Detection of pulmonary nodules by computer-aided diagnosis in multidetector computed tomography: preliminary study of 24 cases

OBJECTIVES: To evaluate the performance of a computer program designed to facilitate the detection of pulmonary nodules using multidetector computed tomography (MDCT) scans of the chest. METHODS: We evaluated 24 consecutive MDCT scans of the chest at the Fleury Diagnostic Imaging Center during the period from October 7 to October 19 of 2006, using a 64-channel CT scanner. The study comprised 12 females and 12 males, ranging from 35 to 77 years of age (mean, 57.9 years). Double reading and a computer-aided diagnosis (CAD) system were used in order to perform two independent analyses of the data. The nodules found using both methods were recorded, and the data were compared. RESULTS: The total sensitivity of CAD for the detection of nodules was 16.5%, increasing to 55% when nodules 1 cm. More than 99% of true nodules detected by CAD were registered in the image double reading process. CONCLUSIONS: In this preliminary 24-case study, the sensitivity of computer program tested was not significantly greater than that of the double-reading process that is routinely performed in this facility.OBJETIVOS: Avaliar o desempenho de um programa para auxílio na detecção de nódulos pulmonares em tomografia computadorizada com múltiplos detectores (TCMD). MÉTODOS: Foram avaliadas 24 tomografias computadorizadas de tórax consecutivas realizadas no Centro de Medicina Diagnóstica Fleury no período de 07/10/2006 a 19/10/2006 usando um tomógrafo helicoidal multidetectores de 64 canais. O estudo compreendeu 12 pacientes do sexo feminino e 12 do sexo masculino, com idades variando entre 35 e 77 anos, idade média de 57,9. As imagens foram analisadas independentemente pelo método da dupla leitura e pelo programa diagnóstico auxiliado por computador (DAC). Os nódulos encontrados nos diferentes processos foram registrados e os dados comparados. RESULTADOS: A sensibilidade total da detecção de nódulos pelo DAC nesse trabalho foi de 16,5%, 55% excluindo os nódulos medindo 1 cm. Menos de 1% dos nódulos verdadeiros destacados pelo DAC não haviam sido registrados no processo de dupla leitura. CONCLUSÕES: Neste trabalho preliminar de 24 casos, o programa testado não conseguiu superar de forma significativa a sensibilidade da dupla leitura realizada de rotina neste serviço.Universidade Federal de São Paulo (UNIFESP) Departamento de Diagnóstico por ImagemCentro de Medicina Diagnóstica FleuryUniversidade Federal de São Paulo (UNIFESP)UNIFESP, Depto. de Diagnóstico por ImagemUNIFESPSciEL

Estradiol Is a Critical Mediator of Macrophage-Nerve Cross Talk in Peritoneal Endometriosis

Endometriosis occurs in approximately 10% of women and is associated with persistent pelvic pain. It is defined by the presence of endometrial tissue (lesions) outside the uterus, most commonly on the peritoneum. Peripheral neuroinflammation, a process characterized by the infiltration of nerve fibers and macrophages into lesions, plays a pivotal role in endometriosis-associated pain. Our objective was to determine the role of estradiol (E2) in regulating the interaction between macrophages and nerves in peritoneal endometriosis. By using human tissues and a mouse model of endometriosis, we demonstrate that macrophages in lesions recovered from women and mice are immunopositive for estrogen receptor beta, with up to 20% being estrogen receptor alpha positive. In mice, treatment with E2 increased the number of macrophages in lesions as well as concentrations of mRNAs encoded by Csf1, Nt3, and the tyrosine kinase neurotrophin receptor, TrkB. By using in vitro models, we determined that the treatment of rat dorsal root ganglia neurons with E2 increased mRNA concentrations of the chemokine C-C motif ligand 2 that stimulated migration of colony-stimulating factor 1-differentiated macrophages. Conversely, incubation of colony-stimulating factor 1 macrophages with E2 increased concentrations of brain-derived neurotrophic factor and neurotrophin 3, which stimulated neurite outgrowth from ganglia explants. In summary, we demonstrate a key rote for E2 in stimulating macrophage-nerve interactions, providing novel evidence that endometriosis is an estrogen-dependent neuroinflammatory disorder

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Treadmill exercise inducing mild to moderate ischemia has no significant effect on skeletal muscle or cardiac 18F-FDG uptake and image quality on subsequent whole-body PET scan.

We report the effects of treadmill exercise on (18)F-FDG uptake in skeletal muscles and image quality of torso PET and compare stress myocardial perfusion imaging patterns with myocardial (18)F-FDG uptake. There were 3 groups of patients: 48 patients underwent PET within 8 h after a treadmill test (Ex 8), 45 patients within 48 h after a treadmill test (Ex 48), and 34 patients without prior exercise. Mean workload (8.4 ± 2.3 [Ex 8] vs. 8.9 ± 2.6 metabolic equivalents [Ex 48]) was similar in both exercise groups. Muscle uptake was assessed by standardized uptake value. Myocardial uptake patterns were compared visually. Minor differences between patient groups were noted only for maximum standardized uptake value in quadriceps muscles. There was no correlation between perfusion defects and myocardial (18)F-FDG uptake patterns. Thus, treadmill exercise does not affect muscle (18)F-FDG uptake or image quality on subsequent PET. Cardiac (18)F-FDG uptake on torso PET scans is unrelated to myocardial perfusion status

Thoracic Manifestations of Collagen Vascular Diseases

Collagen vascular diseases are a diverse group of immunologically mediated systemic disorders that often lead to thoracic changes. the collagen vascular diseases that most commonly involve the lung are rheumatoid arthritis, progressive systemic sclerosis, systemic lupus erythematosus, polymyositis and dermatomyositis, mixed connective tissue disease, and Sjogren syndrome. Interstitial lung disease and pulmonary arterial hypertension are the main causes of mortality and morbidity among patients with collagen vascular diseases. Given the broad spectrum of possible thoracic manifestations and the varying frequency with which different interstitial lung diseases occur, the interpretation of thoracic images obtained in patients with collagen vascular diseases can be challenging. the task may be more difficult in the presence of treatment-related complications such as drug toxicity and infections, which are common in this group of patients. Although chest radiography is most often used for screening and monitoring of thoracic alterations, high-resolution computed tomography can provide additional information about lung involvement in collagen vascular diseases and may be especially helpful for differentiating specific disease patterns in the lung. General knowledge about the manifestations of thoracic involvement in collagen vascular diseases allows radiologists to provide better guidance for treatment and follow-up of these patients.Universidade Federal de São Paulo, Dept Diagnost Imaging, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Diagnost Imaging, BR-04024002 São Paulo, BrazilWeb of Scienc

Thoracic Manifestations of Collagen Vascular Diseases

Collagen vascular diseases are a diverse group of immunologically mediated systemic disorders that often lead to thoracic changes. the collagen vascular diseases that most commonly involve the lung are rheumatoid arthritis, progressive systemic sclerosis, systemic lupus erythematosus, polymyositis and dermatomyositis, mixed connective tissue disease, and Sjogren syndrome. Interstitial lung disease and pulmonary arterial hypertension are the main causes of mortality and morbidity among patients with collagen vascular diseases. Given the broad spectrum of possible thoracic manifestations and the varying frequency with which different interstitial lung diseases occur, the interpretation of thoracic images obtained in patients with collagen vascular diseases can be challenging. the task may be more difficult in the presence of treatment-related complications such as drug toxicity and infections, which are common in this group of patients. Although chest radiography is most often used for screening and monitoring of thoracic alterations, high-resolution computed tomography can provide additional information about lung involvement in collagen vascular diseases and may be especially helpful for differentiating specific disease patterns in the lung. General knowledge about the manifestations of thoracic involvement in collagen vascular diseases allows radiologists to provide better guidance for treatment and follow-up of these patients

Comparative study of clinical, pathological and HRCT findings of primary alveolar proteinosis and silicoproteinosis

Objective: To compare the clinical, high-resolution computed tomography (HRCT) and pathological findings of primary alveolar proteinosis (PAP) and silicoproteinosis.Material and methods: the study included 15 patients with PAP (6 women, 9 men, mean age 31 years) and 13 with silicoproteinosis (13 men, mean age 29.5 years). PAP was diagnosed by lung biopsy in 13 and bronchoalveolar lavage in two patients and silicoproteinosis by bronchoalveolar lavage in 10 and autopsy in three cases. HRCT images were reviewed by two chest radiologists with consensus for the presence, extent and distribution of ground-glass opacities, septal thickening, consolidation and nodules. Radiological-pathological correlation was performed by one radiologist and one chest pathologist.Results: Seven (46%) patients with PAP were asymptomatic; the remainder presented slowly progressive dyspnea and dry cough. All silicoproteinosis patients had dry cough and rapidly progressive dyspnea. the most common HRCT finding on PAP was the crazy-paving pattern (93%). All cases had areas of geographic sparing in the affected lung. the most common finding in silicoproteinosis (92%) was dependent consolidation with calcification in 83%. Centrilobular nodules were common (85%). On pathology, both diseases demonstrated intra-alveolar accumulation of PAS material, thickening of interlobular septae and alveolar walls and no evidence of fibrosis. A few silica particles were seen in silicoproteinosis.Conclusion: Despite the pathological similarities, PAP and silicoproteinosis have distinct clinical and imaging features and prognosis. Bilateral crazy-paving pattern with areas of geographic sparing is characteristic for PAP. Silicoproteinosis presents with bilateral dependent consolidation often with areas of calcification. the crazy-paving pattern is not seen in silicoproteinosis. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Ottawa Gen Hosp, Dept Diagnost Imaging, Ottawa, ON K1H 8L6, CanadaUniv Fed Rio de Janeiro, Univ Hosp, Dept Radiol, BR-21941913 Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Univ Hosp, Dept Radiol, BR-04024002 São Paulo, BrazilUniv Fed Parana, Dept Radiol, BR-08006090 Curitiba, Parana, BrazilFac Med Sao Jose do Rio Preto, Dept Radiol, BR-15015800 Sao Jose Do Rio Preto, BrazilUniversidade Federal de São Paulo, Univ Hosp, Dept Radiol, BR-04024002 São Paulo, BrazilWeb of Scienc