Long-Term Serial Follow-Up of Pulmonary Artery Size and Wall Shear Stress in Fontan Patients

Pulmonary arterial (PA) flow is abnormal after the Fontan operation and is marked by a lack of pulsatility. We assessed the effects of this abnormal flow on the size and function of the PA’s in Fontan patients in long-term serial follow-up. Twenty-three Fontan patients with serial follow-up were included. Median age was 11.1 (9.5–16.0) years at baseline and 15.5 (12.5–22.7) years at follow-up. Median follow-up duration was 4.4 (4.0–5.8) years. Flow and size of the left pulmonary artery were determined using phase-contrast MRI. From this wall shear stress (WSS), distensibility and pulsatility were determined. A group of healthy peers was included for reference. Flow and pulsatility were significantly lower in patients than in controls (p < 0.001). Mean area was comparable in patients and controls, but distensibility was significantly higher in controls (p < 0.001). Mean and peak WSS were significantly lowe

Bone suppression increases the visibility of invasive pulmonary aspergillosis in chest radiographs

Objective: Chest radiographs (CXR) are an important diagnostic tool for the detection of invasive pulmonary aspergillosis (IPA) in critically ill patients, but their diagnostic value is limited by a poor sensitivity. By using advanced image processing, the aim of this study was to increase the value of chest radiographs in the diagnostic work up of neutropenic patients who are suspected of IPA. Methods: The frontal CXRs of 105 suspected cases of IPA were collected from four institutions. Radiographs could contain single or multiple sites of infection. CT was used as reference standard. Five radiologists and two residents participated in an observer study for the detection of IPA on CXRs with and without bone suppressed images (ClearRead BSI 3.2; Riverain Technologies). The evaluation was performed separately for the right and left lung, resulting in 78 diseased cases (or lungs) and 132 normal cases (or lungs). For each image, observers scored the likelihood of focal infectious lesions being present on a continuous scale (0-100). The area under the receiver operating characteristics curve (AUC) served as the performance measure. Sensitivity and specificity were calculated by considering only the lungs with a suspiciousness score of greater than 50 to be positive. Results: The average AUC for only CXRs was 0.815. Performance significantly increased, to 0.853, when evaluation was aided with BSI (p = 0.01). Sensitivity increased from 49% to 66% with BSI, while specificity decreased from 95% to 90%. Conclusion: The detection of IPA in CXRs can be improved when their evaluation is aided by bone suppressed images. BSI improved the sensitivity of the CXR examination, outweighing a small loss in specificity

Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block.

Item does not contain fulltextBACKGROUND: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. CASE REPORTS: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral block at T2-3. One patient also developed an ipsilateral hemidiaphragmatic paresis, an adverse effect that has not been reported before. Subsequent radiologic examination revealed a limited thoracic cephalad spread of the radiopaque dye and a laterally ascending spread from the thoracic paravertebral space toward and around the brachial plexus. We offer potential explanations for these phenomena. CONCLUSIONS: Brachial plexus block can occur by a route parallel to a nerve connecting the second intercostal nerve and T1 nerve, that is, Kuntz nerve. The hemidiaphragmatic paresis was attributed to the ascending spread of local anesthetic toward the area where the phrenic nerve bypasses the subclavian artery and vein

Safety of computer-assisted surgery for cannulated hip screws.

Computer-assisted orthopaedic surgery has developed considerably during the past few years. Several manufacturers produce hardware and software for use in trauma surgery. Validation of these systems before clinical application is mandatory to be sure they work accurately and safely. The accuracy of surgical performance is highly correlated with the cut-out percentages of hip screws. In a standardized operative setting, three cannulated hip screws were inserted in each of 20 sawbones. The screws were positioned either by fluoroscopic navigation technique or by conventional operative technique depending on randomization. Our primary aim was to assess whether computer-navigated screw fixation is equally safe compared with conventional screw fixation using fluoroscopy. To determine safety, we investigated number of drilling attempts, screw position, and radiation time. Secondary to these safety parameters, we also compared the operating time between the two procedures to assess the efficiency of computer navigation. Statistical analysis showed no differences regarding accuracy of screw position. Computer-assisted surgery resulted in fewer drilling attempts and less radiation time, with a similar operation time. We believe the currently used navigation system is safe and accurate

Bone Suppression Increases the Visibility of Invasive Pulmonary Aspergillosis in Chest Radiographs

Contains fulltext : 156855.pdf (publisher's version ) (Open Access

Malignancy risk estimation of pulmonary nodules in screening CTs: Comparison between a computer model and human observers

Contains fulltext : 179583.pdf (publisher's version ) (Open Access

Bone suppression increases the visibility of invasive pulmonary aspergillosis in chest radiographs

Contains fulltext : 139406.pdf (publisher's version ) (Open Access)Chest radiographs (CXR) are an important diagnostic tool for the detection of invasive pulmonary aspergillosis (IPA) in critically ill patients, but their diagnostic value is limited by a poor sensitivity. By using advanced image processing, the aim of this study was to increase the value of chest radiographs in the diagnostic work up of neutropenic patients who are suspected of IPA.The frontal CXRs of 105 suspected cases of IPA were collected from four institutions. Radiographs could contain single or multiple sites of infection. CT was used as reference standard. Five radiologists and two residents participated in an observer study for the detection of IPA on CXRs with and without bone suppressed images (ClearRead BSI 3.2; Riverain Technologies). The evaluation was performed separately for the right and left lung, resulting in 78 diseased cases (or lungs) and 132 normal cases (or lungs). For each image, observers scored the likelihood of focal infectious lesions being present on a continuous scale (0-100). The area under the receiver operating characteristics curve (AUC) served as the performance measure. Sensitivity and specificity were calculated by considering only the lungs with a suspiciousness score of greater than 50 to be positive.The average AUC for only CXRs was 0.815. Performance significantly increased, to 0.853, when evaluation was aided with BSI (p = 0.01). Sensitivity increased from 49\% to 66\% with BSI, while specificity decreased from 95\% to 90\%.The detection of IPA in CXRs can be improved when their evaluation is aided by bone suppressed images. BSI improved the sensitivity of the CXR examination, outweighing a small loss in specificity

Image Quality of Iodine Maps for Pulmonary Embolism: A Comparison of Subtraction CT and Dual-Energy CT

Item does not contain fulltex

Oesophageal dilatation on high-resolution computed tomography scan of the lungs as a sign of scleroderma.

Contains fulltext : 71274.pdf (publisher's version ) (Closed access)BACKGROUND: Systemic sclerosis (SSc) is a generalised autoimmune disease that causes morbidity and reduced life expectancy. Recently, evidence has been accumulating that immunosuppressive treatment in an early stage of the disease could improve survival, enhancing the need for early diagnosis and regular evaluation of organ involvement. Among others, a high-resolution computer tomography (HRCT) scan of the chest is performed for the assessment of pulmonary involvement in SSc. The objective of this study is to evaluate the predictive value of oesophageal dilatation on the HRCT scan for the diagnosis of SSc. METHODS: In total, 105 consecutive patients with scleroderma and 107 consecutive controls were included in this study. The first available scan for each patient and control was evaluated in random order and blinded for the diagnosis, by two independent radiologists, for oesophageal dilatation and interstitial lung disease. RESULTS: The positive predictive value of oesophageal dilatation for the diagnosis of SSc was 83%. No significant correlation of oesophageal dilatation and interstitial lung disease was found in the patients with scleroderma or controls. CONCLUSION: Oesophageal dilatation as visible on an HRCT scan of the chest may alert doctors to look for other signs or symptoms of SSc in these patients, enabling early diagnosis and specific treatment