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Sökning: WFRF:(Torkzad Michael R.)

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  • Beets-Tan, Regina G. H., et al. (författare)
  • Magnetic resonance imaging for the clinical management of rectal cancer patients : recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting
  • 2013
  • Ingår i: European Radiology. - 0938-7994 .- 1432-1084. ; 23:9, s. 2522-2531
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>To develop guidelines describing a standardised approach regarding the acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for clinical staging and restaging of rectal cancer. A consensus meeting of 14 abdominal imaging experts from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) was conducted following the RAND-UCLA Appropriateness Method. Two independent (non-voting) chairs facilitated the meeting. Two hundred and thirty-six items were scored by participants for appropriateness and classified subsequently as appropriate or inappropriate (defined by a parts per thousand yen 80 % consensus) or uncertain (defined by &lt; 80 % consensus). Items not reaching 80 % consensus were noted. Consensus was reached for 88 % of items: recommendations regarding hardware, patient preparation, imaging sequences, angulation, criteria for MRI assessment and MRI reporting were constructed from these. These expert consensus recommendations can be used as clinical guidelines for primary staging and restaging of rectal cancer using MRI. These guidelines recommend standardised imaging for staging and restaging of rectal cancer. The guidelines were constructed through consensus amongst 14 abdominal imaging experts. Consensus was reached by in 88 % of 236 items discussed.</p>
  • Latifi, Ali, et al. (författare)
  • The accuracy of focused abdominal CT in patients presenting to the emergency department
  • 2009
  • Ingår i: Emergency Radiology. - 1070-3004 .- 1438-1435. ; 16:3, s. 209-215
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Focused computed tomography(CT) examination (FCT) is CT limited to a specific abdominal area in an attempt to reduce radiation exposure. We wanted to evaluate FCT on the basis of information from the request form and thus reduce radiation dose to the patient without missing relevant findings. We retrospectively analyzed 189 consecutive acute abdominal CT, dividing the findings as localized in the upper or lower abdomen. Another researcher blindly determined where the CT should be focused to, based only on information provided in the request form. The sensitivity and specificity of FCT in patients with symptoms from only upper abdomen was 100%. Sensitivity, specificity, and accuracy of FCT in patients with symptom from only lower abdomen were 79%, 100%, and 92%, respectively. Our study suggests that among patients with symptoms from the lower abdomen, not examining the upper abdomen would lead to missing relevant findings.</p>
  • Torkzad, Michael R, et al. (författare)
  • Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy.
  • 2011
  • Ingår i: Thrombosis research. - 1879-2472. ; 127 suppl 3
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Pelvic deep vein thrombosis (DVT) is difficult to diagnose during pregnancy. In a two-center trial, we evaluated the agreement between ultrasonography and magnetic resonance imaging (MRI) in diagnosing the extent of DVT into the pelvic veins during pregnancy. MATERIALS AND METHODS: Pregnant women with proximal DVT were examined both with ultrasound and MRI as part of a study designed for treatment of DVT during pregnancy. Ultrasound was performed using color flow by specialist in vascular ultrasound with Doppler and compression techniques. The MRI sequences consisted of a 2D Time of Flight angiography with arterial flow suppression and maximum intensity projection reconstructions; a 3D, T1-w-prepared gradient echo sequence with fat saturation for thrombus imaging; a steady-state free precession sequence; and a Turbo-Spin-Echo. No contrast agent was used. Proportion of agreement (kappa) for detection of DVT in individual veins was measured for different ipsilateral veins and inferior vena cava. RESULTS: All 27 patients were imaged with both techniques at an average gestational age of 29 weeks (range 23-39). Three cases (11.5%) of DVT in the pelvic veins were missed on ultrasound but detected by MRI. The upper limit of the DVT was always depicted at a higher (20 cases, 65.4%) or the same level (seven cases, 34.6%) on MRI than on ultrasound. Agreement expressed as kappa was 0.33 (95% CI 0.27-0.40) demonstrating only fair agreement. In one woman the thrombus had propagated into the inferior vena cava, shown only on MRI. CONCLUSION: Our study suggests that in pregnant women there is only fair agreement between ultrasound and MRI for determination of extent of DVT into pelvic veins, with MRI showing consistently more detailed depiction of extension. Our results indicate that MRI has an important role as a complementary technique in the diagnosis of DVT during pregnancy.
  • Arakelian, Erebouni, et al. (författare)
  • Pulmonary influences on early post-operative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment a retrospective study
  • 2012
  • Ingår i: World Journal of Surgical Oncology. - 1477-7819 .- 1477-7819. ; 10, s. 258
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment option for peritoneal carcinomatosis (PC). There have been few studies on the pulmonary adverse events (AEs) affecting patient recovery after this treatment, thus this study investigated these factors. Methods: Between January 2005 and December 2006, clinical data on all pulmonary AEs and the recovery progress were reviewed for 76 patients with after CRS and HIPEC. Patients with pulmonary interventions (thoracocenthesis and chest tubes) were compared with the non-intervention patients. Two senior radiologists, blinded to the post-operative clinical course, separately graded the occurrence of pulmonary AEs. Results: Of the 76 patients, 6 had needed thoracocentesis and another 6 needed chest tubes. There were no differences in post-operative recovery between the intervention and non-intervention groups. The total number of days on mechanical ventilation, the length of stay in the intensive care unit, total length of hospital stay, tumor burden, and an American Society of Anesthesiologists (ASA) grade of greater than 2 were correlated with the occurrence of atelectasis and pleural effusion. Extensive atelectasis (grade 3 or higher) was seen in six patients, major pleural effusion (grade 3) in seven patients, and signs of heart failure (grade 1-2) in nine patients. Conclusions: Clinical and radiological post-operative pulmonary AEs are common after CRS and HIPEC. However, most of the pulmonary AEs did not affect post-operative recovery.</p>
  • Darkeh, M. H. S. E., et al. (författare)
  • The minimum number of target lesions that need to be measured to be representative of the total number of target lesions (according to RECIST)
  • 2009
  • Ingår i: British Journal of Radiology. - 0007-1285 .- 1748-880X. ; 82:980, s. 681-6
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Response evaluation criteria in solid tumours (RECIST) were introduced as a means to classify tumour response with no definition of the minimum number of lesions. This study was conducted in order to evaluate discrepancies between full assessments based on either all target lesions or fewer lesions. RECIST evaluation was performed on separate occasions based on between one and seven of the target lesions, with simultaneous assessment of non-target lesions. 99 patients were included. 38 patients demonstrated progressive disease, in 61% of whom it was a result of the appearance of new lesions or unequivocal progress in non-target lesions. 32 patients showed stable disease, with 8 having results that differed when 1-3 target lesions were measured. 22 cases were considered as having partial regression, with only 1 case differing when performing 1-3 target lesion assessments. Seven cases demonstrated complete response. The number of discordant cases increased gradually from measuring three lesions to one target lesion. The average number of available target lesions among those with discrepancies was 7.1, which was significantly higher than those demonstrating concordance (4.1 lesions; p&lt;0.05). In conclusion, measuring fewer than four target lesions might cause discrepancies when more than five target lesions are present.</p>
  • Grevfors, Niklas, et al. (författare)
  • Can acute abdominal CT prioritise patients with suspected diverticulitis for a subsequent clean colonic examination?
  • 2012
  • Ingår i: Colorectal Disease. - 1462-8910 .- 1463-1318. ; 14:7, s. 893-896
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Aim: </strong></p><p>The aim of this study was to investigate whether patients with diverticulitis can be prioritised with higher urgency for a subsequent full colonic examination based upon the emergency abdominal computerised tomography (CT) at the time of presentation.</p><p><strong>Method:</strong> </p><p>All patients with a diagnosis of diverticulitis hospitalized during 2006 having CT on admission and a subsequent 'clean colon' examination were reviewed. The CT was reviewed by two independent and blinded senior radiologists (A and B) for signs inconsistent with diverticulitis and suggestive of malignancy. The patients were classified on CT into group 1 (normal findings, non-tumour pathology or benign polyps &lt; 1 cm) and group 2 (benign polyps ≥ 1 cm and cancer).</p><p><strong>Results: </strong></p><p>93 patients were reviewed with 83 in group 1and 10 in group 2. Radiologist A suggested high priority colonic examination in 18% and 50% of groups 1 and 2, and Radiologist B in 63% and 90%. There was a statically significant inter-observer difference and also lower accuracy of Radiologist B than Radiologist A in predicting a subsequent 'clean colon' examination.</p><p><strong>Conclusion: </strong></p><p>Using an emergency acute CT scan at the time of diagnosis of diverticulitis to predict a clean colon examination for neoplasia is not reliable since there is considerable degree of inter-observer difference between rediologista.</p>
  • Latifi, Ali, et al. (författare)
  • Does enteral contrast increase the accuracy of appendicitis diagnosis?
  • 2011
  • Ingår i: Radiologic Technology. - 0033-8397 .- 1943-5657. ; 82:4, s. 294-299
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>BACKGROUND:</strong> Several approaches traditionally have helped opacify the bowel when computed tomography (CT) is used to diagnose appendicitis. With the development of multidetector row CT (MDCT), the need for enteral contrast agents is less obvious. Purpose The objective of this study was to evaluate retrospectively the accuracy of MDCT demonstration of appendicitis using enteral contrast agents.</p> <p><strong>METHODS:</strong> We reviewed radiologic reports of all 246 adult patients with suspected appendicitis who underwent 16-slice MDCT during 2005-2006 at our department. The use of enteral contrast agents and the route of administration were documented by one investigator. A radiologist evaluated whether the responses in the reports were consistent with diagnosis of appendicitis. The accuracy of the radiologic reports was assessed using the results of surgery, histopathology and 3 to 21 months of follow-up.</p> <p><strong>RESULTS:</strong> Of patients studied, 14.6% received no enteral contrast agent, 8.5% received both oral contrast and rectal contrast (enema), 46.7% received oral contrast and 30.1% received rectal contrast enemas. The accuracies for the CT diagnosis of appendicitis with different combinations of agents ranged from 95% to 100%, with no significant difference among groups.</p> <p><strong>CONCLUSION:</strong> Our study shows that the accuracy for diagnosis of appendicitis by abdominal 16-slice MDCT is high regardless of enteral contrast use. Therefore, further use of enteral contrast agents for CT diagnosis of appendicitis in adults cannot be recommended.</p>
  • Påhlman, Lars, et al. (författare)
  • Rectal cancer staging : is there an optimal method?
  • 2011
  • Ingår i: Future Oncology. - 1479-6694. ; 7:1, s. 93-100
  • Forskningsöversikt (refereegranskat)abstract
    • <p>The staging process in a newly diagnosed rectal cancer is divided into three parts. One essential part is the local staging, in which both endorectal ultrasound and MRI are used to disclose the size of the tumor and its correlation to the perirectal fascia, and to identify lymph node deposits and vascular invasion. This local staging process will guide clinicians to decide upon not only the type of surgery (local excision or radical surgery) but also whether or not some type of neoadjuvant treatment, such as radiotherapy and/or chemotherapy, is indicated. The second part is to evaluate whether or not the tumor has already metastasized at diagnosis. The most important organs to evaluate are the liver and lungs, and imaging techniques such as ultrasound. CT-scan, or sometimes PET-CT, and MRI can be used. The third important part is to investigate the rest of the large bowel for synchronous adenomas or cancers. This will preferably be done with colonoscopy or CT-colonography and sometimes barium enema. This article discusses the imaging techniques used for local staging and distant metastases.</p>
  • Suzuki, Chikako, et al. (författare)
  • Interobserver and intraobserver variability in the response evaluation of cancer therapy according to RECIST and WHO-criteria
  • 2010
  • Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 49:4, s. 509-514
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>BACKGROUND:</strong> Response Evaluation Criteria In Solid Tumors (RECIST) and WHO-criteria are used to evaluate treatment effects in clinical trials. The purpose of this study was to examine interobserver and intraobserver variations in radiological response assessment using these criteria.</p><p><strong>MATERIAL AND METHODS:</strong> Thirty-nine patients were eligible. Each patient's series of CT images were reviewed. Each patient was classified into one of four categories according RECIST and WHO-criteria. To examine interobserver variation, response classifications were independently obtained by two radiologists. One radiologist repeated the procedure on two additional different occasions to examine intraobserver variation. Kappa statistics was applied to examine agreement.</p><p><strong>RESULTS:</strong> Interobserver variation using RECIST and WHO-criteria were 0.53 (95% CI 0.33-0.72) and 0.60 (0.39-0.80), respectively. Response rates (RR) according to RECIST obtained by reader A and reader B were 33% and 21%, respectively. RR according to WHO-criteria obtained by reader A and reader B were 33% and 23% respectively. Intraobserver variation using RECIST and WHO-criteria ranged between 0.76-0.96 and 0.86-0.91, respectively.</p><p><strong>CONCLUSION:</strong> Radiological tumor response evaluation according to RECIST and WHO-criteria are subject to considerable inter- and intraobserver variability. Efforts are necessary to reduce inconsistencies from current response evaluation criteria.</p>
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