BackgroundIdiopathic pulmonary fibrosis acute exacerbation (IPF-AE) constitutes IPF’s most devastating event, representing the unexpected superimposition of diffuse alveolar damage of unknown etiology. Guidelines recommend high-dose steroids treatment despite unproven benefit. We hypothesized that previous immunosuppression and the administration of high-dose steroids adversely affect IPF-AE outcome.MethodsWe studied all consecutive patients hospitalized in our department for IPF deterioration from 2007 to June 2013. Our protocol consisted of immediate cessation of immunosuppression (if any), best supportive care, broad-spectrum antimicrobials and thorough evaluation to detect reversible causes of deterioration. Patients were followed-up for survival; post-discharge none received immunosuppression.ResultsTwenty-four out of 85 admissions (28 %) fulfilled IPF-AE criteria. IPF-AE were analyzed both as unique events and as unique patients. As unique events 50 % survived; 3 out of 12 (25 %) in the group previously treated with immunosuppression whereas nine out of 12 (75 %) in the group not receiving immunosuppression (p = 0.041). As unique patients 35.3 % survived; 3 out of 6 (50 %) in the never treated group whereas three out of 11 (27.3 %) in the group receiving immunosuppression (p = 0.685). The history of immunosuppression significantly and adversely influenced survival (p = 0.035). Survival was greater in the never treated group compared to the immunosuppressed patients (p = 0.022). Post-discharge, our IPF-AE survivors had an 83 % 1-year survival.ConclusionsBy applying the above mentioned protocol half of our patients survived. The history of immunosuppression before IPF-AE adversely influences survival. Avoiding steroids in IPF patients may favor the natural history of the disease even at the moment of its most devastating event.
Excessive lordosis is a common finding and may produce mechanical pressure that causes repetitive strains of the interspinous ligament with subsequent degeneration and collapse. Baastrup’s disease (kissing spine syndrome) is a term referring to close approximation of adjacent spinous processes due to degenerative changes of the spine. Baastrup’s disease usually affects the lumbar spine, with L4-L5 being the most commonly affected level. There is higher occurrence at ages over 70 and no gender predilection. Symptoms include back pain with midline distribution that worsens during extension, is relieved during flexion and is exaggerated upon finger pressure at the level of interest. Diagnosis rests on clinical examination and imaging studies. The hallmark of imaging findings is the close approximation and contact of adjacent spinous processes, with all the subsequent findings including oedema, cystic lesions, sclerosis, flattening and enlargement of the articulating surfaces, bursitis and occasionally epidural cysts or midline epidural fibrotic masses. Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies such as excision of the bursa or osteotomy. The purpose of this study is to illustrate the spectrum of imaging findings in Baastrup’s disease and to emphasise upon including the syndrome in the list of potential causes of low-back pain.Teaching Points• Baastrup’s disease refers to close approximation of adjacent spinous processes.• Diagnosis of Baastrup’s disease is verified with clinical examination and imaging studies.• Contact of adjacent spinous processes results in oedema, sclerosis, flattening and enlargement.• Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies.
The introduction of mechanisms for dose reduction resulted in significantly lower patient effective doses for CT examinations of the head, chest and abdomen reported by studies published after 1995. Owing to the limited number of studies reporting patient doses for multislice CT examinations the statistical power to detect differences with single-slice scanners is not yet adequate.
Computed tomography (CT) coronary angiography has been widely used since the introduction of 64-slice scanners and dual-source CT technology, but high radiation doses have been reported. Prospective ECG-gating using a 'step-and-shoot' axial scanning protocol has been shown to reduce radiation exposure effectively while maintaining diagnostic accuracy. 256-slice scanners with 80 mm detector coverage have been currently introduced into practice, but their impact on radiation exposure has not been adequately studied. The aim of this study was to assess radiation doses associated with CT coronary angiography using a 256-slice CT scanner. Radiation doses were estimated for 25 patients scanned with either prospective or retrospective ECG-gating. Image quality was assessed objectively in terms of mean CT attenuation at selected regions of interest on axial coronary images and subjectively by coronary segment quality scoring. It was found that radiation doses associated with prospective ECG-gating were significantly lower than retrospective ECG-gating (3.2 +/- 0.6 mSv versus 13.4 +/- 2.7 mSv). Consequently, the radiogenic fatal cancer risk for the patient is much lower with prospective gating (0.0176% versus 0.0737%). No statistically significant differences in image quality were observed between the two scanning protocols for both objective and subjective quality assessments. Therefore, prospective ECG-gating using a 'step-and-shoot' protocol that covers the cardiac anatomy in two axial acquisitions effectively reduces radiation doses in 256-slice CT coronary angiography without compromising image quality.
Our results suggest that the iterative acquisition protocol provides great potential for reducing radiation exposure and maintaining or improving image quality in CAP CT examinations.
We describe the imaging findings in a rare case of multifocal nodular form of hepatic epithelioid hemangioendothelioma on ultrasound (US) and dynamic contrast-enhanced spiral computed tomography (CT) and MRI. The nodules showed multilayered target appearance on MR images with prominent peripheral rim with high signal intensity (SI) on T1-weighted and very low SI on T2-weighted images, corresponding to thrombosed vascular channels. The above combination of imaging findings is to our knowledge distinct and should suggest the diagnosis of hepatic epithelioid hemangioendothelioma. HEPATIC EPITHELIOID hemangioendothelioma is a rare liver tumor of vascular origin, presenting in diffuse, multifocal, or solitary nodular form (1-3). The latter is considered the earlier form of the neoplasm, gradually evolving into the diffuse one (2). Although the tumor is considered malignant it carries a better prognosis compared to other hepatic malignancies, even in the presence of distal metastases, and it is therefore important to distinguish it from them (2,4). Relatively specific imaging findings include peripheral location of the nodules, capsular flattening or retraction (present in less than 25% of cases), and occasionally a target-like configuration with more sclerotic-fibrous center and cellular proliferative periphery (5). Because of the relative rarity of the nodular form of epithelioid hemangioendothelioma, many published cases were initially misdiagnosed. We present a rare case of multifocal form of epithelioid hemangioendothelioma and describe its discrete imaging findings, consisting of multiple nodules with capsular flattening, retraction, and a multilayered target-like appearance better seen on MR imaging. To our knowledge this is the first report of a multilayered appearance with a peripheral ring of high signal intensity (SI) on T1-weighted images and very low SI on T2 weighted images corresponding to thrombosed vascular channels. These imaging findings in the appropriate clinical setting should be considered highly suggestive of epithelioid hemangioendothelioma. CASE REPORTA 40-year-old male patient presented to our hospital complaining of repeated episodes of low to medium grade fever over a period of six months. Clinical examination was unremarkable except for vague upper abdominal quadrant discomfort. The laboratory workup showed a slight elevation of alkaline phosphatase (ALP), ␥-glutamyl transferase (␥-GT), and lactic dehydrogenase (LDH) levels. There was a gradual increase of erythrocyte sedimentation rate (20 mm at the day of admittance to 90 mm at the 10th day) and C-reactive protein (CRP) levels.Abdominal grayscale ultrasound (US) performed on an ATL HDI 3500 scanner, revealed multiple subcapsular nodules with maximum diameter of 3.5 cm, and a bull's eye appearance with hyperechoic center and hypoechoic periphery (Fig. 1a). Subsequently, a spiral computed tomography (CT) was performed on a spiral scanner (Highspeed DX/i; General Electric Medical Systems), with beam collimation of 7 mm, table increment of ...
This study demonstrated that the application of iDose at CCTA facilitates significant radiation dose reduction by maintaining diagnostic quality. The combination of iDose4 with prospective acquisition is able to significantly reduce effective dose associated with CTCA at values of approximately 2 mSv and even lower.
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