration and morphology of electroconvulsive therapy-induced electroencephalographic seizure activity: A randomized controlled trial.

    Science.gov (United States)

    Nishikawa, Kohki; Yamakage, Michiaki

    2017-02-01

    The clinical adequacy of electroconvulsive therapy (ECT) depends on not only seizure duration but also seizure amplitude and postictal suppression. The objective of this study was to evaluate the effects of combination of a reduced dose of propofol and moderate hyperventilation on seizure duration and electrical stimulus requirement for adequate ictal amplitude and postictal suppression. Prospective, randomized, controlled trial. Operating room at a municipal hospital. Sixty ASA physical status I or II patients scheduled to receive a total of >300 ECT treatments. Patients were randomly assigned to have the three interventions: the use of a standard dose (1mg/kg) of propofol and normoventilation (ETCO2 of 40-45mmHg) (group P/N), the use of a reduced dose (0.5mg/kg) of propofol with divided remifentanil injections and normoventilation (group RP/N), and the use of a reduced dose of propofol with divided remifentanil injections and moderate hyperventilation (ETCO2 of 30-35mmHg) (group RP/H). Patients in groups RP/N and RP/H received remifentanil 1μg/kg followed by propofol 0.5mg/kg for unconsciousness and thereafter remifentanil 1μg/kg immediately before the electrical stimulus. Patients in group RP/H had significantly longer durations of electroencephalographic (EEG) seizures in the early phase of the ECT course (Ppropofol combined with divided supplemental remifentanil under moderate hyperventilation during ECT may contribute to reduced electrical dosage due to the ability of its augmentation of seizure amplitude and postictal suppression in the late phase of the ECT course. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. 5-year follow-up of a randomized clinical study comparing everolimus plus reduced-dose cyclosporine with mycophenolate mofetil plus standard-dose cyclosporine in de novo kidney transplantation: Retrospective single center assessment.

    Science.gov (United States)

    Hiramitsu, Takahisa; Okada, Manabu; Futamura, Kenta; Yamamoto, Takayuki; Tsujita, Makoto; Goto, Norihiko; Narumi, Shunji; Watarai, Yoshihiko; Takeda, Asami; Iwasaki, Kenta; Uchida, Kazuharu; Kobayashi, Takaaki

    2016-10-01

    The aim of this study is to evaluate the efficacy and safety of everolimus plus reduced-dose cyclosporine compared with mycophenolate mofetil plus standard-dose cyclosporine 5years after living donor kidney transplantation. Between March 2008 and August 2009, 24 living donor kidney transplantations were enrolled in a 2-year, multicenter, randomized phase 3 study (RAD001A1202 study). 24 recipients were randomly classified into two groups and closely observed for 5years. 13 recipients were administered steroid, reduced-dose cyclosporine, everolimus and basiliximab (EVR group). 11 recipients were administered steroid, standard-dose cyclosporine, mycophenolate mofetil and basiliximab (STD group). Two groups were compared not only in graft function including estimated glomerular filtration rate (eGFR), and proteinuria, but also in adverse events such as de novo donor-specific antibody (DSA) production, rejection, new-onset diabetes, hyperlipidemia, and cytomegalovirus (CMV) infection. No graft loss was identified in 5years. The incidences of acute T cell rejection, de novo DSA production, hyperlipidemia, and new-onset diabetes were similar. eGFR levels throughout the observation periods were similar. Three cases of proteinuria were identified in STD group. One case of proteinuria observed in EVR group was well controlled with angiotensin receptor blocker. Incidence of CMV infection in CMV antibody-positive recipients was significantly lower in EVR group. The safety and efficacy of reduced-dose cyclosporine and everolimus protocol were similar to those of standard-dose cyclosporine and mycophenolate mofetil other than for superior prevention of CMV infection. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. 一种基于 MDCT 量化系数统计特征的A AC 音频隐写分析方法%A steganalysis method of AAC audio based on statistical features of MDCT quantized coefficients

    Institute of Scientific and Technical Information of China (English)

    王昱洁; 杨萍; 蒋薇薇

    2015-01-01

    文章提出了一种基于MDCT量化系数统计特征的AAC音频隐写分析方法。将AAC音频进行部分解码得到MDCT量化系数,在MDCT量化系数中提取广义高斯分布模型的参数、量化系数分布直方图的频域统计矩、帧内和帧间MDCT量化系数的Markov转移矩阵的部分数据作为隐写分析的特征,最后采用支持向量机进行分类。通过对不同比特率的AAC音频的实验结果表明,文中提出的AAC音频隐写分析方法对于MDCT量化系数中的直接扩频隐写方式的检测效果较好,对于比特率为128 kb/s的AAC音频,在隐写容量较低的情况下也能达到较高的检测率。%A steganalysis method of AAC audio based on statistical features of MDCT quantized coeffi‐cients is proposed .Firstly ,AAC audio is partly decoded to get MDCT quantized coefficients ,and then the parameters of generalized Gaussian distribution (GGD) model ,the statistical moments in fre‐quency domain of the distribution histogram of quantized coefficients ,and some data of the Markov transition matrix of the MDCT quantized coefficients in a frame and between frames are extracted from the MDCT quantized coefficients as the features of steganalysis .Finally ,the support vector machine is used as a classifier .The experimental results of AAC audio at different bitrates reveal that ,the pro‐posed steganalysis method of AAC audio has a good detection effect on the hiding method of the direct spread spectrum modulation on the MDCT quantized coefficients ,and for the AAC audio at 128 kb/s bitrate ,the detection accuracy is high even under the condition of low capacity of steganography .

  6. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial.

    Science.gov (United States)

    Park, J S; Oh, D H; Chang, M Y; Kim, K M

    2016-05-01

    Expiratory muscle strength training (EMST) involves forcible blowing as a means of generating high expiratory pressure, against adjustable resistance. EMST has recently been introduced as a potential treatment for dysphagia. This study was performed to investigate the effects of EMST on the activity of suprahyoid muscles, aspiration and dietary stages in stroke patients with dysphagia. Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group performed EMST with a 70% threshold value of maximal expiratory pressure, using an EMST device, 5 days a week for 4 weeks. The placebo group trained with a sham device. The EMST regime involved 5 sets of 5 breaths through the EMST device for a total of 25 breaths per day. Activity in the suprahyoid muscle group was measured using surface electromyography (sEMG). Further, the penetration-aspiration scale (PAS) was used to assess the results of the videofluoroscopic swallowing study (VFSS). In addition, dietary stages were evaluated using the Functional Oral Intake Scale (FOIS). The experimental group exhibited improved suprahyoid muscle group activity and PAS results, when compared to the placebo group. Following intervention, statistical analysis indicated significant differences in measured suprahyoid muscle activity (P = 0·01), liquid PAS outcomes (P = 0·03) and FOIS results (P = 0·06), but not semisolid type PAS outcomes (P = 0·32), between the groups. This study confirms EMST as an effective treatment for the development of suprahyoid muscle activity in stroke patients with dysphagia. Additionally, improvements in aspiration and penetration outcomes were observed. © 2016 John Wiley & Sons Ltd.

  7. The respiratory drive to thoracic motoneurones in the cat and its relation to the connections from expiratory bulbospinal neurones

    DEFF Research Database (Denmark)

    Saywell, S A; Anissimova, N P; Ford, T W

    2007-01-01

    in the caudal medulla revealed monosynaptic EPSPs in all groups of motoneurones, with the strongest connections to expiratory motoneurones with axons in the internal intercostal nerve. In the latter, connection strength was similar irrespective of the target muscle (e.g. external abdominal oblique or internal...... intercostal) and the EPSP amplitude was positively correlated with the amplitude of the central respiratory drive potential of the motoneurone. For this group, EPSPs were found in 45/83 bulbospinal neurone/motoneurone pairs, with a mean amplitude of 40.5 microV. The overall strength of the connection supports...

  8. Monte Carlo simulations in multi-detector CT (MDCT) for two PET/CT scanner models using MASH and FASH adult phantoms

    Energy Technology Data Exchange (ETDEWEB)

    Belinato, W., E-mail: wbfisica@gmail.com [Bahia Federal Institute of Education, Science and Technology – IFBA, Vitória da Conquista, 45.100-000 (Brazil); Department of Physics, Federal University of Sergipe – UFS, São Cristóvão, 49.100-000 (Brazil); Santos, W.S. [Department of Physics, Federal University of Sergipe – UFS, São Cristóvão, 49.100-000 (Brazil); Paschoal, C.M.M., E-mail: cinthiam.paschoal@gmail.com [Department of Civil Engineering, Vale do Acarau State University – UVA, Sobral 62.040-730 (Brazil); Souza, D.N. [Department of Physics, Federal University of Sergipe – UFS, São Cristóvão, 49.100-000 (Brazil)

    2015-06-01

    The combination of positron emission tomography (PET) and computed tomography (CT) has been extensively used in oncology for diagnosis and staging of tumors, radiotherapy planning and follow-up of patients with cancer, as well as in cardiology and neurology. This study determines by the Monte Carlo method the internal organ dose deposition for computational phantoms created by multidetector CT (MDCT) beams of two PET/CT devices operating with different parameters. The different MDCT beam parameters were largely related to the total filtration that provides a beam energetic change inside the gantry. This parameter was determined experimentally with the Accu-Gold Radcal measurement system. The experimental values of the total filtration were included in the simulations of two MCNPX code scenarios. The absorbed organ doses obtained in MASH and FASH phantoms indicate that bowtie filter geometry and the energy of the X-ray beam have significant influence on the results, although this influence can be compensated by adjusting other variables such as the tube current–time product (mAs) and pitch during PET/CT procedures.

  9. Quantitative assessment of bone marrow attenuation values at MDCT: An objective tool for the detection of bone bruise related to occult sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Henes, F.O.; Groth, M.; Bley, T.A.; Regier, M.; Ittrich, H.; Adam, G.; Bannas, P. [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Nuechtern, J.V. [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Treszl, A. [University Medical Center Hamburg-Eppendorf, Center for Experimental Medicine, Department of Medical Biometry and Epidemiology, Hamburg (Germany)

    2012-10-15

    To prove the feasibility of using Hounsfield attenuation values at MDCT to detect bone bruises related to sacral insufficiency fractures. Twenty-two patients with acute sacrum trauma and no fracture findings at MDCT were included in our prospective study. Two observers independently reviewed CTs regarding visual signs of bone bruises in 132 defined regions of the sacral alae. Interobserver agreement was tested by {kappa} statistics. Subsequently, HU values were obtained in the same regions, and attenuation differences between the two sides were calculated. Validity and reliability were assessed by intraclass correlation coefficient and Bland-Altman analysis. HU differences were subjected to ROC curve analysis to determine sensitivity, specificity, PPV and NPV. MRI served as standard reference. MRI revealed 19 regions with bone bruises and associated sacral insufficiency fractures. HU measurements demonstrated good validity and reliability (r = 0.989). ROC curve analysis exhibited an ideal cutoff value of 35.7 HU density difference between affected and non-affected regions. Visual evaluation revealed moderate agreement ({kappa} = 0.48); diagnostic accuracy was inferior to objective evaluation. Assessment of differences in bone marrow density by HU measurements is an objective and reliable tool for detection of bone bruises associated with occult sacral insufficiency fractures. (orig.)

  10. Anatomical variations in the origins of the celiac axis and the superior mesenteric artery: MDCT angiographic findings and their probable embryological mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yi; Cheng, Cheng; Wang, Lu; Li, Ran; Chen, Jin-hua; Gong, Shui-gen [Institute of Surgery Research, Daping Hospital, Third Military Medical University, Department of Radiology, Chongqing (China)

    2014-08-15

    To identify the spectrum and prevalence of anatomical variations in the origin of the celiac axis (CA), the superior mesenteric artery (SMA) and their major branches by using multidetector computed tomographic (MDCT) angiography. A retrospective evaluation was carried out on 1,500 abdominal MDCT angiography images. The aortic origins of the CA, the SMA and their major branch patterns were investigated. Normal aortic origins of CA and SMA were noted in 1,347 (89.8 %) patients. Seven types of CA and SMA origin variants were identified in 153 (10.2 %) patients. The three most common variations were hepatomesenteric trunk (67 patients, 4.47 %), celiomesenteric trunk (CMT) (51 patients, 3.4 %) and splenomesenteric trunk (18 patients, 1.2 %). An evaluation of CMT was classified as long (34 patients, 66.7 %) or short (17 patients, 33.3 %) subtypes, compared with the length of the common trunk. Further CMT classification was based on the origin of the left gastric artery: subtype I, 26 patients (53.1 %); subtype II, 5 patients (10.2 %); subtype III, 15 patients (30.6 %); subtype IV, 3 patients (6.1 %). Dislocation interruption, incomplete interruption and persistence of the longitudinal anastomosis could be the embryological mechanisms of the variant origins of the CA, the SMA and their major branches. (orig.)

  11. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Klempka, A.; Wagner, M.; Fodor, S.; Schmitt, R. [Cardiovascular Center Bad Neustadt an der Saale, Department of Diagnostic and Interventional Radiology, Bad Neustadt an der Saale (Germany); Prommersberger, K.J. [Clinic for Hand Surgery, Bad Neustadt an der Saale (Germany); Uder, M. [Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Department of Diagnostic Radiology, Erlangen (Germany)

    2016-03-15

    To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF). Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification). In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions. In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography. (orig.)

  12. Comparison between the deconvolution and maximum slope 64-MDCT perfusion analysis of the esophageal cancer: Is conversion possible?

    Energy Technology Data Exchange (ETDEWEB)

    Djuric-Stefanovic, A., E-mail: avstefan@eunet.rs [Unit of Digestive Radiology (First Surgical Clinic), Center of Radiology and MR, Clinical Center of Serbia, Belgrade (Serbia); Faculty of Medicine, University of Belgrade, Belgrade (Serbia); Saranovic, Dj., E-mail: crvzve4@gmail.com [Unit of Digestive Radiology (First Surgical Clinic), Center of Radiology and MR, Clinical Center of Serbia, Belgrade (Serbia); Faculty of Medicine, University of Belgrade, Belgrade (Serbia); Masulovic, D., E-mail: draganmasulovic@yahoo.com [Unit of Digestive Radiology (First Surgical Clinic), Center of Radiology and MR, Clinical Center of Serbia, Belgrade (Serbia); Faculty of Medicine, University of Belgrade, Belgrade (Serbia); Ivanovic, A., E-mail: flydoc@eunet.rs [Unit of Digestive Radiology (First Surgical Clinic), Center of Radiology and MR, Clinical Center of Serbia, Belgrade (Serbia); Faculty of Medicine, University of Belgrade, Belgrade (Serbia); Pesko, P., E-mail: predragpesko@yahoo.com [Clinic of Digestive Surgery (First Surgical Clinic), Clinical Center of Serbia, Belgrade (Serbia); Faculty of Medicine, University of Belgrade, Belgrade (Serbia)

    2013-10-01

    Purpose: To estimate if CT perfusion parameter values of the esophageal cancer, which were obtained with the deconvolution-based software and maximum slope algorithm are in agreement, or at least interchangeable. Methods: 278 esophageal tumor ROIs, derived from 35 CT perfusion studies that were performed with a 64-MDCT, were analyzed. “Slice-by-slice” and average “whole-covered-tumor-volume” analysis was performed. Tumor blood flow and blood volume were manually calculated from the arterial tumor-time–density graphs, according to the maximum slope methodology (BF{sub ms} and BV{sub ms}), and compared with the corresponding perfusion values, which were automatically computed by commercial deconvolution-based software (BF{sub deconvolution} and BV{sub deconvolution}), for the same tumor ROIs. Statistical analysis was performed using Wilcoxon matched-pairs test, paired-samples t-test, Spearman and Pearson correlation coefficients, and Bland–Altman agreement plots. Results: BF{sub deconvolution} (median: 74.75 ml/min/100 g, range, 18.00–230.5) significantly exceeded the BF{sub ms} (25.39 ml/min/100 g, range, 7.13–96.41) (Z = −14.390, p < 0.001), while BV{sub deconvolution} (median: 5.70 ml/100 g, range: 2.10–15.90) descended the BV{sub ms} (9.37 ml/100 g, range: 3.44–19.40) (Z = −13.868, p < 0.001). Both pairs of perfusion measurements significantly correlated with each other: BF{sub deconvolution}, versus BF{sub ms} (r{sub S} = 0.585, p < 0.001), and BV{sub deconvolution}, versus BV{sub ms} (r{sub S} = 0.602, p < 0.001). Geometric mean BF{sub deconvolution}/BF{sub ms} ratio was 2.8 (range, 1.1–6.8), while geometric mean BV{sub deconvolution}/BV{sub ms} ratio was 0.6 (range, 0.3–1.1), within 95% limits of agreement. Conclusions: Significantly different CT perfusion values of the esophageal cancer blood flow and blood volume were obtained by deconvolution-based and maximum slope-based algorithms, although they correlated significantly with

  13. Gastrointestinal tract labeling for MDCT of abdomen: Comparison of low density barium and low density barium in combination with water

    Energy Technology Data Exchange (ETDEWEB)

    Gulati, Kavita; Shah, Zarine K.; Sainani, Nisha; Uppot, Raul; Sahani, Dushyant V. [Massachusetts General Hospital and Harvard Medical School, Department of Abdominal Imaging and Intervention, Boston, MA (United States)

    2008-05-15

    The purpose of the study was to compare the quality of stomach and small bowel marking/labeling using 1,350 ml of low-density barium alone (Volumen) with 900 ml of low-density barium and 450 ml of water for 16-MDCT scans of the abdomen and pelvis and assess cost benefits with the two protocols. In this IRB approved study, 80 consecutive patients scheduled for routine CECT (contrast-enhanced CT) of the abdomen-pelvis were studied. Patients were randomized into two groups and were administered either 1,350 ml of VoLumen (two bottles at 20-min intervals, one half bottle at 50 min and the last half on the table) or 900 ml of Volumen (two bottles at 20-min intervals and 450 ml water on the table). Portal venous phase scanning (detector collimation = 0.625 mm, speed = 18.75 mm, thickness = 5 mm) was subsequently performed. Images were reconstructed in axial and coronal plane at the CT console. Two blinded readers used a pre-designed template to assess distension and wall characteristics of the stomach and small bowel on a 5-point scale. Median scores with the two protocols were compared using the Wilcoxon rank sum test. The stomach and small bowel labeling was rated fair to optimal in all patients and did not differ significantly in the two protocols. The mean scores for distension of the small bowel and stomach were comparable. Inter-observer agreement for bowel labeling was found to be excellent (k 0.81). With the use of coronal images there was increased reader confidence in tracing the small bowel with both protocols. Acceptance for two bottles of Volumen and water was greater among patients as compared to three bottles of VoLumen. Use of two bottles of Volumen and water combination cost less than three bottles of Volumen. Stomach and small bowel labeling with administration of 900 ml of Volumen followed by 450 ml of water is cost effective and compares well to 1,350 ml of Volumen alone. (orig.)

  14. Surface electromyograph activity of submental muscles during swallowing and expiratory muscle training tasks in Huntington's disease patients.

    Science.gov (United States)

    Reyes, Alvaro; Cruickshank, Travis; Thompson, Jennifer; Ziman, Mel; Nosaka, Kazunori

    2014-02-01

    Huntington's disease (HD) patients have difficulty in swallowing, leading to aspiration pneumonia, which is a major cause of death. It seems possible that submental muscles that are crucial for preventing an escape of a bolus into the airway, are affected by HD, but no previous studies have investigated this. To assess surface electromyograph (sEMG) activity of submental muscles during swallowing and expiratory muscle training (EMT) tasks in HD patients in comparison to healthy volunteers. sEMG activities of submental muscles during saliva, water swallowing, EMT tasks performed at 25% and 75% of maximum expiratory pressure were recorded and normalised by the sEMG activity during an effortful swallow in 17 early to mid stage HD patients and 17 healthy volunteers. sEMG activity was greater (pswallowing, but was not significantly different between groups for saliva, water swallowing and EMT at 25%. HD patients had lower sEMG activity for EMT at 75% (p<0.05). Decreases in submental muscle activity were not evident in HD patients except during EMT at 75%. This suggests that relative submental muscle weakness is observed only during a high intensity task in early to mid stage HD patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Comparative Study of Peak Expiratory Flow Rate and Maximum Voluntary Ventilation Between Smokers and Non-Smokers

    Directory of Open Access Journals (Sweden)

    Karia Ritesh M

    2012-04-01

    Full Text Available Objective: Objectives of this study is to study effect of smoking on Peak Expiratory Flow Rate and Maximum Voluntary Ventilation in apparently healthy tobacco smokers and non-smokers and to compare the result of both the studies to assess the effects of smoking Method: The present study was carried out by computerized software of Pulmonary Function Test named ‘Spiro Excel’ on 50 non-smokers and 50 smokers. Smokers are divided in three gropus. Full series of test take 4 to 5 minutes. Tests were compared in the both smokers and non-smokers group by the ‘unpaired t test’. Statistical significance was indicated by ‘p’ value < 0.05. Results: From the result it is found that actual value of Peak Expiratory Flow Rate and Maximum Voluntary Ventilation are significantly lower in all smokers group than non-smokers. The difference of actual mean value is increases as the degree of smoking increases. [National J of Med Res 2012; 2(2.000: 191-193

  16. Effect of pulmonary rehabilitation on tidal expiratory flow limitation at rest and during exercise in COPD patients.

    Science.gov (United States)

    Theodorakopoulou, Elpida P; Gennimata, Sofia-Antiopi; Harikiopoulou, Maria; Kaltsakas, Georgios; Palamidas, Anastasios; Koutsoukou, Antonia; Roussos, Charis; Kosmas, Epameinondas N; Bakakos, Petros; Koulouris, Nickolaos G

    2017-04-01

    We hypothesized that severe COPD patients who present with the disadvantageous phenomenon of Expiratory Flow Limitation (EFL) may benefit as COPD patients without EFL do after implementation of a Pulmonary Rehabilitation (PR) program. Forty-two stable COPD patients were studied at rest and during exercise. EFL and dynamic hyperinflation (DH) were documented using the negative expiratory pressure (NEP) technique and inspiratory capacity (IC) maneuvers, respectively. Patient centered outcomes were evaluated by the Saint-George's Respiratory Questionnaire (SGRQ) and the mMRC dyspnea scale. Before PR, 16 patients presented with EFL at rest and/or during exercise. After PR, EFL was abolished in 15 out of those 16 EFL patients who exhibited a significant increase in IC values. These were mainly accomplished through a modification of the breathing pattern. In the 26 NFL patients no increase was noted in their IC or a modification of their breathing pattern. However, both NFL and EFL COPD patients improved exercise capacity and patients centered outcomes undergoing the same PR program.

  17. Reference values of Forced Expiratory Volumes and pulmonary flows in 3–6 year children: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Cordola Giorgio

    2007-02-01

    Full Text Available Abstract Background The aims of this study were to verify the feasibility of respiratory function tests and to assess their validity in the diagnosis of respiratory disorders in young children. Methods We performed spirometry and collected information on health and parents' lifestyle on a sample of 960 children aged 3–6. Results The cooperation rate was 95.3%. Among the valid tests, 3 or more acceptable curves were present in 93% of cases. The variability was 5% within subjects in 90.8% of cases in all the parameters. We propose regression equations for FVC (Forced Vital Capacity, FEV1, FEV0.5, FEV0.75 (Forced Expiratory Volume in one second, in half a second and in 3/4 of a second, and for Maximum Expiratory Flows at different lung volume levels (MEF75, 50, 25. All parameters are consistent with the main reference values reported in literature. The discriminating ability of respiratory parameters versus symptoms always shows a high specificity (>95% and a low sensitivity ( Conclusion Our study confirms the feasibility of spirometry in young children; however some of the current standards are not well suited to this age group. Moreover, in this restricted age group the various reference values have similar behaviour.

  18. Enhancement pattern of small hepatocellular carcinoma (HCC) at contrast-enhanced US (CEUS), MDCT, and MRI: Intermodality agreement and comparison of diagnostic sensitivity between 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Furlan, Alessandro, E-mail: furlana@upmc.edu [Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 (United States); Marin, Daniele [Department of Radiology, Duke University Medical Center, Durham, NC 27710 (United States); Department of Radiological Sciences, University of Rome-La Sapienza, Rome, 00161 (Italy); Cabassa, Paolo [Department of Radiology, Brescia University, Brescia (Italy); Taibbi, Adele [Department of Radiology, University of Palermo, Palermo, 90127 (Italy); Brunelli, Elena [Department of Radiology, Brescia University, Brescia (Italy); Agnello, Francesco; Lagalla, Roberto; Brancatelli, Giuseppe [Department of Radiology, University of Palermo, Palermo, 90127 (Italy)

    2012-09-15

    Objective: To evaluate agreement between contrast-enhanced ultrasound (CEUS), multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI) for the assessment of typical and atypical enhancement patterns of small hepatocellular carcinoma (HCC); and to compare diagnostic sensitivity of 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines. Materials and methods: Between January 2008 and December 2009, we included cirrhotic patients with newly diagnosed 10–20 mm HCC imaged at two contrast-enhanced imaging techniques among CEUS, MDCT, and MRI. Dynamic studies were reviewed by two radiologists to assess enhancement pattern. Percentage of cases with concordant findings and Cohen coefficient (k) were calculated. McNemar's test was used to compare sensitivity between 2005 and 2010 AASLD guidelines. Results: There were 91 patients (69 M; 22 F; mean age, 68 years) with 96 HCCs, studied with a combination of CEUS and MDCT (n = 59), CEUS and MRI (n = 26), or MDCT and MRI (n = 11). Intermodality agreement for assessment of tumor enhancement pattern was 67% (k = 0.294, P = 0.001). Typical enhancement pattern was detected coincidentally at two imaging modalities in 50 (52%) HCCs. Sensitivity for the diagnosis of HCC increased significantly using the 2010 AASLD (81/96 (84%) vs. 50/96 (52%), P < 0.001). Conclusions: Agreement between two imaging modalities for the detection of typical tumor enhancement pattern was reached in 52% of cases. The 2010 AASLD guidelines significantly increased the sensitivity for the diagnosis of HCC.

  19. Current role of MDCT in the diagnosis of coronary artery disease (2011). A clinical guideline of the Austrian Societies of Cardiology and Radiology; Aktueller Stellenwert der MSCTA in der Koronargefaessdiagnostik (2011). Klinischer Leitfaden der Oesterreichischen Gesellschaften fuer Kardiologie und Radiologie

    Energy Technology Data Exchange (ETDEWEB)

    Hergan, K. [Salzburger Landeskliniken, Paracelsus Medizinische Privatuniv. (Austria). Universitaetsinst. fuer Radiologie; Globits, S. [Landesklinikum St. Poelten (Austria). 3. Medizinische Abt./Kardiologie; Loewe, C. [Medizinische Univ. Wien (AT). Universitaetsklinik fuer Radiodiagnostik] (and others)

    2011-10-15

    The clinical guideline of the Austrian Societies for Cardiology and Radiology on the actual role of MDCT in the diagnosis of coronary artery diseases includes the following issues: CT calcium scoring; CT angiography (CTA) of the coronaries; actually recommended application of MDCR; generally inappropriate use of the technique for specific patients; radiation exposure; structural and organizational framework.

  20. Use of expiratory CT pulmonary angiography to reduce inspiration and breath-hold associated artefact: Contrast dynamics and implications for scan protocol

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    Mortimer, A.M., E-mail: alex_mortimer@hotmail.com [Department of Radiology, Bristol Royal Infirmary, Bristol (United Kingdom); Singh, R.K.; Hughes, J.; Greenwood, R.; Hamilton, M.C.K. [Department of Radiology, Bristol Royal Infirmary, Bristol (United Kingdom)

    2011-12-15

    Aim: To investigate the effects of scanning in expiration during computed tomography pulmonary angiography (CTPA). Materials and methods: One hundred and eighty-one consecutive expiratory CTPA examinations were compared with 145 inspiratory CTPA examinations performed using a standardized protocol through assessment of attenuation seen in the cardiac chambers, pulmonary artery (PA), and ascending aorta. Results: Expiratory scans showed greater attenuation at the pulmonary trunk, right PA, left PA, lobar and segmental PAs (p < 0.05). Expiratory scans showed a lower incidence of transient contrast medium interruption (p < 0.001) and generalized unsatisfactory PA opacification (p < 0.05). Scans with generalized low PA attenuation had lower attenuation in the right ventricle, left heart, and ascending aorta (p < 0.001) suggesting that contrast medium delivery or dilution prior to contrast medium entry into the PA is responsible. Expiratory scans showed lower quality scores (p < 0.001) for depiction of lung parenchyma. Conclusion: Expiratory scanning could be used as an optimal protocol for dedicated PA imaging. However, it suffers from inferior parenchymal imaging and should probably be reserved for failed inspiratory breath-hold CTPA.

  1. Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis.

    Science.gov (United States)

    Silverman, Erin Pearson; Miller, Sarah; Zhang, Yi; Hoffman-Ruddy, Bari; Yeager, James; Daly, Janis J

    2017-01-01

    Weakening and dyscoordination of expiratory muscles in multiple sclerosis (MS) can impair respiratory and swallow function. The objective of this paper is to test a novel expiratory muscle strength training (EMST) device on expiratory pressure, swallow function, and swallow-related quality-of-life (SWAL-QOL) in individuals with MS. Participants with MS were randomized to a five-week breathing practice of either positive pressure load (EMST) or near-zero pressure (sham). We compared baseline to post-treatment data according to maximum expiratory pressure (MEP), abnormal airway penetration and aspiration (PAS), and SWAL-QOL. Both groups improved in MEP (p QOL; but the EMST group had significantly greater gain versus sham on the Burden (p = 0.014) and Pharyngeal Swallow (p = 0.022) domains. Both groups improved in SWAL-QOL domains of Fear, Burden Mental Health, but only the EMST group improved in the SWAL-QOL and domains of Pharyngeal Swallow function, and Saliva management. Results suggest that strengthening of expiratory muscles can occur with repetition of focused breathing practice in the absence of high resistance. Conversely, results from the PAS and SWAL-QOL domains suggest that the high resistance of the EMST was required in order to improve the functional safety (reduced penetration/aspiration) and coordination of swallowing, specifically pharyngeal function and saliva management.

  2. Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study.

    Science.gov (United States)

    Cabral, Elis E A; Resqueti, Vanessa R; Lima, Illia N D F; Gualdi, Lucien P; Aliverti, Andrea; Fregonezi, Guilherme A F

    2017-07-08

    Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls. 16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20cmH2O) were administered in a random order with a 30 minutes rest interval between intensities. During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32L, 0.56 vs. 1.54L, 0.52 vs. 1.8L, at 10, 15, 20cmH2O positive expiratory pressure, for stroke and control groups; pFisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  3. The four different types of internal hernia occurring after laparascopic Roux-en-Y gastric bypass performed for morbid obesity: are there any multidetector computed tomography (MDCT) features permitting their distinction?

    Science.gov (United States)

    Kawkabani Marchini, Aida; Denys, Alban; Paroz, Alexandre; Romy, Sébastien; Suter, Michel; Desmartines, Nicolas; Meuli, Reto; Schmidt, Sabine

    2011-04-01

    Four different types of internal hernias (IH) are known to occur after laparoscopic Roux-en-Y gastric bypass (LRYGBP) performed for morbid obesity. We evaluate multidetector row helical computed tomography (MDCT) features for their differentiation. From a prospectively collected database including 349 patients with LRYGBP, 34 acutely symptomatic patients (28 women, mean age 32.6), operated on for IH immediately after undergoing MDCT, were selected. Surgery confirmed 4 (11.6%) patients with transmesocolic, 10 (29.4%) with Petersen's, 15 (44.2%) with mesojejunal, and 5 (14.8%) with jejunojejunal IH. In consensus, 2 radiologists analyzed 13 MDCT features to distinguish the four types of IH. Statistical significance was calculated (p<0.05, Fisher's exact test, chi-square test). MDCT features of small bowel obstruction (SBO) (n=25, 73.5%), volvulus (n=22, 64.7%), or a cluster of small bowel loops (SBL) (n=27, 79.4%) were inconsistently present and overlapped between the four IH. The following features allowed for IH differentiation: left upper quadrant clustered small bowel loops (p<0.0001) and a mesocolic hernial orifice (p=0.0003) suggested transmesocolic IH. SBL abutting onto the left abdominal wall (p=0.0021) and left abdominal shift of the superior mesenteric vessels (SMV) (p=0.0045) suggested Petersen's hernia. The SMV predominantly shifted towards the right anterior abdominal wall in mesojejunal hernia (p=0.0033). Location of the hernial orifice near the distal anastomosis (p=0.0431) and jejunojejunal suture widening (p=0.0005) indicated jejunojejunal hernia. None of the four IH seems associated with a higher risk of SBO. Certain MDCT features, such as the position of clustered SBL and hernial orifice, help distinguish between the four IH and may permit straightforward surgery.

  4. Usefulness of 64-slice MDCT for follow-up of young children with coronary artery aneurysm due to Kawasaki disease: Initial experience

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    Peng Yun [Imaging Center, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China)], E-mail: ppengyun@yahoo.com; Zeng Jinjin [Imaging Center, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China); Du Zhongdong [Pediatric Cardiovascular Department, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China); Sun Guoqiang [Imaging Center, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China); Guo Huling [Pediatric Cardiovascular Department, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China)

    2009-03-15

    To evaluate the initial application and value of 64-slice multidetector computed tomography as an alternative diagnostic modality in the follow-up of young children with coronary artery aneurysm due to Kawasaki disease. Twelve boys (mean age 5.1 years, range 1.8-7.8 years) for follow-up (time range from 1.1 to 5.1 years) of known Kawasaki disease and coronary artery aneurysm underwent 64-slice MDCT ECG-gated coronary angiography. All data were acquired without breath holding. Two pediatric radiologists independently assessed image quality and the diameter of all coronary segments were measured for each patient. The number, position, shape and size of each coronary artery aneurysm were observed and compared with those of ECHO performed previously. A total of 118/156 segments permitted visualization with diagnostic image quality, the CT measurements showed good inter-observer and intra-observer reliability, coefficients were 0.93 and 0.88, respectively. A total of 30 coronary artery aneurysms were identified with measured mean of 7.5 {+-} 3.8 mm in diameter, and of 12.4 {+-} 9.1 mm in longitudinal lengths.10 tumors were small, 8 tumors were medium and 12 tumors were giant aneurysm. The affected segments included LM7/12(58.3%), 9/12(75%) of LAD1, 4/12(33.3%) of LAD2, 2/12(16.7%) of LCX1; 6/12(50%) of RCA1, 9/12(75%) of RCA2 and 4/12(33.3%) of RCA3, including affected two segments in 9 tumors and three segments in 1 tumor. Calcifications were found in 5 aneurysms and 3/5 with thrombosis; six stenotic segments were found. ECHO failed to detect 8 tumors with 2/8 in LAD, 1/8 in LCX and 5/8 in RCA, and those included 4 small aneurysms. The use of 64-slice MDCT angiography proved valuable for monitoring young children with Kawasaki disease. However, further study is necessary to specify the sensitivity and specificity of MDCT in the follow-up.

  5. Coronary artery bypass graft (CABG) patency: Assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Anders, Katharina [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany)]. E-mail: katharina.anders@idr.imed.uni-erlangen.de; Baum, Ulrich [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Schmid, Michael [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Ropers, Dieter [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Schmid, Axel [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Pohle, Karsten [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Daniel, Werner G. [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Bautz, Werner [Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg (Germany); Achenbach, Stephan [Department of Internal Medicine II, Friedrich-Alexander University of Erlangen-Nuremberg (Germany)

    2006-03-15

    Purpose: To investigate the ability of 16-slice multidetector-row computed tomography (MDCT) to visualize coronary artery bypass graft (CABG) patency and to detect bypass stenoses. Materials and methods: Thirty-two patients with 94 grafts (20 mammary artery grafts, 74 venous grafts) were investigated by 16-slice MDCT using a scan protocol with 12 x 0.75 mm slice collimation (pitch 0.3), 420 ms rotation time and simultaneous electrocardiogram (ECG)-registration. One hundred milliliters iodinated contrast agent were injected with a delay according to the individually determined contrast agent transit time. Patients with heart rates above 60 bpm received oral beta-blockade. Cross-sectional images with a slice width of 1.0 mm (0.5 mm increment) were reconstructed using an ECG-gated half-scan reconstruction or a multisegment reconstruction algorithm depending on the heart rate. Bypass grafts were evaluated concerning patency and presence of stenoses {>=}50% diameter reduction on cross-sectional images, multiplanar reformations and maximum intensity projections by two independent observers. Results were compared to coronary bypass angiography. Results: Sixteen-slice MDCT results were compared to those of invasive coronary angiography concerning absence or presence of bypass graft occlusion or relevant stenosis {>=}50% lumen reduction. Coronary CT angiography (CTA) permitted detection of bypass occlusion with 100% sensitivity (28/28) and 98% specificity (64/65). Seventy-eight percent (observer 1) and 84% (observer 2) of all patent grafts were found to be evaluable concerning presence or absence of stenosis. In 34 of 40 (observer 1) and 38 of 43 (observer 2) bypass grafts, high-grade stenoses were correctly ruled out (specificity 85% versus 88%, sensitivity 80% and 82%). Yet, if all patients with either unevaluable grafts/graft anastomosis or relevant graft stenosis were excluded, only 8/32 patients (25%) had fully diagnostic 'negative' graft-CTA. According to

  6. Short-term effects of three slow expiratory airway clearance techniques in patients with bronchiectasis: a randomised crossover trial.

    Science.gov (United States)

    Herrero-Cortina, B; Vilaró, J; Martí, D; Torres, A; San Miguel-Pagola, M; Alcaraz, V; Polverino, E

    2016-12-01

    To compare the efficacy of three slow expiratory airway clearance techniques (ACTs). Randomised crossover trial. Tertiary hospital. Thirty-one outpatients with bronchiectasis and chronic sputum expectoration. Autogenic drainage (AD), slow expiration with glottis opened in lateral posture (ELTGOL), and temporary positive expiratory pressure (TPEP). Sputum expectoration during each session (primary endpoint) and in the 24-hour period after each session. Leicester Cough Questionnaire (LCQ) score and spirometry results were recorded at the beginning and after each week of treatment. Data were summarised as median difference [95% confidence interval (CI)]. Median (interquartile range) daily expectoration at baseline was 21.1 (15.3 to 35.6)g. During physiotherapy sessions, AD and ELTGOL expectorated more sputum than TPEP [AD vs TPEP 3.1g (95% CI 1.5 to 4.8); ELTGOL vs TPEP 3.6g (95% CI 2.8 to 7.1)], while overall expectoration in the 24-hour period after each session was similar for all techniques (P=0.8). Sputum clearance at 24hours post-intervention was lower than baseline assessment for all techniques [AD vs baseline -10.0g (95% CI -15.0 to -6.8); ELTGOL vs baseline -9.2g (95% CI -14.2 to -7.9); TPEP vs baseline -6.0g (95% CI -12.0 to -6.1)]. The LCQ score increased with all techniques (AD 0.5, 95% CI 0.1 to 0.5; ELTGOL 0.9, 95% CI 0.5 to 2.1; TPEP 0.4, 95% CI 0.1 to 1.2), being similar for all ACTs (P=0.6). No changes in lung function were observed. Slow expiratory ACTs enhance mucus clearance during treatment sessions, and reduce expectoration for the rest of the day in patients with bronchiectasis. NCT01854788. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  7. Diagnóstico sorológico da brucelose bovina em animais adultos vacinados com dose reduzida da cepa 19 de Brucella abortus Serological diagnosis of bovine brucellosis in adult herd vaccinated with Brucella abortus strain 19 reduced dose

    Directory of Open Access Journals (Sweden)

    Gustavo Coelho Jardim

    2006-09-01

    Full Text Available Com o presente trabalho avaliou-se o uso de dose reduzida da vacina produzida com a amostra 19 de Brucella abortus, em rebanho adulto negativo para a enfermidade, por meio de técnicas de diagnóstico sorológico preconizadas pelo Programa Nacional de Controle e Erradicação da Brucelose e Tuberculose Animal e por um ensaio indireto de imunoadsorção enzimática (ELISA ID. A prova de fixação de complemento detectou 46,77% de positivos, o antígeno acidificado tamponado 67,74%, o 2-mercaptoetanol com soroaglutinação lenta 87,09% e o ELISA ID 100%. A dose reduzida interferiu no diagnóstico sorológico. Nenhuma das técnicas apresentou especificidade adequada para uso em rebanho nestas condições, até 3 meses após a vacinação.The study evaluated the use of a reduced dose of the Brucella abortus strain 19 vaccine, in an adult herd negative for the disease, by serological diagnostic techniques, advocated by the Brazilian Program for Animal Brucellosis and Tuberculosis Control and Eradication, and by an indirect ELISA. The complement fixation test detecteed 46.77% positives, the rose bengal test 67.74%, the mercaptoethanol with standard agglutination test 87.09% and the ELISA ID 100%. The reduced dose influenced the serological diagnosis. None of the techniques reached a suitable specificity for use in the herd under those conditions, up to 3 months after vaccination.

  8. Single-energy low-voltage arterial phase MDCT scanning increases conspicuity of adenocarcinoma of the pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Zamboni, Giulia A., E-mail: gzamboni@hotmail.com [Istituto di Radiologia, Policlinico GB Rossi, Azienda Ospedaliera Universitaria Integrata di Verona, P.le LA Scuro 10, 37134 Verona (Italy); Ambrosetti, Maria Chiara, E-mail: mchiara.ambrosetti@gmail.com [Istituto di Radiologia, Policlinico GB Rossi, Azienda Ospedaliera Universitaria Integrata di Verona, P.le LA Scuro 10, 37134 Verona (Italy); Guariglia, Stefania, E-mail: guariglia@gmail.com [U.O. di Fisica Sanitaria, Azienda Ospedaliera Universitaria Integrata di Verona, P.le Stefani 1, 37126 Verona (Italy); Cavedon, Carlo, E-mail: carlo.cavedon@ospedaleuniverona.it [U.O. di Fisica Sanitaria, Azienda Ospedaliera Universitaria Integrata di Verona, P.le Stefani 1, 37126 Verona (Italy); Pozzi Mucelli, Roberto, E-mail: roberto.pozzimucelli@univr.it [Istituto di Radiologia, Policlinico GB Rossi, Azienda Ospedaliera Universitaria Integrata di Verona, P.le LA Scuro 10, 37134 Verona (Italy)

    2014-03-15

    Purpose: To test a single-energy low-voltage CT protocol for pancreatic adenocarcinoma. Methods and materials: A total of 30 patients with pathology-proven pancreatic adenocarcinoma underwent 64-row MDCT with arterial phase at 80 kV and were compared to a similar group of 30 patients scanned with a 120 kV protocol. Scans were compared for quantitative image parameters (attenuation and standard deviation in the pancreas, tumor, aorta), CTDI and DLP using an unpaired t-test. Image noise values for each protocol (SD of the psoas) were compared using an unpaired t-test. Effective dose was calculated for each protocol. CNR (=conspicuity/SDnoise) and FOM (CNR{sup 2}/ED) were calculated. The Catphan600 phantom was used to evaluate image non-uniformity, noise, spatial resolution, and low contrast detectability. Results: Mean patient weight was 68 kg in the study group and 73 kg in the control group (p = 0.0355), while patient diameters at the celiac axis were not significantly different. Mean attenuation was significantly higher at 80 kV in the aorta (517.5 ± 116.4 vs 290.3 ± 76.4 HU) and normal pancreas (154.0 ± 39.95 vs 90.02 ± 19.01 HU) (all p < 0.0001), while no significant difference was observed for adenocarcinoma (61.43 ± 35.61 vs 47.45 ± 18.95; p = n.s.). CTDI and DLP were significantly lower at 80 kV (6.00 ± 0.90 mGy vs 10.24 ± 2.93 mGy, and 180.4 ± 35.49 mGy cm vs 383.8 ± 117 mGy cm, respectively; all p < 0.0001). Tumor conspicuity (HU{sub pancreas} − HU{sub tumor}) was significantly higher at 80 kV (94.2 ± 39.3 vs 39.5 ± 22 HU; p < 0.0001). Mean image noise was significantly higher at 80 kV (28.32 ± 10.06 vs 19.7 ± 7.1 HU; p < 0.0001). Effective dose was significantly lower at 80 kV (1.984 ± 0.39 vs 5.75 ± 1.75 mSv; p < 0.0001). The total DLP for the exam was 1024 ± 31.86 mGy cm for the 80 kV protocol and 1357 ± 62.60 mGy cm for the 120 kV protocol (p < 0.0001). Phantoms showed higher non-uniformity, slightly higher noise, slightly lower MTF

  9. Differential Effects of Intraoperative Positive End-expiratory Pressure (PEEP) on Respiratory Outcome in Major Abdominal Surgery Versus Craniotomy

    DEFF Research Database (Denmark)

    de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal

    2015-01-01

    OBJECTIVES: In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed...... abdominal surgery patients and 5063 craniotomy patients. Analysis was performed using multivariable logistic regression. The primary outcome was a composite of major postoperative respiratory complications (respiratory failure, reintubation, pulmonary edema, and pneumonia) within 3 days of surgery. RESULTS...... odds of respiratory complications in patients undergoing major abdominal surgery (odds ratio 0.53, 95% confidence interval 0.39 - 0.72), effects that translated to deceased hospital length of stay [median hospital length of stay : 6 days (4-9 days), incidence rate ratios for each additional day: 0...

  10. Assessment of impact of high particulate concentration on peak expiratory flow rate of lungs of sand stone quarry workers.

    Science.gov (United States)

    Singh, Suresh Kumar; Chowdhary, G R; Purohit, Gopal

    2006-12-01

    This study was designed to assess the impact of high particulate concentration on peak expiratory flow rate of lungs of sand stone quarry workers. The workers were engaged in different types of activities such as drilling, loading and dressing. These different working conditions had different concentrations of RSPM, leading to different exposure levels in workers. It was found that exposure duration and exposure concentrations were the main factors responsible for damage to the respiratory tracts of the workers. The particles were deposited at various areas of the respiratory system and reduced the peak flow rate. It was also revealed from the study that most of the workers suffered from silicosis if the exposure duration was more than 20 years.

  11. Inspiratory and expiratory HRCT findings in Behcet's disease and correlation with pulmonary function tests

    Energy Technology Data Exchange (ETDEWEB)

    Oezer, Caner [Department of Radiology, Mersin University, Faculty of Medicine, Mersin (Turkey)]. E-mail: cozer@mersin.edu.tr; Duce, Meltem Nass [Department of Radiology, Mersin University, Faculty of Medicine, Mersin (Turkey); Ulubas, Bahar [Department of Respiratory Disease, Mersin University, Faculty of Medicine, Mersin (Turkey); Bicer, Ali [Department of Physical Medicine and Rehabilitation, Mersin University, Faculty of Medicine, Mersin (Turkey); Tuersen, Uemit [Department of Dermatology, Mersin University, Faculty of Medicine, Mersin (Turkey); Apaydin, F. Demir [Department of Radiology, Mersin University, Faculty of Medicine, Mersin (Turkey); Yildiz, Altan [Department of Radiology, Mersin University, Faculty of Medicine, Mersin (Turkey); Camdeviren, Handan [Department of Biostatistics, Mersin University, Faculty of Medicine, Mersin (Turkey)

    2005-10-01

    Purpose: The purpose of our study was to describe the pulmonary parenchymal changes of Behcet's disease using high-resolution computed tomography and to correlate them with pulmonary function tests. Materials and methods: Thirty-four patients with Behcet's disease (18 men, 16 women), 3 of whom were symptomatic, were included as the study group. Four of 34 patients were smokers. Twenty asymptomatic volunteers (12 men, 8 women), 4 of whom were smokers, constituted the control group. The pulmonary function tests and high-resolution computed tomography were performed for both groups. Results: Inspiratory high-resolution computed tomography findings were abnormal in nine patients (26.5%) of the study group. In eight patients, there were multiple abnormalities, whereas one patient had only one abnormality. Pleural thickening and irregularities, major fissure thickening, emphysematous changes, bronchiectasis, parenchymal bands, and irregular densities, and parenchymal nodules were the encountered abnormalities. Inspiratory high-resolution computed tomography scans were normal in the control group. On expiratory scans, there was statistically significant difference between study group and control group when air trapping, especially grades 3 and 4, was compared (P < 0.01). Pulmonary function tests of both the study and the control groups were in normal ranges, and there was no statistically significant difference between the two groups according to pulmonary function tests (P > 0.05). Discussion and conclusion: High-resolution computed tomography is sensitive in the demonstration of pulmonary changes in patients with Behcet's disease. End-expiratory high-resolution computed tomography examination is very useful and necessary to show the presence of air trapping, thus the presence of small airway disease, even if the patient is asymptomatic or has normal pulmonary function tests.

  12. Acute and chronic mesenteric ischemia: MDCT findings Isquemia mesentérica aguda e crônica: achados tomográficos

    Directory of Open Access Journals (Sweden)

    Bruna Schmitz Serpa

    2010-09-01

    Full Text Available Mesenteric ischemia is caused by a reduction in mesenteric blood flow. It can be divided into acute and chronic, based upon the rapidity and the degree to which the blood flow is compromised. The authors retrospectively reviewed 22 cases of mesenteric ischemia, diagnosed by multidetector computed tomography (MDCT in our service, and confirmed by surgery or clinical follow-up. The frequency of the diagnostic findings of chronic and acute mesenteric ischemia was evaluated. The improvement of three-dimensional (3D MDCT allows accurate assessment of mesenteric vessels. Therefore, it demonstrates changes in ischemic bowel segments helpful in determining the primary cause of the disease, and can identify the complications in patients with acute and chronic mesenteric ischemia.A isquemia mesentérica é causada pela redução do fluxo sanguíneo mesentérico. Essa patologia pode ser dividida em aguda e crônica, baseada na rapidez e no grau em que o fluxo sanguíneo está sendo comprometido. Os autores retrospectivamente revisaram 22 casos de isquemia mesentérica, diagnosticados por tomografia computadorizada com mutidetectores (TCMD em nosso serviço, e confirmados por cirurgia ou seguimento clínico. Os achados diagnósticos de isquemia aguda e crônica e sua frequência foram avaliados. Os avanços na TCMD 3D (tridimensional permitiram o acesso detalhado aos vasos mesentéricos. Além disso, é possível demonstrar alterações nos segmentos intestinais, auxiliando na identificação da causa primária da doença e podendo identificar as complicações associadas a isquemia mesentérica e crônica.

  13. Correlation of the CT values of abdominal aorta,renal artery and renal cortex with its thickness on 64-MDCT contrast en-hanced images

    Institute of Scientific and Technical Information of China (English)

    Alomary Mahfooz-Naef; Vikash; Wang Qiu-xia; Zhang Jin-hua; Hu Dao-yu

    2015-01-01

    Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cor-tex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96 patients (50 men and 46 women;16~74 years)with normal kidney function,which was confirmed by kidney function test were enrolled in this stud-y,including bilateral kidneys of 92 cases and unilateral kidney of 4 cases (total of 188 kidneys;92 left,96 right).After intra-venous (IV)injection of contrast agent the kidneys of the selected patients were scanned by MDCT.The scans were per-formed in arterial,venous and 3min delayed phases.All statistical analyses were performed by using IBM SPSS 20.0.Graphs were generated using Graph Pad Prism 5 software.Quantitative data were presented as mean ± standard deviation,while qualitative data were presented as frequency (%).P<0.05 was considered to be statistically significant.Results:The mean renal cortex thickness was (5.19±0.81)mm in all kidneys.In the arterial phase,a statistically significant positive correla-tion between renal cortex CT values and abdominal aortic CT values was showed (r= 0.584;P<0.001).A statistically sig-nificant positive correlation between renal cortex CT values and renal cortex thickness was demonstrated (r= 0.533,P<0.0001).Likewise,there was a positive correlation between renal cortex CT value and renal artery CT values (r= 0.43,P<0.001).Conclusion:It is a promising approach to assess the individual kidney function by measuring abdominal aorta CT value,renal artery CT value,renal cortex CT value and renal cortex thickness using contrast MDCT.

  14. Computer-aided liver volumetry: performance of a fully-automated, prototype post-processing solution for whole-organ and lobar segmentation based on MDCT imaging.

    Science.gov (United States)

    Fananapazir, Ghaneh; Bashir, Mustafa R; Marin, Daniele; Boll, Daniel T

    2015-06-01

    To evaluate the performance of a prototype, fully-automated post-processing solution for whole-liver and lobar segmentation based on MDCT datasets. A polymer liver phantom was used to assess accuracy of post-processing applications comparing phantom volumes determined via Archimedes' principle with MDCT segmented datasets. For the IRB-approved, HIPAA-compliant study, 25 patients were enrolled. Volumetry performance compared the manual approach with the automated prototype, assessing intraobserver variability, and interclass correlation for whole-organ and lobar segmentation using ANOVA comparison. Fidelity of segmentation was evaluated qualitatively. Phantom volume was 1581.0 ± 44.7 mL, manually segmented datasets estimated 1628.0 ± 47.8 mL, representing a mean overestimation of 3.0%, automatically segmented datasets estimated 1601.9 ± 0 mL, representing a mean overestimation of 1.3%. Whole-liver and segmental volumetry demonstrated no significant intraobserver variability for neither manual nor automated measurements. For whole-liver volumetry, automated measurement repetitions resulted in identical values; reproducible whole-organ volumetry was also achieved with manual segmentation, p(ANOVA) 0.98. For lobar volumetry, automated segmentation improved reproducibility over manual approach, without significant measurement differences for either methodology, p(ANOVA) 0.95-0.99. Whole-organ and lobar segmentation results from manual and automated segmentation showed no significant differences, p(ANOVA) 0.96-1.00. Assessment of segmentation fidelity found that segments I-IV/VI showed greater segmentation inaccuracies compared to the remaining right hepatic lobe segments. Automated whole-liver segmentation showed non-inferiority of fully-automated whole-liver segmentation compared to manual approaches with improved reproducibility and post-processing duration; automated dual-seed lobar segmentation showed slight tendencies for underestimating the right hepatic lobe

  15. Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hoven, Andor F. van den, E-mail: a.f.vandenhoven@umcutrecht.nl; Leeuwen, Maarten S. van, E-mail: m.s.vanleeuwen@umcutrecht.nl; Lam, Marnix G. E. H., E-mail: m.lam@umcutrecht.nl; Bosch, Maurice A. A. J. van den, E-mail: mbosch@umcutrecht.nl [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine (Netherlands)

    2015-02-15

    PurposeCurrent anatomical classifications do not include all variants relevant for radioembolization (RE). The purpose of this study was to assess the individual hepatic arterial configuration and segmental vascularization pattern and to develop an individualized RE treatment strategy based on an extended classification.MethodsThe hepatic vascular anatomy was assessed on MDCT and DSA in patients who received a workup for RE between February 2009 and November 2012. Reconstructed MDCT studies were assessed to determine the hepatic arterial configuration (origin of every hepatic arterial branch, branching pattern and anatomical course) and the hepatic segmental vascularization territory of all branches. Aberrant hepatic arteries were defined as hepatic arterial branches that did not originate from the celiac axis/CHA/PHA. Early branching patterns were defined as hepatic arterial branches originating from the celiac axis/CHA.ResultsThe hepatic arterial configuration and segmental vascularization pattern could be assessed in 110 of 133 patients. In 59 patients (54 %), no aberrant hepatic arteries or early branching was observed. Fourteen patients without aberrant hepatic arteries (13 %) had an early branching pattern. In the 37 patients (34 %) with aberrant hepatic arteries, five also had an early branching pattern. Sixteen different hepatic arterial segmental vascularization patterns were identified and described, differing by the presence of aberrant hepatic arteries, their respective vascular territory, and origin of the artery vascularizing segment four.ConclusionsThe hepatic arterial configuration and segmental vascularization pattern show marked individual variability beyond well-known classifications of anatomical variants. We developed an individualized RE treatment strategy based on an extended anatomical classification.

  16. MDCT Evaluation of Left Atrium and Pulmonary Vein in the Patients with Atrial Fibrillation: Comparison with the Non-Atrial Fibrillation Group

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Jung; Choi, Eun Jeong; Ham, Soo Yeon; Oh, Yu Whan; Kim, Young Hoon [Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Yong, Hwan Seok [Korea University Guro Hospital, Seoul (Korea, Republic of); Yang, Kyung Sook [Korea University, Seoul (Korea, Republic of)

    2011-02-15

    The anatomy of the left atrium (LA) and the pulmonary veins (PVs) is important in planning and performing successful electrophysiologic ablation (EPA) for atrial fibrillation (Afib) patients. The authors estimated the findings of LA and PVs of Afib patients by MDCT, and compared these with the findings of LA and PVs of the non- Afib group using coronary CT angiography (CCTA). From September, 2009 to February, 2010, 91 Afib patients underwent PVCT (male: female = 72:19, mean age = 55.0-years-old) before EPA. At same time, 90 patients underwent CCTA (male: female = 73:17, mean age = 59.1- years-old). Two radiologists reviewed and analyzed all axial and 3D images of LA and PVs retrospectively with consensus. The average LA volumes of the Afib group(100.49 mm3) was larger than that of the non-Afib group (78.38 mm3) (p<0.05). The average lengths of the LA right wall in the Afib group (40.25 mm) was longer than that of the non-Afib group (37.3 mm) (p<0.05). The average distances between the PV ostium and first segmental bifurcation of the Lt superior PV (LSPV) and the RSPV were shorter in the Afib group (LSPV, 19.38 mm: RSPV, 11.49 mm) than in the non-Afib group (LSPV, 23.23 mm: RSPV, 14.25 mm) (p<0.05). There were higher incidences of anomalous branches such as ostial, accessory branches, or common ostia in the Afib group versus the non-Afib group (p<0.05). In Afib group, variable parameters of LA and PVs were obtained and estimated by MDCT, and there was statistically significant difference in the parameters of LA and PVs between Afib and non-Afib groups

  17. Measurement of pentane in expiratory gas during rabbit hepatic ischemia/ reperfusion by solid-phase microextraction and gas chromatography–mass spectrometry (SPME GC/MS).

    Science.gov (United States)

    Liu, Shujuan; Shi, Jinghui; Wang, Changsong; Li, Peng; Gong, Yulei; He, Ying; Xu, Guowang; Li, Jianyi; Luo, Ailin; Li, Enyou

    2012-06-01

    The aim of this study was to determine the changes in the pentane concentration of expiratory gas as well as the relationship between this pentane concentration and hepatic oxidative stress during rabbit hepatic ischemia/reperfusion using solid-phase microextraction (SPME) and gas chromatography–mass spectrometry (GC/MS). 45 white male rabbits with body weights between 2.5 and 3.0 kg were randomly assigned to the following three groups: the 10 min ischemia group (group S); the 20 min ischemia group (group M); or the 30 min ischemia group(group L). Expiratory gases were collected prior to ischemia (T0) and for 1, 10, 20, 30, 60 and 120 min (T1–T6) following reperfusion. Pentane concentrations were determined using SPME and GC/MS. In addition, arterial blood samples were collected, and serum aminotransferase(AST) and malondialdehyde (MDA) concentrations were measured. In the three groups, the pentane concentrations of the expiratory gases at points T1 and T2 were significantly increased(P pentane in expiratory gases, which can reflect the degree of oxidative stress during hepatic ischemia/reperfusion.

  18. Influence of Changing the Diameter of the Bubble Generator Bottle and Expiratory Limb on Bubble CPAP: An in vitro Study

    Directory of Open Access Journals (Sweden)

    Chun-Shan Wu

    2012-12-01

    Conclusion: The size and submergence depth of an expiratory limb of a CPAP circuit, the diameter of the bubble generator bottle, and the compliance of the model lung all influence the magnitude and frequency of the transmitted pressure waveform. Therefore, these factors may affect lung volume recruitment and breathing efficiency in bubble CPAP.

  19. Elderly hematic myeloid tumor patients treated with decitabine and reduced-dose CAG regimen%地西他滨联合减量CAG方案治疗老年血液髓系肿瘤

    Institute of Scientific and Technical Information of China (English)

    黄涛; 刘德斌

    2014-01-01

    Objective:To study the curative effect and safety of decitabine and reduced-dose CAG regimen for elderly hematic myeloid tumor patients.Methods:10 cases of elderly hematic myeloid tumor patients were treated with decitabine and reduced-dose CAG regimen[decit-abine 15-20mg/(m2· d),qd,iv,d1-5;aclarubicin 10mg/d,qd,iv,d1-4;Ara-C 10mg/m2,q12h,iv,d1-10;G-CSF 300ug/d,qd,ih,d1-10].Results:1 case lasted for 6 courses,and 2 cases lasted for 4 courses,4 cases lasted for 3 courses,and 2 cases lasted for 2 courses,1 case las-ted for 1 course.There were 3 cases of CR(1 case of MDS,2 cases of AML),5 cases of PR(3 cases of MDS,2 cases of AML),2 cases of NR(1 case of AML,1 case of MDS/MPD,died of lung infection).Conclusion:Decitabine and reduced-dose CAG regimen should be an effective treat-ment of the elderly hematic myeloid tumor patients with high safety and tolerable treatment-related mortality.%目的:观察地西他滨联合减量CAG方案治疗老年血液髓系肿瘤的疗效和安全性。方法:10例老年血液髓系肿瘤患者应用地西他滨+减量CAG方案[地西他滨15~20mg/(m2· d),1天1次静注,d1~5;阿克拉霉素10mg/d,1天1次静注,d1~4;阿糖胞苷10mg/m2,12小时1次,静注,d1~10;G-CSF 300ug/d,1天1次,皮下注射,d1~10]。观察患者疗效及不良反应。结果:1例使用6个疗程,2例使用4个疗程,4例使用3个疗程,2例使用2个疗程,1例使用1个疗程,其中3例获完全缓解(1例MDS,2例AML),5例获部分缓解(3例MDS,2例AML),2例疾病进展(1例AML,1例MDS/MPD),最后因肺部感染死亡。结论:地西他滨联合减量CAG方案治疗老年血液髓系肿瘤,疗效良好,不良反应可耐受,值得尽早应用。

  20. Transient expiratory flow interruptions (TEFI increase expiratory flow in acute asthma exacerbation Incremento del flujo espiratorio luego de interrupciones transitorias en la exacerbación aguda de asma

    Directory of Open Access Journals (Sweden)

    Alejandra Fernández

    2009-10-01

    Full Text Available We have shown that expiratory flows increase when expirations are rapidly interrupted in stable asthmatic patients. We hypothesized that a similar increase could be obtained in patients with acute exacerbation of bronchial asthma treated in the Emergency Room. A total of 30 asthmatic patients were randomly allocated into two groups, the study and the control groups. Patients in the study group were connected to a device with an inspiratory line designed to administer pressurized aerosols. The expiratory line passed through a valve completely interrupting flow at 4 Hz, with an open/closed time ratio of 10/3. The control group patients were also connected to the device, but with the valve kept open. Mean expiratory flow at tidal volume (MEFTV was measured under basal conditions and at 4, 8 and 12 minutes after connecting the patients to the device. All patients received standard treatment throughout the procedure. At all time points MEFTV increased more in the study than in the control group (p Demostramos que el flujo espiratorio máximo, en pacientes asmáticos en estado estable, se incrementaba cuando se generaban rápidas y transitorias interrupciones del flujo. Formulamos la hipótesis de que un incremento similar podría ser observado en pacientes con exacerbación aguda de asma tratados en la sala de emergencias. Un total de 30 pacientes asmáticos fueron distribuidos al azar en dos grupos. Los pacientes del grupo en estudio fueron conectados a un aparato con una vía inspiratoria diseñada para la administración de aerosoles. La vía espiratoria pasaba por una válvula que interrumpía el flujo completamente a 4 hz, con una relación tiempo abierta/tiempo cerrada de 10/3. Los pacientes del grupo control también fueron conectados al aparato pero con la válvula siempre abierta. Se midió el flujo medio de la espiración a volumen circulante en condiciones basales y a los 4, 8 y 12 minutos después de conectado el paciente al equipo. Todos

  1. 小肠活动性出血的MDCT诊断%The diagnostic performance of MDCT in active small intestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    林承露; 刘术松; 涂苍慨

    2012-01-01

    solutions drinking (as negative contrast agent) were executed before CT scanning, except for patients presenting to the emergency room. Slice thickness of 2. 0 mm reconstruction, and multi-plane reformation were performed to help searching for the abnormal intestinal wall and enteric cavity. Presence and location of bleeding and likely cause of hemorrhage identified at MDCT were compared with the surgical or endoscopic findings. Results Compared with plain scanning, intraluminal hyperatrenuating material in small bowel at arterial phase, which the shape and optical density altered at venous phase, was the direct signs of active bleeding. MDCT demonstrated active bleeding in 13 of 15 patients, and local thickening wall of intestine, which was enhanced obviously, occurred after contrast material injection in ail patients. 1 he sensitivity, specificity, positive predictive value- and negative predictive value of MDCT in fixing active bleeding were 97% , 100% . 100% . and 88% . respectively. Findings of MDCT and surgical or endoscopic results were concordant for fixing the bleeding point. Conclusion The sign of intraluminal hyperattenuating material in small bowel at arterial phase, which the shape and optical density altered at venous phase, was the characteristic signs of active bleeding. The local thickening wall of intestine which was enhanced obviously occurred after contrast material injection hinted the location of active hemorrhage. MDCT is very useful to fix the location of active bleeding, as well as the potential cause.

  2. Paired maximum inspiratory and expiratory plain chest radiographs for assessment of airflow limitation in chronic obstructive pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, Takashi, E-mail: tkino@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Kawayama, Tomotaka, E-mail: kawayama_tomotaka@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Imamura, Youhei, E-mail: mamura_youhei@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Sakazaki, Yuki, E-mail: sakazaki@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Hirai, Ryo, E-mail: hirai_ryou@kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Ishii, Hidenobu, E-mail: shii_hidenobu@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Suetomo, Masashi, E-mail: jin_t_f_c@yahoo.co.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Matsunaga, Kazuko, E-mail: kmatsunaga@kouhoukai.or.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Azuma, Koichi, E-mail: azuma@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Fujimoto, Kiminori, E-mail: kimichan@med.kurume-u.ac.jp [Department of Radiology, Kurume University School of Medicine, Kurume (Japan); Hoshino, Tomoaki, E-mail: hoshino@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan)

    2015-04-15

    Highlights: •It is often to use computed tomography (CT) scan for diagnosis of chronic obstructive pulmonary disease. •CT scan is more expensive and higher. •A plane chest radiography more simple and cheap. Moreover, it is useful as detection of pulmonary emphysema, but not airflow limitation. •Our study demonstrated that the maximum inspiratory and expiratory plane chest radiography technique could detect severe airflow limitations. •We believe that the technique is helpful to diagnose the patients with chronic obstructive pulmonary disease. -- Abstract: Background: The usefulness of paired maximum inspiratory and expiratory (I/E) plain chest radiography (pCR) for diagnosis of chronic obstructive pulmonary disease (COPD) is still unclear. Objectives: We examined whether measurement of the I/E ratio using paired I/E pCR could be used for detection of airflow limitation in patients with COPD. Methods: Eighty patients with COPD (GOLD stage I = 23, stage II = 32, stage III = 15, stage IV = 10) and 34 control subjects were enrolled. The I/E ratios of frontal and lateral lung areas, and lung distance between the apex and base on pCR views were analyzed quantitatively. Pulmonary function parameters were measured at the same time. Results: The I/E ratios for the frontal lung area (1.25 ± 0.01), the lateral lung area (1.29 ± 0.01), and the lung distance (1.18 ± 0.01) were significantly (p < 0.05) reduced in COPD patients compared with controls (1.31 ± 0.02 and 1.38 ± 0.02, and 1.22 ± 0.01, respectively). The I/E ratios in frontal and lateral areas, and lung distance were significantly (p < 0.05) reduced in severe (GOLD stage III) and very severe (GOLD stage IV) COPD as compared to control subjects, although the I/E ratios did not differ significantly between severe and very severe COPD. Moreover, the I/E ratios were significantly correlated with pulmonary function parameters. Conclusions: Measurement of I/E ratios on paired I/E pCR is simple and

  3. Fractional exhaled nitric oxide and forced expiratory flow between 25% and 75% of vital capacity in children with controlled asthma

    Directory of Open Access Journals (Sweden)

    Ji-Yong Yoon

    2012-09-01

    Full Text Available &lt;B&gt;Purpose:&lt;/B&gt; Fractional exhaled nitric oxide (FeNO and forced expiratory flow between 25% and 75% of vital capacity (FEF&lt;sub&gt;25-75&lt;/sub&gt; are not included in routine monitoring of asthma control. We observed changes in FeNO level and FEF&lt;sub&gt;25-75&lt;/sub&gt; after FeNO-based treatment with inhaled corticosteroid (ICS in children with controlled asthma (CA. &lt;B&gt;Methods:&lt;/B&gt; We recruited 148 children with asthma (age, 8 to 16 years who had maintained asthma control and normal forced expiratory volume in the first second (FEV1 without control medication for ?#243; months. Patients with FeNO levels &gt;25 ppb were allocated to the ICStreated (FeNO-based management or untreated group (guideline-based management. Changes in spirometric values and FeNO levels from baseline were evaluated after 6 weeks. &lt;B&gt;Results:&lt;/B&gt; Ninety-three patients had FeNO levels &gt;25 ppb. These patients had lower FEF&lt;sub&gt;25-75&lt;/sub&gt; % predicted values than those with FeNO levels ?#178;5 ppb (P&lt;0.01. After 6 weeks, the geometric mean (GM FeNO level in the ICS-treated group was 45% lower than the baseline value, and the mean percent increase in FEF&lt;sub&gt;25-75&lt;/sub&gt; was 18.7% which was greater than that in other spirometric values. There was a negative correlation between percent changes in FEF&lt;sub&gt;25-75&lt;/sub&gt; and FeNO (r=-0.368, P=0.001. In contrast, the GM FeNO and spirometric values were not significantly different from the baseline values in the untreated group. &lt;B&gt;Conclusion:&lt;/B&gt; The anti-inflammatory treatment simultaneously improved the FeNO levels and FEF&lt;sub&gt;25-75&lt;/sub&gt; in CA patients when their FeNO levels were &gt;25 ppb.

  4. COMPARATIVE STUDY OF CIRCADIAN RHYTHM OF PEAK EXPIRATORY FLOW RATE IN SOUTH INDIAN HEALTHY FEMALES AND ASTHMATIC FEMALES

    Directory of Open Access Journals (Sweden)

    Sindhura

    2016-02-01

    Full Text Available AIM AND OBJECTIVES Cross-sectional study to compare the peak expiratory flow rate with the help of “Mini-Wright” peak flow meter among females, normal healthy subjects and subjects who are asthmatics of age group 20–40 years. METHOD 60 adult females of age group 20-40 years (30-Healthy and 30-Asthmatics for whom baseline pulmonary function testing was done to differentiate normal and asthmatic. All cases were clinically examined to rule-out any obvious cardiopulmonary diseases. Subjects were provided one mini Wright’s peak expiratory flow meter, were individually trained for measuring their own PEFR in L/min and were instructed to record the readings with Wright’s portable peak flow meter at 5:00 am, 8:00 am, 11:00 am, 14:00 pm, 17:00 pm, 20:00 pm and 23:00 pm on two consecutive days. They were instructed to obtain at least three recordings at a time. RESULTS In healthy subjects it is observed that mean PEFR values at morning 5:00 hours was 276.966, which is the lowest value of day and 440.653 at evening 17:00 hour, which is the highest value of the day for this shows there is a progressive rise of about 59.1% in mean PEFR value from early morning till evening and at night 11:00 hours we got a mean value of 340.143, a decline of 22.809% when compared to peak value of the day (17:00 hours. In Asthmatic, early morning mean PEFR value at 5:00 hours was 157.888, which is lowest value of the day and 369.774 at evening at 17:00 hours, which is the highest mean PEFR value of the day. There is a significant rise of about 134.2002% in the mean PEFR value from early morning till evening and at night 11:00 hours we got a mean value of 197.666, a decline of 46.5441% when compared to peak value of the day (17:00 hours. CONCLUSION It is seen that though the circadian rhythm in asthmatics follows a similar pattern, i.e. PEFR dip in morning and PEFR peak in late afternoon, but the swing of PEFR from the mean value is more than in normal subjects. A

  5. Accuracy of multi-detector computed tomography (MDCT) in staging of renal cell carcinoma (RCC): analysis of risk factors for mis-staging and its impact on surgical intervention.

    Science.gov (United States)

    El-Hefnawy, Ahmed S; Mosbah, Ahmed; El-Diasty, Tarek; Hassan, Mohammed; Shaaban, Atallah A

    2013-08-01

    To assess the accuracy of multi-detector computed tomography (MDCT) in preoperative staging of renal cell carcinoma (RCC) and to detect the possible risk factors for mis-staging. In addition, the impact of radiological mis-staging on surgical decision and operative procedures was evaluated. Data files of 693 patients, who underwent either radical or partial nephrectomy after preoperative staging by MDCT between January 2003 and December 2010, were retrospectively reviewed. Radiological data were compared to surgical and histopathological findings. Patients were classified according to 2009 TNM staging classification. Diagnostic accuracy per stage and its impact on surgical intervention were evaluated. The overall accuracy was 64.5%, and over-stage was detected in 29.5% and under-stage in 6%. Sensitivity and specificity were highest in stage T3b (85 and 99.5%, respectively), while T4 showed the lowest sensitivity and PPV (57 and 45%). Degree of agreement with pathological staging was substantial in T1 (κ = 0.7), fair in T2 (κ = 0. 4), perfect in T3b (κ = 0.81), and slight for the other stages (κ = 7 cm represent the significant risk factors (RR: 1.6, 95% CI: 1.1-2.3, P Mis-staging was seen to have no negative impact on surgical decision. MDCT is an accepted tool for renal tumor staging. Tumor mis-staging after MDCT is of little clinical importance. Large tumor size >7 cm and conventional RCC are risk factors for tumor mis-staging.

  6. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training.

    Science.gov (United States)

    Wheeler-Hegland, Karen M; Rosenbek, John C; Sapienza, Christine M

    2008-10-01

    This study investigated the concurrent biomechanical and electromyographic properties of 2 swallow-specific tasks (effortful swallow and Mendelsohn maneuver) and 1 swallow-nonspecific (expiratory muscle strength training [EMST]) swallow therapy task in order to examine the differential effects of each on hyoid motion and associated submental activation in healthy adults, with the overall goal of characterizing task-specific and overload properties of each task. Twenty-five healthy male and female adults (M = 25 years of age) participated in this prospective, experimental study with 1 participant group. Each participant completed all study tasks (including normal swallow, Mendelsohn maneuver swallow, effortful swallow, and EMST task) in random order during concurrent videofluoroscopy and surface electromyography recording. Results revealed significant differences in the trajectory of hyoid motion as measured by overall displacement and angle of elevation of the hyoid bone. As well, timing of hyoid movement and amplitude differences existed between tasks with regard to the activation of the submental musculature. Study results demonstrated differential effects of the 3 experimental tasks on the principles of task specificity and overload. These principles are important in the development of effective rehabilitative programs. Subsequent direction for future research is suggested.

  7. Maximal expiratory flow-volume types in young subjects with past history of nasal allergy and bronchial asthma.

    Directory of Open Access Journals (Sweden)

    Meguro,Tadamichi

    1991-02-01

    Full Text Available Pulmonary function tests were performed on 252 healthy young subjects free from respiratory and allergic symptoms, and 80 young subjects with past history of nasal allergy (PNA and 10 subjects with past history of bronchial asthma (PBA. All the subjects were non-smokers. Maximal expiratory flow-volume (MEFV curves were visually classified into five types (A-E. The percent distribution of type A in healthy subjects was significantly higher than in the PNA group, while the total sum of percentage of types B, C, and D in the PNA group was significantly higher than in the healthy subjects. The percent distribution of type E in the PNA group was similar to that in the healthy subjects. The percent distribution of MEFV types were significantly different between healthy males and healthy females. The percent distribution of types A, B and E were the highest in healthy subjects, PNA and PBA groups, respectively. Conclusively, the difference in the percent distributions of MEFV types was recognized among healthy subjects, PNA and PBA groups.

  8. Influence of Positive End-Expiratory Pressure on Myocardial Strain Assessed by Speckle Tracking Echocardiography in Mechanically Ventilated Patients

    Directory of Open Access Journals (Sweden)

    Federico Franchi

    2013-01-01

    Full Text Available Purpose. The effects of mechanical ventilation (MV on speckle tracking echocardiography- (STE-derived variables are not elucidated. The aim of the study was to evaluate the effects of positive end-expiratory pressure (PEEP ventilation on 4-chamber longitudinal strain (LS analysis by STE. Methods. We studied 20 patients admitted to a mixed intensive care unit who required intubation for MV and PEEP titration due to hypoxia. STE was performed at three times: (T1 PEEP = 5 cmH2O; (T2 PEEP = 10 cmH2O; and (T3 PEEP = 15 cmH2O. STE analysis was performed offline using a dedicated software (XStrain MyLab 70 Xvision, Esaote. Results. Left peak atrial-longitudinal strain (LS was significantly reduced from T1 to T2 and from T2 to T3 (. Right peak atrial-LS and right ventricular-LS showed a significant reduction only at T3 (. Left ventricular-LS did not change significantly during titration of PEEP. Cardiac chambers’ volumes showed a significant reduction at higher levels of PEEP (. Conclusions. We demonstrated for the first time that incremental PEEP affects myocardial strain values obtained with STE in intubated critically ill patients. Whenever performing STE in mechanically ventilated patients, care must be taken when PEEP is higher than 10 cmH2O to avoid misinterpreting data and making erroneous decisions.

  9. Low Positive Airway Pressure without Positive End-Expiratory Pressure Decreases Blood Loss during Hepatectomy in Living Liver Donors.

    Science.gov (United States)

    Iguchi, Tomohiro; Ikegami, Toru; Fujiyoshi, Tetsuhiro; Yoshizumi, Tomoharu; Shirabe, Ken; Maehara, Yoshihiko

    2017-01-01

    Despite the development of strategies to minimize blood loss during hepatectomy challenges remain. Our aim was to determine whether low positive airway pressure (PAP) without positive end-expiratory pressure (PEEP) could minimize blood loss during hepatectomy. Forty-one living liver donors who underwent extended left lobectomy or right lobectomy between December 2012 and November 2013 were retrospectively analyzed. In the standard PAP group (n = 18), tidal volume was 8-10 ml/kg, respiratory rate was 10-12/min and PEEP was maintained at 5 cm H2O. In the low PAP group (n = 23), tidal volume was reduced to 5 ml/kg, respiratory rate was increased to 15/min and PEEP maintained at 0 cm H2O. Low central venous pressure (CVP) was maintained during surgery in all cases. The low PAP group had significantly less blood loss (p = 0.0075) and shorter operation time (p = 0.0303) than the standard PAP group. In multiple regression analysis, ventilation mode and median CVP were found to be determining factors for blood loss. In no case did the ventilation mode affect perioperative management. Low PAP without PEEP is a safe mechanical ventilation mode that might help minimize blood loss along with CVP monitoring during hepatectomy. © 2016 S. Karger AG, Basel.

  10. Decreased Peak Expiratory Flow Associated with Muscle Fiber-Type Switching in Spinal and Bulbar Muscular Atrophy.

    Science.gov (United States)

    Yamada, Shinichiro; Hashizume, Atsushi; Hijikata, Yasuhiro; Inagaki, Tomonori; Suzuki, Keisuke; Kondo, Naohide; Kawai, Kaori; Noda, Seiya; Nakanishi, Hirotaka; Banno, Haruhiko; Hirakawa, Akihiro; Koike, Haruki; Halievski, Katherine; Jordan, Cynthia L; Katsuno, Masahisa; Sobue, Gen

    2016-01-01

    The aim of this study was to characterize the respiratory function profile of subjects with spinal and bulbar muscular atrophy (SBMA), and to explore the underlying pathological mechanism by comparing the clinical and biochemical indices of this disease with those of amyotrophic lateral sclerosis (ALS). We enrolled male subjects with SBMA (n = 40) and ALS (n = 25) along with 15 healthy control subjects, and assessed their respiratory function, motor function, and muscle strength. Predicted values of peak expiratory flow (%PEF) and forced vital capacity were decreased in subjects with SBMA compared with controls. In SBMA, both values were strongly correlated with the trunk subscores of the motor function tests and showed deterioration relative to disease duration. Compared with activities of daily living (ADL)-matched ALS subjects, %PEF, tongue pressure, and grip power were substantially decreased in subjects with SBMA. Both immunofluorescence and RT-PCR demonstrated a selective decrease in the expression levels of the genes encoding the myosin heavy chains specific to fast-twitch fibers in SBMA subjects. The mRNA levels of peroxisome proliferator-activated receptor gamma coactivator 1-alpha and peroxisome proliferator-activated receptor delta were up-regulated in SBMA compared with ALS and controls. In conclusion, %PEF is a disease-specific respiratory marker for the severity and progression of SBMA. Explosive muscle strength, including %PEF, was selectively affected in subjects with SBMA and was associated with activation of the mitochondrial biogenesis-related molecular pathway in skeletal muscles.

  11. Reduced Doses of a Sulfonylurea Herbicide for Weed Management in Wheat Fields of Punjab, Pakistan Dosis Reducidas de Herbicida Sulfonilurea para Control de Malezas en Trigo en Punjab, Pakistán

    Directory of Open Access Journals (Sweden)

    Abdul Khaliq

    2011-09-01

    Full Text Available Reduction in herbicide usage without compromising yields can lead to less environmental harm and lower production costs. Field trials were conducted to appraise the efficacy of reduced doses (25, 50, and 75% of the label dose of a post emergence sulfonylurea herbicide [Atlantis 3.6WG (iodo+mesosulfuron] to control weeds in wheat (Triticum aestivum L. fields of Punjab, Pakistan. Below-labeled-doses were quite effective in suppressing total weed density (72-95% and biomass (83-94%, and wheat grain yield was increased by 22 to 48% over the weedy control, while label dose of iodo+mesosulfuron improved yield by 53%. Iodo+mesosulfuron at 25 and 50% of the label dose inhibited grass weeds by 43 to 64%, albeit their biomass was suppressed by > 80% over control. Wheat yields for reduced herbicide doses (50 and 75% were not different with label dose. Economic analysis revealed that the maximum marginal rate of return was recorded for 50% of the label herbicide dose and was followed by that observed for 25% of the label dose. Reduced doses of herbicide can be an effective tool in minimizing herbicide inputs and lowering production costs in wheat production without compromising yields.Reducción del uso de herbicidas sin comprometer el rendimiento puede dar lugar a menos riesgos ambientales y disminución de los costos de producción. Los ensayos de campo se llevaron a cabo para evaluar la eficacia de dosis reducidas (25, 50 y 75% de la dosis de etiqueta de un herbicida sulfonilurea [Atlantis3.6WG (yodo + mesosulfurón] de post emergencia para controlar las malezas en trigo (Triticum aestivum L. en campos de Punjab, Pakistán. Las dosis por debajo de la recomendada en la etiqueta eran muy eficaces en la supresión de la densidad total de malezas (72-95% y biomasa (83-94%, y rendimiento en grano de trigo se incrementó en un 22 a 48% por sobre el control, mientras que la dosis de etiqueta de yodo + mesosulfurón mejoró el rendimiento en un 53%. Yodo

  12. Step-and-shoot prospectively ECG-gated versus retrospectively ECG-gated with tube current modulation coronary CT angiography using the 128-slice MDCT: comparison of image quality and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Dong Wook (Dept. of Family Medicine, Medial Research Institute, Pusan National Univ. Yangsan Hospital, School of Medicine, Gyeongsangnam-do, (Korea, Republic of)); Choo, Ki Seok; Baik, Seung Kug; Kim, Yong Woo; Jeon, Ung Bae (Dept. of Radiology, Medial Research Institute, Pusan National Univ. Yangsan Hospital, School of Medicine, Gyeongsangnam-do, (Korea, Republic of)), email: kschoo0618@naver.com; Kim, Jeong Soo (Dept. of Cardiology, Medial Research Institute, Pusan National Univ. Yangsan Hospital, School of Medicine, Gyeongsangnam-do (Korea, Republic of)); Lim, Soo Jin (Dept. of Cardiology, Kim Hae Joongang Hospital, Gyeongsangnam-do (Korea, Republic of))

    2011-02-15

    Background: Little is known regarding image quality and the required radiation dose for step-and-shoot and retrospective coronary computed tomography angiography (CCTA) with tube current modulation (TCM) in 128-slice multidetector CT (MDCT) coronary angiography. Purpose: To compare image quality and radiation dose in patients who underwent 128-slice MDCT by the step-and- shoot method with those in patients who underwent 128-slice MDCT with retrospective CCTA with TCM. Material and Methods: CCTA obtained with 128-slice MDCT was retrospectively evaluated in 160 patients. Two independent reviewers separately scored the subjective image quality of the coronary artery segments (1, excellent; 4, poor) for step-and-shoot (68, mean heart rate [HR]: 59.3+-6.8) and retrospective CCTA with TCM (77, mean HR: 59.1+-9.8). Interobserver variability was calculated. Effective radiation doses of both scan techniques were calculated with dose-length product. Results: There was good agreement for quality scores of coronary artery segment images between the independent reviewers (k=0.72). The number of coronary artery segments that could not be evaluated was 2.85% (27 of 947) in the step-and-shoot and 1.87% (20 of 1071) in retrospective CCTA with TCM. Image quality scores were not significantly different (P>.05). Mean patient radiation dose was 63% lower for step-and-shoot (1.94+-0.70 mSv) than for retrospective CCTA with TCM (4.51+-1.18 mSv) (P<0.0001). For patients who underwent step-and-shoot or retrospective CCTA with TCM, an average HR of 63.5 beats per minute was identified as the threshold for the prediction of non-diagnostic image quality for both protocols. There were no significant differences in the image quality of both methods between obese (body mass index [BMI>=25) and non-obese patients (BMI<25), but radiation doses were higher in the obesity group than in the non-obesity group for both methods. Conclusion: Both step-and-shoot and retrospective CCTA with TCM using 128

  13. Association of C-reactive protein and homocysteine with subclinical coronary plaque subtype and stenosis using low-dose MDCT coronary angiography.

    Science.gov (United States)

    Lin, Tsann; Liu, Juhn-Cherng; Chang, Li-Ya; Shen, Chien-Wei

    2010-10-01

    Given the uncertainty regarding the relationship of C-reactive protein (CRP) and homocysteine (Hcy) to atherosclerotic burden, our aim was to determine whether CRP and Hcy are related to the presence of subclinical coronary plaque and stenosis. We did a cross-sectional analysis of data gathered on 1248 consecutive, newly self-referred, middle-aged subjects who underwent health check ups at China Medical University Hospital. Participants had at least one cardiac risk factor, but no known coronary heart disease. Low-dose multidetector computed tomography coronary angiography (MDCT-CA) was used to measure coronary artery stenosis and identify plaque subtypes. Subjects were divided into quartiles based on levels of high-sensitivity (hs)-CRP and Hcy. hs-CRP level and Hcy level were associated with the relative proportion of plaque subtypes; Hcy level (P0.05) was associated with prevalence of artery segment stenosis. After multivariate adjustment for traditional cardiovascular risk factors through logistic regression analysis, neither hs-CRP level nor Hcy level was independently associated with coronary plaque subtypes and stenosis (P>0.05). Subclinical atherosclerosis is mildly increased in subjects with higher CRP and Hcy levels, but this association is not independent of traditional cardiovascular risk factors. CRP and Hcy are poor predictors of atherosclerotic burden and coronary stenosis. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  14. A new approach to the assessment of lumen visibility of coronary artery stent at various heart rates using 64-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Groen, J.M.; Greuter, M.J.W.; Ooijen, P.M.A. van; Oudkerk, M. [University Medical Center Groningen, University of Groningen, Department of Radiology, Hanzeplein 1, P.O. Box 30001, Groningen (Netherlands)

    2007-07-15

    Coronary artery stent lumen visibility was assessed as a function of cardiac movement and temporal resolution with an automated objective method using an anthropomorphic moving heart phantom. Nine different coronary stents filled with contrast fluid and surrounded by fat were scanned using 64-slice multi-detector computed tomography (MDCT) at 50-100 beats/min with the moving heart phantom. Image quality was assessed by measuring in-stent CT attenuation and by a dedicated tool in the longitudinal and axial plane. Images were scored by CT attenuation and lumen visibility and compared with theoretical scoring to analyse the effect of multi-segment reconstruction (MSR). An average increase in CT attenuation of 144 {+-} 59 HU and average diminished lumen visibility of 29 {+-} 12% was observed at higher heart rates in both planes. A negative correlation between image quality and heart rate was non-significant for the majority of measurements (P > 0.06). No improvement of image quality was observed in using MSR. In conclusion, in-stent CT attenuation increases and lumen visibility decreases at increasing heart rate. Results obtained with the automated tool show similar behaviour compared with attenuation measurements. Cardiac movement during data acquisition causes approximately twice as much blurring compared with the influence of temporal resolution on image quality. (orig.)

  15. Fractal Dimension Analysis of MDCT Images for Quantifying the Morphological Changes of the Pulmonary Artery Tree in Patients with Pulmonary Hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Haitao; Li, Ning; Guo, Lijun; Gao, Fei; Liu, Cheng [Shandong University, Shandong Medical Imaging Research Institute, Shandong (Korea, Republic of)

    2011-06-15

    The aim of this study was to use fractal dimension (FD) analysis on multidetector CT (MDCT) images for quantifying the morphological changes of the pulmonary artery tree in patients with pulmonary hypertension (PH). Fourteen patients with PH and 17 patients without PH as controls were studied. All of the patients underwent contrast-enhanced helical CT and transthoracic echocardiography. The pulmonary artery trees were generated using post-processing software, and the FD and projected image area of the pulmonary artery trees were determined with Image J software in a personal computer. The FD, the projected image area and the pulmonary artery pressure (PAP) were statistically evaluated in the two groups. The FD, the projected image area and the PAP of the patients with PH were higher than those values of the patients without PH (p < 0.05, t-test). There was a high correlation of FD with the PAP (r = 0.82, p < 0.05, partial correlation analysis). There was a moderate correlation of FD with the projected image area (r = 0.49, p < 0.05, partial correlation analysis). There was a correlation of the PAP with the projected image area (r = 0.65, p < 0.05, Pearson correlation analysis). The FD of the pulmonary arteries in the PH patients was significantly higher than that of the controls. There is a high correlation of FD with the PAP.

  16. Effect of ultra-low doses, ASIR and MBIR on density and noise levels of MDCT images of dental implant sites

    Energy Technology Data Exchange (ETDEWEB)

    Widmann, Gerlig; Schullian, Peter [Medical University of Innsbruck, Department of Radiology, Innsbruck (Austria); Al-Shawaf, Reema; Al-Sadhan, Ra' ed; Al-Ekrish, Asma' a A. [King Saud University, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, Riyadh (Saudi Arabia); Hoermann, Romed [Medical University of Innsbruck, Division of Clinical and Functional Anatomy, Innsbruck (Austria)

    2017-05-15

    Differences in noise and density values in MDCT images obtained using ultra-low doses with FBP, ASIR, and MBIR may possibly affect implant site density analysis. The aim of this study was to compare density and noise measurements recorded from dental implant sites using ultra-low doses combined with FBP, ASIR, and MBIR. Cadavers were scanned using a standard protocol and four low-dose protocols. Scans were reconstructed using FBP, ASIR-50, ASIR-100, and MBIR, and either a bone or standard reconstruction kernel. Density (mean Hounsfield units [HUs]) of alveolar bone and noise levels (mean standard deviation of HUs) was recorded from all datasets and measurements were compared by paired t tests and two-way ANOVA with repeated measures. Significant differences in density and noise were found between the reference dose/FBP protocol and almost all test combinations. Maximum mean differences in HU were 178.35 (bone kernel) and 273.74 (standard kernel), and in noise, were 243.73 (bone kernel) and 153.88 (standard kernel). Decreasing radiation dose increased density and noise regardless of reconstruction technique and kernel. The effect of reconstruction technique on density and noise depends on the reconstruction kernel used. (orig.)

  17. Fully automated lobe-based airway taper index calculation in a low dose MDCT CF study over 4 time-points

    Science.gov (United States)

    Weinheimer, Oliver; Wielpütz, Mark O.; Konietzke, Philip; Heussel, Claus P.; Kauczor, Hans-Ulrich; Brochhausen, Christoph; Hollemann, David; Savage, Dasha; Galbán, Craig J.; Robinson, Terry E.

    2017-02-01

    Cystic Fibrosis (CF) results in severe bronchiectasis in nearly all cases. Bronchiectasis is a disease where parts of the airways are permanently dilated. The development and the progression of bronchiectasis is not evenly distributed over the entire lungs - rather, individual functional units are affected differently. We developed a fully automated method for the precise calculation of lobe-based airway taper indices. To calculate taper indices, some preparatory algorithms are needed. The airway tree is segmented, skeletonized and transformed to a rooted acyclic graph. This graph is used to label the airways. Then a modified version of the previously validated integral based method (IBM) for airway geometry determination is utilized. The rooted graph, the airway lumen and wall information are then used to calculate the airway taper indices. Using a computer-generated phantom simulating 10 cross sections of airways we present results showing a high accuracy of the modified IBM. The new taper index calculation method was applied to 144 volumetric inspiratory low-dose MDCT scans. The scans were acquired from 36 children with mild CF at 4 time-points (baseline, 3 month, 1 year, 2 years). We found a moderate correlation with the visual lobar Brody bronchiectasis scores by three raters (r2 = 0.36, p < .0001). The taper index has the potential to be a precise imaging biomarker but further improvements are needed. In combination with other imaging biomarkers, taper index calculation can be an important tool for monitoring the progression and the individual treatment of patients with bronchiectasis.

  18. MDCT evaluation of aortic root and aortic valve prior to TAVI. What is the optimal imaging time point in the cardiac cycle?

    Energy Technology Data Exchange (ETDEWEB)

    Jurencak, Tomas; Turek, Jakub; Nijssen, Estelle C. [Maastricht University Medical Center, Department of Radiology, P. Debyelaan 25, P.O. Box 5800, AZ, Maastricht (Netherlands); Kietselaer, Bastiaan L.J.H. [Maastricht University Medical Center, Department of Radiology, P. Debyelaan 25, P.O. Box 5800, AZ, Maastricht (Netherlands); Maastricht University Medical Center, CARIM School for Cardiovascular Diseases, Maastricht (Netherlands); Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Mihl, Casper; Kok, Madeleine; Wildberger, Joachim E.; Das, Marco [Maastricht University Medical Center, Department of Radiology, P. Debyelaan 25, P.O. Box 5800, AZ, Maastricht (Netherlands); Maastricht University Medical Center, CARIM School for Cardiovascular Diseases, Maastricht (Netherlands); Ommen, Vincent G.V.A. van [Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Garsse, Leen A.F.M. van [Maastricht University Medical Center, Department of Cardiothoracic Surgery, Maastricht (Netherlands)

    2015-07-15

    To determine the optimal imaging time point for transcatheter aortic valve implantation (TAVI) therapy planning by comprehensive evaluation of the aortic root. Multidetector-row CT (MDCT) examination with retrospective ECG gating was retrospectively performed in 64 consecutive patients referred for pre-TAVI assessment. Eighteen different parameters of the aortic root were evaluated at 11 different time points in the cardiac cycle. Time points at which maximal (or minimal) sizes were determined, and dimension differences to other time points were evaluated. Theoretical prosthesis sizing based on different measurements was compared. Largest dimensions were found between 10 and 20 % of the cardiac cycle for annular short diameter (10 %); mean diameter (10 %); effective diameter and circumference-derived diameter (20 %); distance from the annulus to right coronary artery ostium (10 %); aortic root at the left coronary artery level (20 %); aortic root at the widest portion of coronary sinuses (20 %); and right leaflet length (20 %). Prosthesis size selection differed depending on the chosen measurements in 25-75 % of cases. Significant changes in anatomical structures of the aortic root during the cardiac cycle are crucial for TAVI planning. Imaging in systole is mandatory to obtain maximal dimensions. (orig.)

  19. Differentiation of a Femoral Hernia from an Inguinal Hernia on Isotropic Multidetector-Row CT (MDCT): the Benefit of Inguinal Ligament Coronal-Oblique Images

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ju Hyun; Jang, Kyung Mi; Kim, Min Jeong; Ko, Ji Young; Koh, Sung Hye; Yie, Mi Yeon; Min, Kwang Seon; Kim, In Gyu [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Choi, Dong Il; Park, Yul Ri [Samsung Medical Center, Seoul (Korea, Republic of)

    2009-04-15

    This study was designed to evaluate the diagnostic value of the use of inguinal ligament coronal-oblique CT images in the differentiation of femoral hernias from inguinal hernias. A total of 32 patients (with 11 femoral hernias and 21 inguinal hernias) underwent CT imaging. All of the examinations were performed with a 16- multidetector row CT (MDCT) scanner with contrast enhancement, and transverse sections, coronal sections and coronal-oblique CT images were reformed along an imaginary inguinal ligament plane. Two independent observers retrospectively evaluated the CT scans. Image analysis was first performed with only transverse and coronal images. A second analysis was then performed with transverse, coronal and coronal- oblique images. The mean angle difference between coronal and coronal-oblique CT images was 8.0 degrees (range, 0-22 degrees). A radiologist correctly diagnosed the presence of a femoral hernia in nine (82%) of 11 patients and a radiology fellow correctly diagnosed the presence of a femoral hernia in seven (64%) of 11 patients in the first session. Both of the reviewers made the correct diagnosis in all patients in the second session. For inguinal hernias, both reviewers correctly diagnosed all patients during both sessions. The coronal-oblique CT images were the most valuable images for the evaluation of the relationship between hernias of the neck and inguinal ligament. Inguinal ligament coronal-oblique CT images can provide additional diagnostic value in the evaluation of groin hernias.

  20. The effects of positive end-expiratory pressure on respiratory system mechanics and hemodynamics in postoperative cardiac surgery patients

    Directory of Open Access Journals (Sweden)

    J.O.C. Auler Jr.

    2000-01-01

    Full Text Available We prospectively evaluated the effects of positive end-expiratory pressure (PEEP on the respiratory mechanical properties and hemodynamics of 10 postoperative adult cardiac patients undergoing mechanical ventilation while still anesthetized and paralyzed. The respiratory mechanics was evaluated by the inflation inspiratory occlusion method and hemodynamics by conventional methods. Each patient was randomized to a different level of PEEP (5, 10 and 15 cmH2O, while zero end-expiratory pressure (ZEEP was established as control. PEEP of 15-min duration was applied at 20-min intervals. The frequency dependence of resistance and the viscoelastic properties and elastance of the respiratory system were evaluated together with hemodynamic and respiratory indexes. We observed a significant decrease in total airway resistance (13.12 ± 0.79 cmH2O l-1 s-1 at ZEEP, 11.94 ± 0.55 cmH2O l-1 s-1 (P<0.0197 at 5 cmH2O of PEEP, 11.42 ± 0.71 cmH2O l-1 s-1 (P<0.0255 at 10 cmH2O of PEEP, and 10.32 ± 0.57 cmH2O l-1 s-1 (P<0.0002 at 15 cmH2O of PEEP. The elastance (Ers; cmH2O/l was not significantly modified by PEEP from zero (23.49 ± 1.21 to 5 cmH2O (21.89 ± 0.70. However, a significant decrease (P<0.0003 at 10 cmH2O PEEP (18.86 ± 1.13, as well as (P<0.0001 at 15 cmH2O (18.41 ± 0.82 was observed after PEEP application. Volume dependence of viscoelastic properties showed a slight but not significant tendency to increase with PEEP. The significant decreases in cardiac index (l min-1 m-2 due to PEEP increments (3.90 ± 0.22 at ZEEP, 3.43 ± 0.17 (P<0.0260 at 5 cmH2O of PEEP, 3.31 ± 0.22 (P<0.0260 at 10 cmH2O of PEEP, and 3.10 ± 0.22 (P<0.0113 at 15 cmH2O of PEEP were compensated for by an increase in arterial oxygen content owing to shunt fraction reduction (% from 22.26 ± 2.28 at ZEEP to 11.66 ± 1.24 at PEEP of 15 cmH2O (P<0.0007. We conclude that increments in PEEP resulted in a reduction of both airway resistance and respiratory elastance. These results

  1. Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals

    Science.gov (United States)

    de Albuquerque, Isabella Martins; Cardoso, Dannuey Machado; Masiero, Paulo Ricardo; Paiva, Dulciane Nunes; Resqueti, Vanessa Regiane; Fregonezi, Guilherme Augusto de Freitas; Menna-Barreto, Sérgio Saldanha

    2016-01-01

    ABSTRACT Objective: To evaluate the effects of positive expiratory pressure (PEP) on pulmonary epithelial membrane permeability in healthy subjects. Methods: We evaluated a cohort of 30 healthy subjects (15 males and 15 females) with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10), 15 cmH2O (n = 10), and 20 cmH2O (n = 10). The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. Results: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044), 15 cmH2O (p = 0.044), and 20 cmH2O (p = 0.004)-in comparison with that observed during spontaneous breathing. Conclusions: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects. PMID:28117469

  2. Is there an optimal level of positive expiratory pressure (PEP) to improve walking tolerance in patients with severe COPD?

    Science.gov (United States)

    Russo, Davide; Simonelli, Carla; Paneroni, Mara; Saleri, Manuela; Piroddi, Ines Maria Grazia; Cardinale, Francesco; Vitacca, Michele; Nicolini, Antonello

    2016-07-01

    The application of positive expiratory pressure (PEP) devices during exercise had been proposed in order to counteract the pulmonary hyperinflation, reduce the dyspnea and thus increase the exercise tolerance in patients with severe chronic obstructive pulmonary disease (COPD). This randomized controlled crossover trial investigated the effect of two different levels of PEP (1 cmH2O and 10 cmH2O) on distance covered at 6minute walk test (6MWT) in patients with severe COPD. Secondary outcomes were the evaluation of PEP effects on physiological and pulmonary function variables. Seventy-two severe COPD patients, referred to our hospitals as in and out patients, were recruited. A basal 6MWT without devices was performed on the first day, and then repeated with PEP 1 cmH2O (PEP1) and 10 cmH2O (PEP10), with a randomized crossover design. Slow and forced spirometries, including the inspiratory capacity measure, were repeated before and after each 6MWT. 50 patients (average age 69,92 year, mean FEV1 41,42% of predicted) concluded the trial. The 6MWT improved significantly among both PEP levels and baseline (323,8 mt at baseline vs. 337,8 PEP1 and 341,8 PEP10; p<.002 and p<.018, respectively). The difference between PEP10 and PEP1 did not reach the significance. No improvements were found in pulmonary function, symptoms and physiological variables after the 6MWT. In patients with severe COPD, the application of 1 cmH2O of PEP seems to improve the exercise tolerance as 10 cmH2O, with similar dyspnea. Further studies should investigate the effects of low levels of PEP on aerobic training programs. Copyright © 2016 SEPAR. Published by Elsevier Espana. All rights reserved.

  3. Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals

    Directory of Open Access Journals (Sweden)

    Isabella Martins de Albuquerque

    Full Text Available ABSTRACT Objective: To evaluate the effects of positive expiratory pressure (PEP on pulmonary epithelial membrane permeability in healthy subjects. Methods: We evaluated a cohort of 30 healthy subjects (15 males and 15 females with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10, 15 cmH2O (n = 10, and 20 cmH2O (n = 10. The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. Results: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044, 15 cmH2O (p = 0.044, and 20 cmH2O (p = 0.004-in comparison with that observed during spontaneous breathing. Conclusions: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects.

  4. Review: artifical ventilation with positive end-expiratory pressure (PEEP). Historical background, terminology and patho-physiology.

    Science.gov (United States)

    Stokke, D B

    1976-09-01

    CPPV (continuous positive pressure ventilation) is obviously superior to IPPV (intermittent positive pressure ventilation) for the treatment of patients with acute respiratory insufficiency (ARI) and results within a few minutes in a considerable increase in the oxygen transport. The principle is to add a positive end-expiratory plateau (PEEP) to IPPV, with a subsequent increase in FRC (functional residual capacity) resulting in re-opening in first and foremost the declive alveolae, which can then once again take part in the gas exchange and possibly re-commence the disrupted surfactant production. In this manner the ventilation/perfusion ratio in the diseases lungs is normalized and the intrapulmonary shunting of venous blood (Qs/Qt) will decrease. At the same time the dead space ventilation fraction (VD/VT) normalizes and the compliance of the lungs (CL) increases. The PEEP value, which results in a maximum oxygen transport, and the lowest dead space fraction, also appears to result in the greatest total static compliance (CT) and the greatest increase in mixed venous oxygen tension (PVO2); this value can be termed "optimal PEEP". The greater the FRC is, with an airway pressure = atmospheric pressure, the lower the PEEP value required in order to obtain maximum oxygen transport. If the optimal PEEP value is exceeded the oxygen transport will fall because of a falling Qt (cardiac output) due to a reduction in venous return. CT and PVO2 will fall and VD/VT will increase. Increasing hyperinflation of the alveolae will result in a rising danger of alveolar rupture. The critical use of CPPV treatment means that the lungs may be safeguarded against high oxygen percents. The mortality of newborn infants with RDS (respiratory distress syndrome) has fallen considerably after the general introduction of CPPV and CPAP (continuous positive airway pressures). The same appears to be the case with adults suffering from ARI (acute respiratory insufficiency).

  5. Peripheral chemoreceptors tune inspiratory drive via tonic expiratory neuron hubs in the medullary ventral respiratory column network.

    Science.gov (United States)

    Segers, L S; Nuding, S C; Ott, M M; Dean, J B; Bolser, D C; O'Connor, R; Morris, K F; Lindsey, B G

    2015-01-01

    Models of brain stem ventral respiratory column (VRC) circuits typically emphasize populations of neurons, each active during a particular phase of the respiratory cycle. We have proposed that "tonic" pericolumnar expiratory (t-E) neurons tune breathing during baroreceptor-evoked reductions and central chemoreceptor-evoked enhancements of inspiratory (I) drive. The aims of this study were to further characterize the coordinated activity of t-E neurons and test the hypothesis that peripheral chemoreceptors also modulate drive via inhibition of t-E neurons and disinhibition of their inspiratory neuron targets. Spike trains of 828 VRC neurons were acquired by multielectrode arrays along with phrenic nerve signals from 22 decerebrate, vagotomized, neuromuscularly blocked, artificially ventilated adult cats. Forty-eight of 191 t-E neurons fired synchronously with another t-E neuron as indicated by cross-correlogram central peaks; 32 of the 39 synchronous pairs were elements of groups with mutual pairwise correlations. Gravitational clustering identified fluctuations in t-E neuron synchrony. A network model supported the prediction that inhibitory populations with spike synchrony reduce target neuron firing probabilities, resulting in offset or central correlogram troughs. In five animals, stimulation of carotid chemoreceptors evoked changes in the firing rates of 179 of 240 neurons. Thirty-two neuron pairs had correlogram troughs consistent with convergent and divergent t-E inhibition of I cells and disinhibitory enhancement of drive. Four of 10 t-E neurons that responded to sequential stimulation of peripheral and central chemoreceptors triggered 25 cross-correlograms with offset features. The results support the hypothesis that multiple afferent systems dynamically tune inspiratory drive in part via coordinated t-E neurons.

  6. Evaluation of low tidal volume with positive end-expiratory pressure application effects on arterial blood gases during laparoscopic surgery.

    Science.gov (United States)

    Baki, Elif Dogan; Kokulu, Serdar; Bal, Ahmet; Ela, Yüksel; Sivaci, Remziye Gül; Yoldas, Murat; Çelik, Fatih; Ozturk, Nilgun Kavrut

    2014-07-01

    Pneumoperitoneum (PNP) and patient positions required for laparoscopy can induce pathophysiological changes that complicate anesthetic management during laparoscopic procedures. This study investigated whether low tidal volume and positive end-expiratory pressure (PEEP) application can improve ventilatory and oxygenation parameters during laparoscopic surgery. A total of 60 patients undergoing laparoscopic surgery were randomized to either the conventional group (n = 30, tidal volume = 10 mL/kg, rate = 12/minute, PEEP = 0 cm H(2)O) or the low tidal group with PEEP group (n = 30, tidal volume = 6 mL/kg, rate = 18/minute, PEEP = 5 cm H(2)O) at maintenance of anesthesia. Hemodynamic parameters, peak plateau pressure (Pplat) and arterial blood gases results were recorded before and after PNP. There was a significant increase in the partial pressure of arterial carbon dioxide (PaCO(2)) values after PNP in the conventional group in the reverse Trendelenburg (41.28 mmHg) and Trendelenburg positions (44.80 mmHg;p = 0.001), but there was no difference in the low tidal group at any of the positions (36.46 and 38.56, respectively). We saw that PaO(2) values recorded before PNP were significantly higher than the values recorded 1 hour after PNP in the two groups at all positions. No significant difference was seen in peak inspiratory pressure (Ppeak) at the reverse Trendelenburg position before and after PNP between the groups, but there was a significant increase at the Trendelenburg position in both groups (conventional; 21.67 cm H(2)O, p = 0.041, low tidal; 23.67 cm H(2)O, p = 0.004). However, Pplat values did not change before and after PNP in the two groups at all positions. The application of low tidal volume + PEEP + high respiratory rate during laparoscopic surgeries may be considered to improve good results of arterial blood gases. Copyright © 2014. Published by Elsevier B.V.

  7. Positive end-expiratory pressure (PEEP) does not depress left ventricular function in patients with pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Calvin, J.E.; Driedger, A.A.; Sibbald, W.J.

    1981-08-01

    Researchers evaluated the effects of positive end-expiratory pressure (PEEP) on left ventricular function in 15 patients with acute respiratory insufficiency secondary to pulmonary edema with invasive (pressure; flow) measurements and radionuclide angiography (RA). Using RNA allowed a definition of the left ventricular ejection fraction (LVEF), and then calculation of the left ventricular end-diastolic volume (LVEDV), both before and after PEEP. With a mean PEEP of 14.2 +/- 1.8 cm H2O (mean +/- SD) (range, 10 to 15), a fall in the cardiac index (4.34 +/- 1.5 to 3.84 +/- 1.4 L/min/M2; p less than 0.001) was accompanied by a significant decrease in the stroke volume index (42 +/- 13 to 39 +/- 12 ml/beat M2; p less than 0.01) and pulse rate (103.4 +/- 14.3 to 98 +/- 13.5 beats/min; p less than 0.01). The decrease in the stroke volume index was primarily due to a significant decrease in left ventricular preload (LVEDV) from 85.9 +/- 19 to 71.4 +/- 21.4 ml/m2 (p less than 0.01). Simultaneously, the mean LVEF increased from 0.47 +/- 0.10 to 0.53 +/- 0.08 (p less than 0.05), despite a significant increase in the systemic vascular resistance (1,619 +/- 575 to 1,864 +/- 617 dynes . s. cm-5/M2; p less than 0.01). Researchers concluded that the use of PEEP in patients with acute pulmonary edema, to the degree used in this study, may depress cardiac output by simply decreasing left ventricular preload. Researchers were unable to produce any evidence that would support a change in the contractile state of the left ventricle as a cause of depressed forward flow with the use of PEEP.

  8. Observational study on efficacy of negative expiratory pressure test proposed as screening for obstructive sleep apnea syndrome among commercial interstate bus drivers - protocol study

    Directory of Open Access Journals (Sweden)

    Hirata Raquel P

    2011-12-01

    Full Text Available Abstract Background Obstructive sleep apnea (OSA is a respiratory disease characterized by the collapse of the extrathoracic airway and has important social implications related to accidents and cardiovascular risk. The main objective of the present study was to investigate whether the drop in expiratory flow and the volume expired in 0.2 s during the application of negative expiratory pressure (NEP are associated with the presence and severity of OSA in a population of professional interstate bus drivers who travel medium and long distances. Methods/Design An observational, analytic study will be carried out involving adult male subjects of an interstate bus company. Those who agree to participate will undergo a detailed patient history, physical examination involving determination of blood pressure, anthropometric data, circumference measurements (hips, waist and neck, tonsils and Mallampati index. Moreover, specific questionnaires addressing sleep apnea and excessive daytime sleepiness will be administered. Data acquisition will be completely anonymous. Following the medical examination, the participants will perform a spirometry, NEP test and standard overnight polysomnography. The NEP test is performed through the administration of negative pressure at the mouth during expiration. This is a practical test performed while awake and requires little cooperation from the subject. In the absence of expiratory flow limitation, the increase in the pressure gradient between the alveoli and open upper airway caused by NEP results in an increase in expiratory flow. Discussion Despite the abundance of scientific evidence, OSA is still underdiagnosed in the general population. In addition, diagnostic procedures are expensive, and predictive criteria are still unsatisfactory. Because increased upper airway collapsibility is one of the main determinants of OSA, the response to the application of NEP could be a predictor of this disorder. With the

  9. Randomized study comparing full dose monotherapy (S-1 followed by irinotecan) and reduced dose combination therapy (S-1/oxaliplatin followed by S-1/irinotecan) as initial therapy for older patients with metastatic colorectal cancer: NORDIC 9.

    Science.gov (United States)

    Winther, Stine Braendegaard; Österlund, Pia; Berglund, Åke; Glimelius, Bengt; Qvortrup, Camilla; Sorbye, Halfdan; Pfeiffer, Per

    2017-08-16

    Metastatic colorectal cancer (mCRC) is a disease of older age, but there is a relative lack of knowledge about effects of chemotherapy in older patients as they are under-represented in clinical trials. Little data can guide whether the strategy in older mCRC patients should be a sequential full-dose monotherapy chemotherapy approach or a dose-reduced combination chemotherapy approach. The oral 5FU prodrug S-1 seems to have less side effects than capecitabine and should be an optimal drug for older patients, but few data are available. Improved geriatric assessments are needed to select which older patients should receive therapy. The NORDIC 9 trial is a Nordic multicenter randomized phase II study comparing full dose monotherapy (S-1 30 mg/m(2) twice daily days 1-14 every 3 weeks, followed by second line irinotecan 250-350 mg/m(2) iv day 1 every 3 weeks or 180-250 mg/m(2) iv day 1 every 2 weeks) with reduced dose combination therapy (S-1 20 mg/m(2) days 1-14 + oxaliplatin 100 mg/m(2) iv day 1 every 3 weeks, followed by second line S-1 20 mg/m(2) days 1-14 + irinotecan 180 mg/m(2) day 1 every 3 week) for older patients (≥70 years) with mCRC who are not candidates for full-dose standard combination therapy. Additional bevacizumab (7.5 mg/kg) is optional in first-line. Blood samples and tumor tissue will be collected to investigate predictive markers. Geriatric screening tools (G-8, VES-13, Timed-Up-and-Go and Handgrip strength), Charlson Comorbidty Index and quality of life (EORTC QLQ-C30) will be evaluated as predictors of efficacy and toxicity. The target sample size is 150 patients. The primary endpoint is progression-free survival and secondary endpoints are time-to-failure of strategy, overall survival, response rate, toxicity, and correlations between biomarkers, pre-treatment characteristics and geriatric assessments. The study will add knowledge on how to treat older mCRC patients who are not candidates for standard combination therapy

  10. Expiratory flow limitation detected by negative expiratory pressure in children with asthma%呼气相气道内负压法检测呼气流速受限在哮喘患儿中的应用

    Institute of Scientific and Technical Information of China (English)

    李俊梅; 郑成中; 陈爱欢

    2013-01-01

    目的 探讨呼气相气道内负压法(NEP)检测呼气流速受限(EFL)在儿童哮喘患者中实施的可行性,及其与常规阻塞性肺通气功能指标第一秒用力呼气容积(FEV1)、加拿大医学研究委员会推荐的呼吸困难严重程度分级标准(MRC评分)的相关性.方法 选取2012年6~12月在该院就诊的儿童哮喘患者64例,其中46例稳定期,18例急性发作,给予MRC评分,然后分别进行常规肺通气功能检测及NEP检测EFL.结果 (1)所有哮喘患儿均能很好耐受NEP.(2)肺通气功能情况:64例哮喘患儿的FEV1均值为(71.33±13.92)% pred,18例急性发作患儿FEV1均值为(52.91±13.87)% pred.(3)MRC评分:64例哮喘患儿中10例MRC评分为2分,其余54例MRC评分为1分.MRC与FEV1的相关系数是-0.635(P<0.05).(4)NEP检测EFL情况:46例哮喘患儿坐位和仰卧位均未出现EFL,8例坐位和仰卧位均有EFL,10例坐位时无EFL,仅仰卧位出现EFL.3分法EFL与FEV1及MRC的相关系数分别为-0.607、0.964(P <0.05).5分法EFL与FEV1及MRC的相关系数分别为-0.626、0.966(P<0.05).结论 (1)NEP可用于检测儿童哮喘的EFL情况.(2)NEP检测EFL与FEV1显著相关.(3)NEP检测EFL指标和FEV1均与MRC评分显著相关,但EFL与MRC评分的相关性更强.%Objective The purpose of this study was to evaluate the feasibility of expiratory flow limitation(EFL) detected by negative(NEP) and the correlation between EFL and routine lung function measurements(Forced expiratory volume in first second,FEV1),EFL and MRC dyspnea scale,in patients with stable and acute asthma,to find a simple,reliable and objective method for the diagnosis,differential diagnosis,the severity of disease and evaluation of severity and efficacy of treatment for asthma,and a objective method reflecting the severity of dyspnea.Methods Sixty-four children enrolled in No.306 Hospital of PLA from Jun.to Dec.in 2012 were included in this study.The severity of dyspnea was rated according to the dyspnea

  11. Comparative evaluation of ventilatory function through pre and postoperative peak expiratory flow in patients submitted to elective upper abdominal surgery.

    Science.gov (United States)

    Scheeren, Caio Fernando Cavanus; Gonçalves, José Júlio Saraiva

    2016-01-01

    to evaluate the ventilatory function by Peak Expiratory Flow (PEF) in the immediate pre and postoperative periods of patients undergoing elective surgical procedures in the upper abdomen. we conducted a prospective cohort study including 47 patients admitted to the Hospital Regional de Mato Grosso do Sul from July to December 2014, who underwent elective surgeries of the upper abdomen, and submiited to spirometric evaluation and measurement of PEF immediately before and after surgery. of the 47 patients, 22 (46.8%) were male and 25 (53.20%) female. The mean preoperative PEF was 412.1±91.7, and postoperative, 331.0±87.8, indicating significant differences between the two variables. Men had higher PEF values than women, both in the pre and postoperative periods. There was a reasonable inverse correlation between age and decreased PEF. Both situations showed statistical significance (psexo masculino, e 25 (53,20%) do sexo feminino. A média do PFE pré-operatório foi 412,1±91,7, e do pós-operatório de 331,0±87,8, indicando diferenças significantes entre as duas variáveis. O sexo masculino apresentou maiores valores de PFE do que o feminino, tanto no pré-cirúrgico quanto no pós-cirúrgico. Observou-se razoável correlação inversamente proporcional entre as variáveis idade e diminuição do PFE. Ambas as situações mostraram significância estatística (p<0,001). O grupo composto por fumantes apresentou menores valores de PFE tanto no pré como no pós-operatório. O grupo composto por portadores de co-morbidades (HAS e/ou DM) apresentou menores valores de PFE tanto no pré como no pós-operatório (p=0,005). Em ambos os grupos, o pós-operatório determinou uma diminuição significativa do PFE (p<0,001). O tipo de cirurgia realizada e o tipo de anestesia não mostraram diferenças significantes em relação ao PFE. as variáveis mais implicadas na diminuição da função ventilatória, avaliadas através da PFE, foram: idade avançada, tabagismo e

  12. COMBINED REDUCED FORCED EXPIRATORY VOLUME IN 1-SECOND (FEV1) AND PERIPHERAL ARTERY DISEASE IN SEDENTARY ELDERS WITH FUNCTIONAL LIMITATIONS

    Science.gov (United States)

    Vaz Fragoso, Carlos A.; Hsu, Fang-Chi; Brinkley, Tina; Church, Timothy; Liu, Christine K.; Manini, Todd; Newman, Anne B.; Stafford, Randall S.; McDermott, Mary M.; Gill, Thomas M.

    2014-01-01

    Objectives Because they are potentially modifiable and may coexist, we evaluated the combined occurrence of a reduced forced expiratory volume in 1-second (FEV1) and peripheral artery disease (PAD), including its association with exertional symptoms, physical inactivity, and impaired mobility, in sedentary elders with functional limitations. Design Cross-sectional. Setting Lifestyle Interventions and Independence in Elder (LIFE) Study. Participants 1307 sedentary community-dwelling persons, mean age 78.9, with functional limitations (Short Physical Performance Battery [SPPB] <10). Measurements A reduced FEV1 was defined by a Z-score <-1.64 (< lower limit of normal), while PAD was defined by an ankle-brachial index <1.00. Exertional dyspnea was defined as moderate-to-severe (modified Borg index), immediately after a 400-meter walk test (400MWT). Exertional leg symptoms were established by the San Diego Claudication Questionnaire. Physical inactivity was evaluated by percent of accelerometry wear-time with activity <100 counts/min (top quartile established high sedentary-time). Mobility was evaluated by the 400MWT (gait-speed <0.8 m/s defined as slow) and SPPB (≤7 defined moderate-to-severe mobility impairment). Results A combined reduced FEV1 and PAD was established in 6.0% (78/1307) of participants. However, among those who had a reduced FEV1, 34.2% (78/228) also had PAD, while 20.8% (78/375) of those who had PAD also had a reduced FEV1. The two combined conditions were associated with exertional dyspnea (adjusted odds ratio [adjOR] 2.59 [1.20, 5.60]) and slow gait-speed (adjOR 3.15 [1.72, 5.75]) but not with exertional leg symptoms, high sedentary-time, and moderate-to-severe mobility impairment. Conclusions In sedentary community-dwelling elders with functional limitations, a reduced FEV1 and PAD frequently coexisted and, in combination, were strongly associated with exertional dyspnea and slow gait-speed (a frailty indicator that increases the risk of

  13. Application of 64MDCT multislice perfusion imaging in colorectal carcinoma%64排螺旋CT多层灌注成像对结直肠癌的临床应用

    Institute of Scientific and Technical Information of China (English)

    冯仕庭; 孙灿辉; 彭振鹏; 郭欢仪; 李子平; 孟悛非

    2010-01-01

    目的 研究结直肠癌(CRC)的64排螺旋CT(64MDCT)灌注成像时间-密度曲线(TDC)及诸参数与肿瘤分期、浆膜浸润、淋巴结及远处转移和CEA等的关系.方法 对33例CRC患者进行64MDCT多层灌注成像检查.绘制所选层面靶动脉、靶静脉及肿瘤感兴趣区(ROI)的TDC.CT灌注的参数包括:血流量(BF)、血容量(BY)、平均通过时间(MTT)和表面通透性(PS).肿瘤按TNM分期,TDC根据形态进行分型.对CT灌注参数与TNM分期、浆膜浸润、淋巴结及远处转移和CEA等诸因素的相关性进行统计学分析.结果 CRC的TDC分为5种类型,TNM分期中各期的TDC可表现为5型中的一种或多种.CRC的灌注参数在各期中的差异无统计学意义,BV、MTT与浆膜浸润有关(t=-2.63和-2.24,P=0.0137和0.0331),BV与肿瘤大小存在正相关(r=0.41,P=0.02),BF、MTT与肿瘤分期、浆膜浸润、淋巴结转移、远处转移和CEA等均无关(P>0.05).结论 MDCT多层灌注成像可反映CRC的血流灌注状况,可能为临床治疗方案提供客观依据.%Objective To study the correlation of time-density curves (TDC), parameters revealed by 64-multidetector-row C