USPIO-enhanced MR imaging appears valuable for assessment of axillary lymph node metastases in patients with breast carcinomas and is superior to nonenhanced MR imaging.
The aim of this study was to analyze pulmonary embolism (PE) occurrence and retrospective clinical outcome in patients with clinically suspected acute PE and a negative spiral CT angiography (SCTA) of the pulmonary arteries. Within a 35-month period, 485 consecutive patients with clinical symptoms of acute PE underwent SCTA of the pulmonary arteries. Patients with a negative SCTA and without anticoagulation treatment were followed-up and formed the study group. Patient outcome and recurrence of PE was evaluated retrospectively during a period of 6 months after the initial SCTA, and included a review of computerized patient records, and interviews with physicians and patients. Patients were asked to fill out a questionnaire concerning all relevant questions about their medical history and clinical course during the follow-up period. Special attention was focused on symptoms indicating recurrent PE, as well as later confirmation and therapy of PE. Of the 485 patients, 325 patients (67%) had a negative scan, 134 (27.6%) had radiological signs of PE, and 26 (5.4%) had an indeterminant result. Of 325 patients with a negative scan, 269 (83%) were available for follow-up. The main reasons for loss to follow-up were change of address, name, or phone number, or non-resident patients who left abroad. Of 269 patients available for follow-up, 49 patients (18.2% of 269) received anticoagulant treatment because of prior or recent deep venous thrombosis (32.6%) or a history of PE (34.7%), cardiovascular disease (18.4%), high clinical probability (8.2%), positive ventilation-perfusion scan (4.2%), and elevated D-dimer test (2%). The remaining 220 patients, who did not receive anticoagulant medication, formed the study group. Of this study group, 1 patient died from myocardial infarction 6 weeks after the initial SCTA, and the postmortem examination also detected multiple peripheral emboli in both lungs ( p=0.45%; 0.01-2.5, 95% confidence interval). The PE did not occur in any other patient. In patients with suspected PE and negative SCTA without anticoagulant therapy, the risk of recurrent PE in this study was less than 1% and similar to that in patients after a negative pulmonary angiogram. Therefore, we conclude that patients can be managed safely without anticoagulation therapy; however, this approach may not be appropriate for critically ill patients and those with persistent high clinical suspicion of acute PE.
Background Contrast‐enhanced magnetic resonance imaging (CE‐MRI) of the breast is highly sensitive for breast cancer detection. Multichannel coils and 3T scanners can increase signal, spatial, and temporal resolution. In addition, the T 1 ‐reduction effect of a gadolinium‐based contrast agent (GBCA) is higher at 3T. Thus, it might be possible to reduce the dose of GBCA at 3T without losing diagnostic information. Purpose To compare a three‐quarter (0.075 mmol/kg) dose of the high‐relaxivity GBCA gadobenate dimeglumine, with a 1.5‐fold higher than on‐label dose (0.15 mmol/kg) of gadoterate meglumine for breast lesion detection and characterization at 3T CE‐MRI. Study Type Prospective, randomized, intraindividual comparative study. Population Eligible were patients with imaging abnormalities (BI‐RADS 0, 4, 5) on conventional imaging. Each patient underwent two examinations, 24–72 hours apart, one with 0.075 mmol/kg gadobenate and the other with 0.15 mmol/kg gadoterate administered in a randomized order. In all, 109 patients were prospectively recruited. Field Strength/Sequence 3T MRI with a standard breast protocol (dynamic‐CE, T 2 w‐TSE, STIR‐T 2 w, DWI). Assessment Histopathology was the standard of reference. Three blinded, off‐site breast radiologists evaluated the examinations using the BI‐RADS lexicon. Statistical Tests Lesion detection, sensitivity, specificity, and diagnostic accuracy were calculated per‐lesion and per‐region, and compared by univariate and multivariate analysis (Generalized Estimating Equations, GEE). Results Five patients were excluded, leaving 104 women with 142 histologically verified breast lesions (109 malignant, 33 benign) available for evaluation. Lesion detection with gadobenate (84.5‐88.7%) was not inferior to gadoterate (84.5–90.8%) ( P ≥ 0.165). At per‐region analysis, gadobenate demonstrated higher specificity (96.4–98.7% vs. 92.6–97.3%, P ≤ 0.007) and accuracy (96.3–97.8% vs. 93.6–96.1%, P ≤ 0.001) compared with gadoterate. Multivariate analysis demonstrated superior, reader‐independent diagnostic accuracy with gadobenate (odds ratio = 1.7, P < 0.001 using GEE). Data Conclusion A 0.075 mmol/kg dose of the high‐relaxivity contrast agent gadobenate was not inferior to a 0.15 mmol/kg dose of gadoterate for breast lesion detection. Gadobenate allowed increased specificity and accuracy. Level of Evidence : 1 Technical Efficacy : Stage 2 J. Magn. Reson. Imaging 2019;49:1157–1165.
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