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O Lucidarme

Publications and source records attributed to O Lucidarme.

15 recordsLinked to original sources
PubMed1999

Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience.

OBJECTIVE: The objective of this study was to evaluate inter- and intraobserver agreement in the diagnosis of central pulmonary embolism using contrast-enhanced helical CT among observers with variable experience in the interpretation of pulmonary CT angiograms. MATERIALS AND METHODS: Helical CT angiograms of 60 patients clinically suspected of having pulmonary embolism were analyzed retrospectively and independently by two chest radiologists, one cardiovascular radiologist, and three general radiologists. The films were rated a second time by the chest radiologists to assess intraobserver variability. Findings for pulmonary embolism were categorized as positive, negative, or indeterminate at the main, lobar, and segmental pulmonary artery levels. RESULTS: The observers interpreted 19-21 CT angiograms as positive for pulmonary embolism (mean, 19.7) and one to six as indeterminate (mean, 3.2). Agreement occurred among all observers in 50 patients (83.3%), among five observers in six patients (10.0%), among four observers in three patients (5.0%), and among three observers in one patient (1.7%). Interobserver agreement was very good (kappa, .85) for the diagnosis of pulmonary embolism on a per-patient basis. Agreement on a per-artery basis for all arteries was moderate (66%; kappa, .56); for lobar arteries was good (83%; kappa, .75); and for segmental arteries was moderate (57%; kappa, .47). Mean intraobserver agreement on a per-patient basis was very good (93%; kappa, .87). CONCLUSION: Inter- and intraobserver agreement in the diagnosis of pulmonary embolism with helical CT is very good despite a wide variety of experience among radiologists.

Adult↗
PubMed1998

Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle.

PURPOSE: To evaluate a lung biopsy technique in which a detachable, 18-gauge, coaxial guide around a central notched stylet is used as a cutting needle. MATERIALS AND METHODS: The records of 89 consecutive patients (41 women, 48 men; aged 21-86 years) who underwent coaxial percutaneous core biopsy of 91 lung lesions that required needle passage through normal lung tissue (mean lesion size, 33.6 mm; range, 9-80 mm) were studied. Detachable, 18-gauge, coaxial automated cutting needles were used. RESULTS: The mean number of needle passes was 2.5 (range, 1-4). All biopsies yielded sufficient tissue for histopathologic (n = 91) and, if necessary, bacteriologic (n = 12) evaluation (mean core length, 5 mm; range, 1-15 mm). Eighty-nine lesions had definitive diagnoses. Seventy-five lesions were proved to be malignant; seventy (93%) could be accurately diagnosed with coaxial percutaneous core biopsy samples. Fourteen lesions were proved to be benign; 10 (71%) were specifically diagnosed with biopsy samples. Among the 91 biopsies, the overall diagnostic accuracy was 88% (80 of 91 lesions). A pneumothorax occurred in 31 cases (34%), three (3%) of which necessitated placement of a chest tube. Postbiopsy hemoptysis occurred and resolved spontaneously in nine cases (10%). CONCLUSION: This technique provides a core biopsy specimen without the need for an on-site cytopathologist during the procedure. It has a high diagnostic accuracy and an acceptable rate of complications.

Adult↗
PubMed1998

Expiratory CT scans for chronic airway disease: correlation with pulmonary function test results.

OBJECTIVE: The purpose of our study was to correlate findings on expiratory CT scans with results of pulmonary function tests (PFTs) and to determine whether these techniques may be complementary in assessing airway obstruction. MATERIALS AND METHODS: Seventy-four patients with suspected chronic airway disease and 10 healthy nonsmokers underwent inspiratory and expiratory CT scans and PFTs. An air trapping score, corresponding to the ratio of the cross-sectional air trapping area versus the total cross-sectional lung area on expiratory CT, and a reduction score, representing the change in cross-sectional lung area at inspiration and expiration, were calculated using a quantitative grid. The two scores were then correlated with the results of the PFTs. RESULTS: Expiratory air trapping was seen in 18 (51%) of 35 patients with severe airway obstruction (forced expiratory volume in 1 sec [FEV1]:vital capacity < 80%) (group A), in 21 (72%) of 29 patients with predominantly small airways obstruction (abnormal flow-volume curve and FEV1:vital capacity > or = 80%) (group B1), and in four (40%) of 10 patients with normal PFT results (group B2). Expiratory air trapping was never seen in the 10 healthy subjects. Air trapping scores were 27%, 12%, and 8% for groups A, B1, and B2, respectively, with significant negative correlations with FEV1 (r = -.45), FEV1:vital capacity (r = -.31), and forced expiratory flow at 25% of vital capacity (r = -.57). Reduction scores were 18%, 30%, 35%, and 43%, for the groups A, B1, B2, and the healthy group, respectively, with significant correlations with all the PFT indexes (r = .35 to .66) except total lung capacity. CONCLUSION: Air trapping may permit detection of airway obstruction in patients with clinically suspected chronic airway disease even when PFTs are normal. Furthermore, expiratory CT allows one to calculate a reduction score for a cross-sectional lung area that appears to be better correlated with the degree of airway obstruction measured on PFTs.

Adult↗
PubMed1996

Bronchiectasis: comparative assessment with thin-section CT and helical CT.

PURPOSE: To compare thin-section computed tomography (CT) and helical CT in the detection and assessment of the extent of bronchiectasis. MATERIALS AND METHODS: Both thin-section and helical CT scans were obtained in 50 consecutive patients with clinical symptoms suggestive of bronchiectasis. Thin-section CT was performed with 1.5-mm collimation and 10-mm intervals, and helical CT was performed with 3-mm collimation and a pitch of 1.6 during a 24-second breath hold. Three observers evaluated 593 segments on CT scans both independently and in consensus. Radiation dose was measured for both techniques. RESULTS: Bronchiectasis was noted in 77 segments (22 patients) on thin-section CT scans compared with 90 segments (26 patients) on helical CT scans. No findings were positive for bronchiectasis on only thin-section CT scans. Interobserver agreement was statistically significantly better (P < .05) in identification of segments that were positive for bronchiectasis on helical CT scans (kappa = 0.87) than on thin-section CT scans (kappa = 0.71). Total skin dose of radiation delivered with helical CT was 3.4 times greater than that delivered with thin-section CT. CONCLUSION: Helical scanning can improve CT depiction of bronchiectasis but with an increase in radiation exposure to the patient. It should be used in patients considered for surgery or for thin-section CT scans that are difficult to interpret.

Adult↗
PubMed1996

[Comparative evaluation of iopamidol 300 versus 370 during spiral x-ray computed tomographic studies of the thorax].

PURPOSE: A retrospective study was performed to assess the role of iodine concentration on the opacification of different vascular compartments of the chest with a nonionic contrast agent (Iopamidol) during routine spiral CT examination. MATERIAL AND METHOD: 105 injected spiral CTs of the chest were studied. 50 examinations were done with Iopamidol 300 (iodine concentration 300 g/L) (I300). 55 examinations were done with Iopamidol 370 (iodine concentration 370 g/L) (I370). A constant 24- g total iodine dose was delivered with no difference in the injected iodine flow rates (respectively 0.6 and 0.55 g/s). Images were scored for opacification success, opacification quality and for artefacts in each vascular, of the chest. RESULTS: There was no statistically significant difference in opacification success or in opacification quality, in each chest vascular compartment between the group receiving I300 and the group receiving I370. Artefact frequencies on the lower part of superior vena cava were however different, 24% and 41.8% respectively. CONCLUSION: For a constant injected iodine flow rate, a moderate increase in iodine concentration, with decreased injection volume and flow rate, had little or no effect on opacification of the aorta and the pulmonary artery. The presence of artefacts on the lower part of the superior vena cava would suggest that the use of lower concentration contrast media would be advisable for specific vena cava examinations.

Adult↗
PubMed1995

[Imaging of COPD].

Standard chest radiographs have been shown to be insensitive for the diagnosis of morphologic abnormalities of airways. Computed tomography is the most sensitive and specific investigation to diagnose emphysema. However, as emphysema may be missed on computed tomography, this investigation cannot be used to definitely rule out the diagnosis. Computed tomography may contribute to the investigation of bronchiolitis, and it is now considered as the gold standard for establishing the diagnosis of bronchiectasis. Imaging may contribute to identify complications such as bronchopulmonary infection, pulmonary hypertension, pneumothorax, cancer of the lung, compressive bullae, and pulmonary embolism.

Bronchiolitis↗
PubMed1995

Ductal carcinoma in situ: MR imaging-histopathologic correlation.

PURPOSE: To correlate histopathologic and magnetic resonance (MR) imaging findings of ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Thirty-six women with DCIS underwent preoperative contrast material-enhanced subtraction dynamic MR imaging. Concomitant early contrast enhancement in the breast parenchyma with normal vessels was considered a positive finding. The size and shape of early enhancement were correlated with the size and density packing of ducts involved by DCIS. Tumor angiogenesis in the stroma that surrounded the ducts was evaluated with immunoperoxidase staining. RESULTS: Early contrast enhancement was demonstrated in 34 patients with DCIS but not in two patients with comedo-type DCIS. Tumor angiogenesis was demonstrated in the stroma. The size and morphology of contrast-enhanced lesions significantly correlated with the size (P = .0085) and density packing of ducts involved by DCIS (P = .012). CONCLUSION: Contrast enhancement on dynamic MR images of DCIS may be due to the presence of tumor angiogenesis in the stroma.

Breast↗
PubMed1995

[Unilateral inguinal hernia in infants: costs, risks and benefits of herniography? Methodology].

AIM: To assess the validity and the interest to health of systematic herniography in cases of unilateral inguinal hernia in children under two years of age. METHOD: Decision theory was used to assess the effect of herniography on individual health by estimating gonadic benefit and establishing a benefit-risk ratio, and on collective health by the use of cost-effectiveness analysis. RESULTS: a decision tree and algorithms were developed. DISCUSSION: Decision analysis is used in complex medical decision making, clarifying choices and subdividing a problem into several more manageable sub-problems. The threshold approach pinpoints factors requiring more information.

Cost-Benefit Analysis↗
PubMed1995

[Unilateral inguinal hernia in infants: costs, risks and benefits of herniography? Results].

AIM: To assess the advantages of systématic herniography in cases of unilateral inguinal hernia in infants. METHOD: Decision analysis presented in the first part of this article was used. A preliminary retrospective study of 348 cases as well as a literature review were utilized to determine the probabilities required in order to create and run the decision aid algorithm. Gonadic benefit was used as the health indicator. RESULTS: For males, gonadic benefit procured by the herniography depends on the risk of strangulation in cases of groin hernia and on the frequency of testicular atrophy after inguinal hernioplasty. The evaluation of these two elements largely determines the choice of medical and surgical practices. For a 0.44% risk of post-operative testicular atrophy and a risk of strangulated hernia estimated at 20%, the cost-effectiveness ratio is FF, 199681 to save a testicle. One testicle is saved every 455 herniographies, with 24 possible post-examination complications. For female, herniography provides no gonadic benefit. DISCUSSION: Decision analysis permits the quantification of results, leading to improved clinical judgement and facilitating the evaluation of medical practice.

Atrophy↗
PubMed1994

Nonpalpable breast tumors: diagnosis with contrast-enhanced subtraction dynamic MR imaging.

PURPOSE: To determine the accuracy of contrast material-enhanced subtraction dynamic magnetic resonance (MR) imaging in the diagnosis of nonpalpable breast tumors. MATERIALS AND METHODS: One hundred forty-three patients underwent surgical biopsy of a nonpalpable breast lesion. Their mammograms showed microcalcifications (n = 80), opacity (n = 52), architectural distortion (n = 10), or asymmetric density (n = 1). All patients underwent a preoperative gadolinium tetraazacyclododecanetetraacetic acid-enhanced subtraction dynamic study. Any early contrast enhancement in the breast parenchyma was considered pathologic. RESULTS: At histologic analysis, 27 intraductal carcinomas, 37 invasive carcinomas, and 79 benign lesions were found. Dynamic MR studies showed early contrast enhancement in 61 of 64 breast cancers (sensitivity, 95%) and in 37 of 79 benign lesions (specificity, 53%). Two invasive lobular carcinomas and one tubular carcinoma showed no early contrast enhancement. CONCLUSION: Subtraction dynamic MR imaging may be helpful to rule out malignancy in nonpalpable breast tumors.

Adult↗
PubMedDate not supplied

Clustered breast microcalcifications: evaluation by dynamic contrast-enhanced subtraction MRI.

OBJECTIVE: Our goal was to evaluate dynamic contrast-enhanced subtraction MRI in the diagnosis of isolated clustered calcifications of the breast. MATERIALS AND METHODS: One hundred seventy-two patients underwent surgical biopsy for isolated clustered breast calcifications. Their mammograms showed round (n = 88) or linear/irregular (n = 84) microcalcifications. All patients had a preoperative Gd-DOTA-enhanced subtraction dynamic study. Any early contrast enhancement in the breast parenchyma concomitant with early enhancement of normal vessels was considered positive. RESULTS: Fifty-eight in situ carcinomas, 22 invasive carcinomas, and 92 benign lesions were found at histological analysis. Dynamic MR sequences showed early contrast enhancement in 76 of 80 malignant lesions (sensitivity 95%) and in 45 of 92 benign lesions (specificity 51%). Two invasive and two intraductal carcinomas did not show early contrast enhancement. Three independent observers agreed in rating early contrast enhancement in 143 of 172 lesions. CONCLUSION: Poor specificity limits the diagnostic accuracy of dynamic contrast-enhanced subtraction MRI in distinguishing benign from malignant microcalcifications on mammography.

Adult↗