Differential

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  • 文章类型: Journal Article
    目的:描述和评估目前关于骨凝集素炎(OCI)的MRI特征在OCI诊断和与其他疾病区分方面的知识。
    方法:数据库PubMed,EMBASE,Scopus,和WebofScience从开始到2024年3月,使用搜索词“磁共振成像”(PubMed中的MESH术语)和“骨炎凝集素”进行搜索,仅限于英语。两名审稿人独立筛选标题,摘要,和全文合格性,并根据诊断准确性研究的质量评估评估偏差的风险,QUADAS-2.
    结果:搜索确定了53条记录。病例报告,信件/笔记,会议摘要被排除在外,产生24份全文评估报告,9篇研究文章,14条评论,一本书的章节。发现五项回顾性研究研究符合审查条件。OCI的详细MRI特征仅在两项对疼痛患者的研究中进行了描述,这些患者包括明显的软骨下髂骨硬化,通常伴有位于硬化周围的骨髓水肿(BME),并显示出连续分布并经常伴有骶骨BME。很少有糜烂,没有发生强直。骨髓中的脂肪沉积很频繁,与BME相似,通常位于与前应变相关的关节区域。QUADAS-2评估揭示了所有分析的研究中存在偏倚的风险,特别是关于MRI特征的一般适用性。
    结论:缺乏描述有疼痛和无疼痛的OCI患者一般组的特征性MRI特征的有效数据。
    OBJECTIVE: To describe and  evaluate the current knowledge of MRI characteristics of osteitis condensans ilii (OCI) in the diagnostics and differentiation of OCI from other conditions.
    METHODS: The databases PubMed, EMBASE, Scopus, and Web of Science were searched from their inception to March 2024 using the search terms \"Magnetic Resonance Imaging\" (MESH term in PubMed) and \"osteitis condensans ilii\" and limited to English language. Two reviewers independently screened titles, abstracts, and full-text eligibility and assessed the risk of bias according to Quality Assessment of Diagnostic Accuracy Studies, QUADAS-2.
    RESULTS: The search identified 53 records. Case reports, letters/notes, and conference abstracts were excluded, resulting in 24 reports assessed by full-text, 9 research articles, 14 reviews, and a book chapter. Five retrospective research studies were found eligible for the review. Detailed MRI features of OCI were only described in two studies of patients with pain where they encompassed manifest subchondral iliac sclerosis often accompanied by bone marrow edema (BME) located peripheral to the sclerosis and displaying a continuous distribution and frequently accompanied by sacral BME. Erosions were rare and ankylosis did not occur. Fat deposition in the bone marrow was frequent and similar to BME often located to anterior strain-related joint areas. The QUADAS-2 assessments revealed risks of bias in all studies analyzed, especially regarding general applicability of the MRI features.
    CONCLUSIONS: There is a lack of valid data describing characteristic MRI features in general groups of OCI patients with and without pain.
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  • 文章类型: Journal Article
    目的:评估定量磁共振(MR)成像生物标志物在区分炎性胰腺肿块(IPM)和胰腺癌(PC)中的诊断性能。
    方法:使用PubMed进行了文献检索,Embase,Cochrane图书馆,和WebofScience到2023年8月。诊断准确性研究2(QUADAS-2)的质量评估用于评估研究的偏倚风险和适用性。汇集的敏感性,特异性,正似然比,负似然比,和诊断比值比使用DerSimonian-Laird方法计算。使用单因素荟萃回归分析来确定异质性的潜在因素。
    结果:本荟萃分析包括24项研究。IPM的两种主要类型,肿块型胰腺炎(MFP)和自身免疫性胰腺炎(AIP),它们的表观扩散系数(ADC)值不同。与PC相比,MFP的ADC值较高,但AIP值较低。ADC的合并敏感性/特异性为0.80/0.85用于区分MFP和PC和0.82/0.84用于区分AIP和PC。上游主胰管最大直径(dMPD)的合并敏感性/特异性为0.86/0.74,截止dMPD≤4mm,和0.97/0.52,截止dMPD≤5mm。灌注分数(f)的合并敏感性/特异性为0.82/0.68,质量刚度值为0.82/0.77。
    结论:定量MR成像生物标志物可用于区分IPM和PC。MFP和AIP之间的ADC值不同,他们应该分开考虑在未来的研究。
    结论:定量MR参数可作为非侵入性成像生物标志物,用于区分恶性胰腺肿瘤和胰腺炎性肿块,因此有助于避免不必要的手术。
    结论:•几种定量MR成像生物标志物在炎性胰腺肿块和胰腺癌的鉴别诊断中表现良好。•ADC值可以辨别胰腺癌与肿块型胰腺炎或自身免疫性胰腺炎,如果两种炎性肿块类型没有合并。•主胰管的直径对于区分自身免疫性胰腺炎和胰腺癌具有最高的特异性。
    OBJECTIVE: To evaluate the diagnostic performance of quantitative magnetic resonance (MR) imaging biomarkers in distinguishing between inflammatory pancreatic masses (IPM) and pancreatic cancer (PC).
    METHODS: A literature search was conducted using PubMed, Embase, the Cochrane Library, and Web of Science through August 2023. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to evaluate the risk of bias and applicability of the studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated using the DerSimonian-Laird method. Univariate meta-regression analysis was used to identify the potential factors of heterogeneity.
    RESULTS: Twenty-four studies were included in this meta-analysis. The two main types of IPM, mass-forming pancreatitis (MFP) and autoimmune pancreatitis (AIP), differ in their apparent diffusion coefficient (ADC) values. Compared with PC, the ADC value was higher in MFP but lower in AIP. The pooled sensitivity/specificity of ADC were 0.80/0.85 for distinguishing MFP from PC and 0.82/0.84 for distinguishing AIP from PC. The pooled sensitivity/specificity for the maximal diameter of the upstream main pancreatic duct (dMPD) was 0.86/0.74, with a cutoff of dMPD ≤ 4 mm, and 0.97/0.52, with a cutoff of dMPD ≤ 5 mm. The pooled sensitivity/specificity for perfusion fraction (f) was 0.82/0.68, and 0.82/0.77 for mass stiffness values.
    CONCLUSIONS: Quantitative MR imaging biomarkers are useful in distinguishing between IPM and PC. ADC values differ between MFP and AIP, and they should be separated for consideration in future studies.
    CONCLUSIONS: Quantitative MR parameters could serve as non-invasive imaging biomarkers for differentiating malignant pancreatic neoplasms from inflammatory masses of the pancreas, and hence help to avoid unnecessary surgery.
    CONCLUSIONS: • Several quantitative MR imaging biomarkers performed well in differential diagnosis between inflammatory pancreatic mass and pancreatic cancer. • The ADC value could discern pancreatic cancer from mass-forming pancreatitis or autoimmune pancreatitis, if the two inflammatory mass types are not combined. • The diameter of main pancreatic duct had the highest specificity for differentiating autoimmune pancreatitis from pancreatic cancer.
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  • 文章类型: Journal Article
    胸片是大多数放射科最常见的影像学检查,这些研究中最常见的适应症之一是疑似感染。因此,放射科医生必须意识到肺部感染的较不常见的影像学模式,如果他们要在解释这种适应症的胸部X光片方面增加价值。这篇综述使用基于病例的格式来说明一系列可能与急性肺部感染相关的影像学发现,并强调应提示对社区获得性肺炎以外的疾病进行调查的发现,以防止误诊和延误适当的管理。
    The chest radiograph is the most common imaging examination performed in most radiology departments, and one of the more common indications for these studies is suspected infection. Radiologists must therefore be aware of less common radiographic patterns of pulmonary infection if they are to add value in the interpretation of chest radiographs for this indication. This review uses a case-based format to illustrate a range of imaging findings that can be associated with acute pulmonary infection and highlight findings that should prompt investigation for diseases other than community-acquired pneumonia to prevent misdiagnosis and delays in appropriate management.
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  • 文章类型: Journal Article
    腹壁是广泛的病理状况的位置,从良性到恶性。通常建议使用影像学来评估已知的可触及的腹部肿块。然而,腹壁病变通常是偶然发现的,代表了临床和诊断的挑战。了解可能的病因和并发症,结合临床病史和实验室检查结果,对于正确管理这些条件至关重要。特定的影像学线索可以帮助放射科医生缩小鉴别诊断范围并区分恶性和良性过程。在这篇图片评论中,我们将重点关注横截面成像在腹壁可能遇到的非肿瘤性良性肿块和过程,特别关注他们的管理。独特的超声成像线索,与计算机断层扫描(CT)和磁共振(MR)的发现相比,以及达到诊断和指导患者管理的临床和实用技巧,为放射科医生提供完整的诊断指南。
    The abdominal wall is the location of a wide spectrum of pathological conditions, from benign to malignant ones. Imaging is often recommended for the evaluation of known palpable abdominal masses. However, abdominal wall pathologies are often incidentally discovered and represent a clinical and diagnostic challenge. Knowledge of the possible etiologies and complications, combined with clinical history and laboratory findings, is crucial for the correct management of these conditions. Specific imaging clues can help the radiologist narrow the differential diagnosis and distinguish between malignant and benign processes. In this pictorial review, we will focus on the non-neoplastic benign masses and processes that can be encountered on the abdominal wall on cross-sectional imaging, with a particular focus on their management. Distinctive sonographic imaging clues, compared with computed tomography (CT) and magnetic resonance (MR) findings will be highlighted, together with clinical and practical tips for reaching the diagnosis and guiding patient management, to provide a complete diagnostic guide for the radiologist.
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  • 文章类型: Journal Article
    子宫肉瘤很少见,预后不良的侵袭性肿瘤,可能会受到手术方法不足的进一步负面影响,例如碎裂。没有区分平滑肌瘤和恶性子宫肿瘤的临床和放射学标准。然而,一些超声和磁共振成像结果可能是有益的。我们提出了一种超声引导下经子宫腔(UG-TUC)芯针活检子宫病变的技术。因为手术是器官内活检,没有针管污染的风险。该技术还可以对经阴道切开活检无法触及的病变进行活检。自动活检系统的核心针通过宫颈管插入子宫腔,并在超声控制下指向并激活子宫肌层病变。局限性子宫肉瘤的标准局部治疗是整块全子宫切除术;对于肌瘤,有多种选择,包括保守治疗或肿瘤切除术和使用微创技术进行肿瘤粉碎。肉瘤的碎裂显著恶化肿瘤学结果,因此应避免。子宫病变的UG-TUC核心针活检可以补充成像,以获得足够的材料用于可疑或未确定病变的组织学和分子分析。从而促进治疗计划并降低意外肉瘤的风险。
    Uterine sarcomas are rare, aggressive tumors with poor prognosis that can be further negatively affected by inadequate surgical approaches such as morcellation. There are no clinical and radiologic criteria for differentiating leiomyoma from malignant uterine tumors. However, some ultrasonography and magnetic resonance imaging findings may be informative. We present a technique of ultrasound-guided trans-uterine cavity (UG-TUC) core needle biopsy for uterine lesions. As the procedure is an in-organ biopsy, there is no risk of needle canal contamination. The technique also enables the biopsy of lesions inaccessible by the transvaginal tru-cut biopsy. The core needle of the automatic biopsy system is inserted via the cervical canal into the uterine cavity and is directed and activated at the myometrial lesion under ultrasound control. The standard local treatment of localized uterine sarcomas is en bloc total hysterectomy; for fibroids, there are multiple options including conservative management or tumorectomy and tumor morcellation using minimally invasive techniques. Fragmentation of the sarcoma significantly worsens oncologic outcomes and should therefore be avoided. The UG-TUC core needle biopsy of uterine lesions can complement imaging to obtain sufficient material for histologic and molecular analyses of suspected or undetermined lesions, thus facilitating treatment planning and decreasing the risk of unsuspected sarcomas.
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  • 文章类型: Journal Article
    胸片是大多数放射科最常见的影像学检查,这些研究中最常见的适应症之一是疑似感染。因此,放射科医生必须意识到肺部感染的较不常见的影像学模式,如果他们要在解释这种适应症的胸部X光片方面增加价值。这篇综述使用基于病例的格式来说明一系列可能与急性肺部感染相关的影像学发现,并强调应提示对社区获得性肺炎以外的疾病进行调查的发现,以防止误诊和延误适当的管理。
    The chest radiograph is the most common imaging examination performed in most radiology departments, and one of the more common indications for these studies is suspected infection. Radiologists must therefore be aware of less common radiographic patterns of pulmonary infection if they are to add value in the interpretation of chest radiographs for this indication. This review uses a case-based format to illustrate a range of imaging findings that can be associated with acute pulmonary infection and highlight findings that should prompt investigation for diseases other than community-acquired pneumonia to prevent misdiagnosis and delays in appropriate management.
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  • 文章类型: Journal Article
    Tuberculosis (TB) is a public health issue that affects mostly, but not exclusively, developing countries. Abdominal TB is difficult to detect at first, with the incidence ranging from 10% to 30% of individuals with lung TB. Symptoms are non-specific, examinations can be misleading, and biomarkers commonly linked with other diseases can also make appropriate diagnosis difficult. As a background for this literature review, the method used was to look into the main characteristics and features of abdominal tuberculosis that could help with differentiation on the PubMed, Science Direct, and Academic Oxford Journals databases. The results were grouped into three categories: A. general features (the five forms of abdominal tuberculosis: wet and dry peritonitis, lymphadenopathy, lesions at the level of the cavitary organs, lesions at the level of the solid organs), B. different intra-abdominal organs and patterns of involvement (oesophageal, gastro-duodenal, jejunal, ileal, colorectal, hepatosplenic, and pancreatic TB with calcified lymphadenopathy, also with description of extraperitoneal forms), and C. special challenges of the differential diagnosis in abdominal TB (such as diagnostic overlap, the disease in transplant candidates and transplant recipients, and zoonotic TB). The study concluded that, particularly in endemic countries, any disease manifesting with peritonitis, lymphadenopathy, or lesions at the level of the intestines or solid organs should have workups and protocols applied that can confirm/dismiss the suspicion of abdominal tuberculosis.
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  • 文章类型: Journal Article
    OBJECTIVE: This review aimed to analyze the use of differential validation of nursing diagnosis.
    METHODS: Integrative literature review with search on international databases. The diagnoses, the type of the diagnosis differential validation, the sample, the method, main results, and the limitations were extracted. Ten studies were included.
    RESULTS: Differential diagnostic validation publication dates from 1994, and Brazil was the predominant country.
    CONCLUSIONS: This method seems helpful in improving diagnosis accuracy, particularly those related to subjective, behavioral, or complex human responses.
    CONCLUSIONS: Using this model may facilitate understanding the specificity of nursing diagnosis, which is critical for teaching clinical reasoning and for new opportunities to research.
    UNASSIGNED: O objetivo desta revisão foi analisar a utilização da validação diferencial de diagnósticos de enfermagem. MÉTODOS: Revisão integrativa da literatura com pesquisa em bases de dados internacionais. Foram extraídos dados referentes ao tipo de diagnóstico, validação diferencial, amostra, metodologia, principais resultados e limitações. Foram incluídos 10 estudos.
    UNASSIGNED: Foram identificadas publicações desde 1994, sendo o Brasil o país predominante. CONCLUSÕES: Este modelo parece ser útil para melhorar a precisão do diagnóstico, particularmente aqueles relacionados a respostas humanas subjetivas, comportamentais ou complexas. IMPLICAÇÕES PARA A PRÁTICA: O uso deste modelo pode facilitar a compreensão da especificidade do diagnóstico de enfermagem, que é fundamental para o ensino do raciocínio clínico, para novas oportunidades de pesquisa.
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  • 文章类型: Case Reports
    背景:硬脊膜动静脉瘘(SDAVF)是一种极为罕见的中枢神经系统血管畸形,由于类似的早期症状和临床特征,常与退行性脊柱疾病混淆。这里,报告1例SDAVF腰椎术后8年复发的病例,并总结相关文献。
    方法:一名54岁男性因腰痛入院,下肢麻木和间歇性跛行。随后的成像发现腰椎管狭窄。手术治疗后,患者的症状明显缓解,他能够进行日常活动。然而,8年后出现类似症状,然后确认SDAVF诊断。患者在症状发作后7个月接受了神经外科手术。随访时间为14个月,患者仍有边缘性神经症状。
    结论:该病例强调了迅速诊断SDAVF的重要性。由于其非特异性临床表现,外科医生的临床经验和明确的影像学检查是不可或缺的。此外,及时的神经外科手术是有效的,并且可以显着改善患者的预后。
    BACKGROUND: Spinal dural arteriovenous fistula (SDAVF) is an extremely rare vascular malformation of the central nervous system that is often confused with degenerative spinal disorders due to similar early symptoms and clinical features. Here, we report a case of SDAVF recurrence 8 years after lumbar spine surgery and summarize relevant literature.
    METHODS: A 54-year-old male was admitted to our hospital complaining of lower back pain, numbness in both lower extremities and intermittent claudication. Subsequent imaging identified lumbar spinal stenosis. Following surgical treatment, the patient\'s symptoms significantly resolved, and he was able to perform daily activities. However, similar symptoms appeared 8 years later, followed by confirmation of SDAVF diagnosis. The patient underwent neurosurgery 7 mo after symptom onset. The follow-up period lasted 14 mo, and the patient remains with marginal neurological symptoms.
    CONCLUSIONS: This case highlights the importance of prompt SDAVF diagnosis. Due to its nonspecific clinical presentation, the clinical experience of the surgeon and definitive imaging examination are indispensable. Additionally, timely neurosurgery is effective and may significantly improve patient outcomes.
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  • 文章类型: Case Reports
    Erythrasma is a bacterial infection of the skin typically caused by Corynebacterium minutissimum. This pathogen infects the stratum corneum in warm and wet areas of the skin. Most commonly, the axillary, inguinal, and interdigital regions are affected. A 60-year-old man presented for the examination of a pedunculated lesion on his right proximal thigh. Upon examination of the lesion, adjacent areas of central hypopigmentation and peripheral hyperpigmented scaling were also noted bilaterally in the groin region. Differential diagnoses of candidiasis, dermatophyte infection, erythrasma, pityriasis versicolor, and terra firma-forme dermatosis were considered. Wood lamp examination revealed bright coral-pink fluorescence. Correlation of the clinical examination and the Wood lamp finding established the diagnosis of erythrasma. Twice daily topical 2% mupirocin ointment therapy led to the resolution of our patient\'s erythrasma. In this case report, the diagnosis, differential diagnoses, and treatment of erythrasma are reviewed.
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