Quantification of Liver Steatosis: Is CT Equivalent to PDFF?
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American Journal Of Roentgenology
2021
Journal Article
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Pseudocirrhosis in Breast Cancer - Experience From an Academic Cancer Center.
breast cancer; CT; liver metastases; METASTASIS; hepatocellular failure; portal hypertension; pseudocirrhosis; CARCINOMA; CHEMOTHERAPY; CIRRHOSIS; LIVER-FAILURE; PORTAL-HYPERTENSION
Background: Pseudocirrhosis is characterized by radiological changes in the liver that resemble cirrhosis, but with more rapid onset and progression. Though reported most frequently in patients with metastatic breast cancer, little is known about its prognostic factors and impact on breast cancer outcomes.; Methods: In this observational study, we reviewed abdominal CT and/or MRI scan reports of all patients with invasive breast cancer diagnosed at our center, during a ten-year period, to identify patients with pseudocirrhosis. Exclusion criteria included lack of baseline imaging, pre-existing cirrhosis, hepatitis B or C, other chronic liver diseases, or heavy alcohol use. Routine descriptive statistical measures were used. Survival distributions were estimated using Kaplan-Meier method, and Cox regression was used for multivariate analysis. Two-tailed p < 0.05 was considered significant.; Results: Eighty-six patients were included - all were females, median age was 57.5 years, and 90% were Caucasian; 86% of primary tumors were hormone-receptor positive and 17% were HER2 positive. Most patients (98%) had metastatic disease with liver involvement (94%), and were heavily pre-treated - 97% with chemotherapy, 85% with hormonal therapy, and 19% with anti-HER2 agents. Median interval from breast cancer diagnosis to pseudocirrhosis was 75.4 months (IQR 35.2-115.3 months). Thirty-six percentage of patients had ≥1 signs of portal hypertension and 49% had ≥1 signs of hepatocellular failure. Pseudocirrhosis led to permanent discontinuation of chemotherapy, endocrine therapy, and all systemic therapies in 29%, 31%, and 20% patients, respectively. Median overall survival from diagnosis of pseudocirrhosis was 10.0 months (95%CI 5.2-14.8 months). On multivariate analysis, coagulopathy, hyperbilirubinemia, hypoalbuminemia, and cancer progression were independently predictive of mortality.; Conclusions: In this largest series, to date, of breast cancer with pseudocirrhosis, the latter was often complicated by portal hypertension and hepatocellular failure, and markedly impacted breast cancer management. Survival was shorter for patients who developed hepatocellular failure. (Copyright © 2021 Gopalakrishnan, Shajihan, Purysko and Abraham.)
Gopalakrishnan D; Shajihan A; Purysko AS; Abraham J
Frontiers in Oncology
2021
2021-07-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.3389/fonc.2021.679163" target="_blank" rel="noreferrer noopener">10.3389/fonc.2021.679163</a>
Systematic Review: The Role of Intravenous and Oral Contrast in the Computed Tomography Evaluation of Acute Appendicitis
acute appendicitis; contrast; CT
BACKGROUND: This systematic review provides practicing emergency physicians updated information regarding the role of oral and intravenous contrast in the computed tomography (CT) evaluation of acute appendicitis. METHODS: A PubMed literature search was conducted from January 1, 1996 to December 31, 2018 and limited to human clinical trials written in English with relevant keywords. High-quality studies were identified and then underwent a structured review. Recommendations are made based on the literature review. RESULTS: Fifty-seven articles met criteria for rigorous review, of which 14 were appropriate for citation in this review. Excellent evidence shows that oral contrast does not improve the test characteristics of CT with intravenous contrast (IVCT) in the evaluation of adults suspected of having acute appendicitis. Good evidence shows that noncontrast abdominal CTs have excellent test characteristics for this same group of patients. CONCLUSIONS: Considering its downsides and lack of utility, the medical literature does not support using oral contrast in the evaluation of acute appendicitis. There is no direct evidence showing that IVCT is better than a noncontrast CT in the evaluation of acute appendicitis; however, the available literature is consistent with slightly better test characteristics for IVCTs. Still, if IVCT cannot be obtained in a timely manner, noncontrast CTs are extremely accurate in detecting this disease.
Soucy Zachary; Cheng David; Vilke Gary M; Childers Richard
The Journal of Emergency Medicine
2019
2019-12-13
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2019.10.034" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2019.10.034</a>
PMID: 31843324
Contrast enhanced ultrasound for focal liver lesions: how accurate is it?
diagnosis; ultrasonography; Radiology; metaanalysis; Nuclear Medicine & Medical Imaging; ct; us; hepatocellular carcinoma; benign; ceus; Contrast enhanced ultrasound; Focal liver lesions; mri; Sensitivity; washout
With the recent FDA approval for characterization of focal liver lesions (FLL) in both pediatric and adult patients using Lumason (sulfur hexafluoride microbubbles), increased use of ultrasound contrast for routine clinical use is expected. This agent has been available for many years in Europe and Asia, and a large body of literature is available regarding the sensitivity and specificity of this agent. In addition, a few studies have directly compared CEUS to CECT and CEMRI for the characterization of focal liver lesions. This paper reviews the literature to provide a background to investigators in the United States as to the accuracy of CEUS in the characterization of FLL. This paper reviews the literature regarding sulfur hexafluoride microbubbles (Lumason in the USA and Sonovue in the rest of the world) since it is the only FDA approved agent in the USA for characterization of FLL. The results of other ultrasound contrast agents which are not FDA approved for abdominal indications (approval for cardiac indications) most likely will have similar results.
Barr R G
Abdominal Radiology
2018
2018-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1007/s00261-017-1257-6" target="_blank" rel="noreferrer noopener">10.1007/s00261-017-1257-6</a>
Factors associated with imaging overuse in the emergency department: A systematic review
care; computed-tomography scans; costs; ct; Emergency department; Emergency Medicine; Health; Health care; Imaging; Overuse; patient; physicians; Quality measurement; radiation-exposure; research agenda; retrospective-analysis; transferred trauma patients
Background: Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. Methods: We searched MEDLINE (R) and Embase (R) from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. Results: Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pretransfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. Conclusions: The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED. (C) 2017 Elsevier Inc. All rights reserved.
Tung M; Sharma R; Hinson J S; Nothelle S; Pannikottu J; Segal J B
American Journal of Emergency Medicine
2018
2018-02
Journal Article
<a href="http://doi.org/10.1016/j.ajem.2017.10.049" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.10.049</a>
Incidental Detection of an Aortic Stent Endoleak With Contrast-Enhanced Sonography
Acoustics; aneurysm repair; angiography; computed-tomography; ct; endovascular repair; evar; Nuclear Medicine & Medical Imaging; Radiology; ultrasound
Sousaris N; McCutcheon J; Barr R
Journal of Ultrasound in Medicine
2014
2014-04
Journal Article
<a href="http://doi.org/10.7863/ultra.33.4.738" target="_blank" rel="noreferrer noopener">10.7863/ultra.33.4.738</a>
Radiation risk associated with computed tomography and high frequency emergency department users
ct; Emergency Medicine
Peter D J
Annals of Emergency Medicine
2007
2007-01
Journal Article
<a href="http://doi.org/10.1016/j.annemergmed.2006.07.953" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2006.07.953</a>
Pulmonary lymphadenopathy
adenopathy; childhood; children; ct; Immunology; Infectious Diseases; manifestations; Pediatrics; sarcoidosis; tuberculosis
Omlor G J
Pediatric Infectious Disease Journal
2001
2001-04
Journal Article
<a href="http://doi.org/10.1097/00006454-200104000-00013" target="_blank" rel="noreferrer noopener">10.1097/00006454-200104000-00013</a>