incidental findings

偶然发现
  • 文章类型: Journal Article
    UNASSIGNED: To conduct a survey on the use of the term \"interstitial lung abnormalities\" in radiology reports in Brazil, propose an appropriate Portuguese-language translation for the term, and provide a brief review of the literature on the topic.
    UNASSIGNED: A survey was sent via electronic message to various radiologists in Brazil, asking about their familiarity with the term, which translation of the term they use in Portuguese, and whether they use the criteria proposed by the Fleischner Society.
    UNASSIGNED: A total of 163 responses were received, from all regions of Brazil. Although the vast majority (88%) of the respondents stated that they were familiar with the term \"interstitial lung abnormalities\", there was considerable variation regarding the equivalent term they used in Portuguese.
    UNASSIGNED: We suggest that the term \"anormalidades pulmonares intersticiais\" be used in order to standardize radiology reports and disseminate knowledge of these findings in Brazil.
    UNASSIGNED: Fazer um levantamento sobre o uso do termo interstitial lung abnormalities nos laudos radiológicos no Brasil, propor uma tradução para o termo e fazer uma breve revisão sobre o tema.
    UNASSIGNED: Foi enviada uma pesquisa, por meio de mensagem eletrônica, para diversos radiologistas de todo o Brasil, questionando sobre a familiarização com o termo, qual tradução em português utilizam e se usam os critérios propostos pela diretriz da Sociedade Fleischner.
    UNASSIGNED: Foram recebidas 163 respostas de todas as regiões do Brasil e a grande maioria dos radiologistas respondeu estar familiarizado com o termo interstitial lung abnormalities (88%), mas houve grande variação em relação ao termo utilizado como tradução para o português.
    UNASSIGNED: Sugerimos a padronização do termo “anormalidades pulmonares intersticiais”, a fim de uniformizar os relatórios radiológicos e difundir esta entidade no País.
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  • 文章类型: Journal Article
    目的:偶然弥散加权成像(DWI)阳性皮质下和皮质病变,或急性偶发性脑微梗塞(CMIs),是一种常见的脑缺血,可以在发生后大约2周内在磁共振DWI上检测到。急性偶发性CMI在癌症患者中更为常见。急性偶发性CMI是否能预测未来的缺血性卒中仍然未知。我们旨在研究癌症患者的急性偶发CMI与随后的缺血性卒中或短暂性脑缺血发作(TIA)之间的关系。
    方法:这是一项回顾性队列研究。我们使用了Clalit健康服务记录,代表了以色列一半以上的人口,为了识别成年人的肺部,乳房,胰腺,或在2014年1月至2020年4月期间接受脑MRI检查的结肠癌。我们纳入了在癌症诊断前1年至诊断后1年之间接受扫描的患者。主要结果是缺血性卒中或TIA,使用国际疾病分类,第九次修订代码。次要结果是颅内出血(ICH)和死亡率。记录从第一次MRI直到主要结果,死亡,或随访结束(2023年1月)。Cox比例风险模型用于计算有和没有急性附带CMI的患者的风险比(HR),作为时间依赖的协变量。
    结果:研究队列包括1,618例癌症患者,其中,59(3.6%)在至少1次脑部MRI上出现急性偶发CMI。从急性偶发CMI到中风或TIA的中位时间(四分位距)为26天(14-84)。在多变量分析中,急性偶发CMI患者的卒中或TIA风险较高(HR2.97,95%CI1.08~8.18,p=0.035).多变量分析后,急性偶发CMI也与死亡率相关(HR2.76,95%CI2.06-3.71,p<0.001);未发现与ICH相关。
    结论:活动期癌症患者脑MRI上的急性偶发CMI与近期缺血性卒中或TIA和死亡率的风险增加相关。这一发现可能表明,在癌症患者中随机检测到的急性偶发CMI可能会指导主要的脑血管风险预防和病因检查。
    OBJECTIVE: Incidental diffuse-weighted imaging (DWI)-positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMIs), are a common type of brain ischemia, which can be detected on magnetic resonance DWI for approximately 2 weeks after occurrence. Acute incidental CMI was found to be more common in patients with cancer. Whether acute incidental CMI predicts future ischemic stroke is still unknown. We aimed to examine the association between acute incidental CMI in patients with cancer and subsequent ischemic stroke or transient ischemic attack (TIA).
    METHODS: This is a retrospective cohort study. We used Clalit Health Services records, representing over half of the Israeli population, to identify adults with lung, breast, pancreatic, or colon cancer who underwent brain MRI between January 2014 and April 2020. We included patients who underwent scan between 1 year before cancer diagnosis and 1 year after diagnosis. Primary outcome was ischemic stroke or TIA using International Classification of Diseases, Ninth Revision codes. Secondary outcomes were intracranial hemorrhage (ICH) and mortality. Records were followed from first MRI until primary outcome, death, or end of follow-up (January 2023). Cox proportional hazards models were used to calculate hazard ratio (HR) for patients with and without acute incidental CMI, as a time-dependent covariate.
    RESULTS: The study cohort included 1,618 patients with cancer, among whom, 59 (3.6%) had acute incidental CMI on at least 1 brain MRI. The median (interquartile range) time from acute incidental CMI to stroke or TIA was 26 days (14-84). On multivariable analysis, patients with acute incidental CMI had a higher stroke or TIA risk (HR 2.97, 95% CI 1.08-8.18, p = 0.035) compared with their non-CMI counterparts. Acute incidental CMIs were also associated with mortality after multivariable analysis (HR 2.76, 95% CI 2.06-3.71, p < 0.001); no association with ICH was found.
    CONCLUSIONS: Acute incidental CMI on brain MRI in patients with active cancer is associated with an increased risk of near-future ischemic stroke or TIA and mortality. This finding might suggest that randomly detected acute incidental CMI in patients with cancer may guide primary cerebrovascular risk prevention and etiologic workup.
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  • 文章类型: Journal Article
    已对大脑进行磁共振成像(MRI)以评估多种颅内病理。非对比T2加权图像是几乎所有神经成像协议中常规采集的序列。在脑成像上偶然遇到各种脑血管病变并不少见。神经放射科医师应评估常规T2加权图像的偶发性脑血管病变,无论研究的主要指征如何。血管结构通常在T2加权图像上表现出低信号流量空隙。根据我们的经验,对于典型的神经放射学家来说,大的脑血管异常是很容易看到的。在这篇文章中,我们介绍了常规非对比T2加权MRI上各种颅内脑血管病变的特征性影像学表现.这些包括动脉瘤,动静脉畸形,动脉闭塞,毛细血管扩张症,海绵状畸形,硬脑膜动静脉瘘,moyamoya,增生性血管病,和Galen畸形的静脉.
    Magnetic resonance imaging (MRI) of the brain has been implemented to evaluate multiple intracranial pathologies. Non-contrast T2-weighted images are a routinely acquired sequence in almost all neuroimaging protocols. It is not uncommon to encounter various cerebrovascular lesions incidentally on brain imaging. Neuroradiologists should evaluate the routine T2-weighted images for incidental cerebrovascular lesions, irrespective of the primary indication of the study. Vascular structures typically demonstrate a low signal flow-void on the T2-weighted images. In our experience, large cerebrovascular abnormalities are easily visible to a typical neuroradiologist. In this article, we present the spectrum of the characteristic imaging appearance of various intracranial cerebrovascular lesions on routine non-contrast T2-weighted MRI. These include aneurysm, arteriovenous malformation, arterial occlusion, capillary telangiectasia, cavernous malformation, dural arteriovenous fistula, moyamoya, proliferative angiopathy, and vein of Galen malformation.
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  • 文章类型: Case Reports
    在这个案例报告中,我们展示了一个60多岁的男人,他偶然发现了一个右肾上腺肿块,结果是肾上腺神经鞘瘤.这是一种非常罕见的肿瘤,起源于雪旺氏细胞,并涉及周围神经。肿瘤是通过开放肾上腺切除术切除的,这种15厘米长的肾上腺神经鞘瘤是文献中报道的最大的肾上腺神经鞘瘤之一,没有>16厘米的报道。这个案例强调了对偶然发现的肾上腺肿块的原因保持开放心态的重要性,鉴于横截面成像的访问增加,这是肾上腺肿瘤呈现的一种越来越常见的方式。除了介绍病例和肾上腺神经鞘瘤背后的病理基础外,我们包括对文献的回顾和对偶然发现的肾上腺肿块的一般性讨论。
    In this case report, we present a man in his 60s who presented with an incidentally discovered right adrenal mass, which turned out to be an adrenal schwannoma. This is a very rare tumour that originates from Schwann cells and involves the peripheral nerves. The tumour was removed by open adrenalectomy, and this 15-cm adrenal schwannoma is one of the largest reported in the literature, with none >16 cm having ever been reported. This case highlights the importance of keeping an open mind about the cause of an incidentally discovered adrenal mass, which is an increasingly common way for adrenal tumours to present given the increased access to cross-sectional imaging. As well as presenting the case and the pathological basis behind adrenal schwannomas, we include a review of the literature and a general discussion about incidentally discovered adrenal masses.
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  • 文章类型: Case Reports
    一名51岁的女性,她的手臂上有一个2毫米布雷斯洛厚度的黑色素瘤,她有99mTc纳米胶体淋巴闪烁显像定位相关的前哨淋巴结。确定了一个腋窝淋巴结,和组织学证实乳腺组织来源的微转移。患者的乳房成像和随后的活检证实同侧III期乳腺癌,采用肿块切除术和腋窝淋巴结清除治疗。这是首例针对不同肿瘤起源进行的前哨淋巴结活检的偶然实体癌诊断病例。这说明了识别前哨淋巴结重叠淋巴分布的重要性,可以排出多个器官。
    UNASSIGNED: A 51-year-old woman with a 2-mm-Breslow-thickness melanoma on her arm had 99mTc-nanocolloid lymphoscintigraphy to localize the associated sentinel lymph node. A single axillary node was identified, and histology confirmed a micrometastasis of breast tissue origin. Imaging of the patient\'s breasts and subsequent biopsy confirmed ipsilateral stage III breast cancer, which was treated with lumpectomy and axillary node clearance. This is the first reported case of an incidental solid cancer diagnosis from a sentinel lymph node biopsy undertaken for a different tumor origin. This illustrates the importance of recognizing overlapping lymphatic distribution of sentinel lymph nodes, which can drain multiple organs.
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  • 文章类型: English Abstract
    随着激光技术的发展,良性前列腺增生(BPH)的手术有了很大的进步;钬激光前列腺摘除术(HoLEP),无论前列腺大小如何,都可以安全且具有最小的侵入性。HoLEP后偶发前列腺癌(iPCa)的发生率一定。预测器,包括年龄,活检,历史,术前前列腺特异性抗原,和前列腺体积。我们比较了2015年7月至2022年12月在我们医院接受HoLEP的257例BPH患者中有无偶发癌的病例。在257名患者中,发现29例(11.3%)患有偶发癌。尽管有1例患者改用内分泌治疗,但其余患者在监测治疗下预后良好。偶发癌组磁共振成像(MRI)表现提示癌的病例比例明显高于偶发癌组(p=0.009)。此外,偶发癌预测因素的单因素分析显示,MRI表现存在显着差异(比值比[OR]2.92;置信区间[CI]1.33-6.42),和多变量分析显示相似的结果(OR2.92;CI1.33-6.42)。在我们的医院,我们目前进行MRI扫描用于术前形态学评估,但不用于癌症诊断.然而,根据获得的结果,我们的目标是积极利用MRI进行术前恶性筛查,除了PSA。
    Surgery for benign prostatic hyperplasia (BPH) has greatly advanced with the development of laser technology ; and holmium laser enucleation of the prostate (HoLEP), which can be performed safely and with minimal invasiveness regardless of prostate size. Incidental prostate carcinoma (iPCa) following HoLEP occurs at a certain rate. Predictors, include age, biopsy, history, preoperative prostate specific antigen, and prostate volume. We compared cases with and without incidental carcinoma detection among 257 patients with BPH who underwent HoLEP at our hospital from July 2015 to December 2022. Among the 257 patients, 29 (11.3%) were found to have incidental carcinoma. Although 1 patient switched to endocrine therapy the remaining patients showed good prognosis under surveillance therapy. The proportion of cases with magnetic resonance imaging (MRI) findings suggestive of carcinoma was significantly higher in the incidental carcinoma detection group (p=0.009). Furthermore, univariate analysis of incidental carcinoma predictive factors revealed a significant difference in MRI findings (odds ratio [OR] 2.92 ; confidence interval [CI] 1.33-6.42), and multivariate analysis showed similar results (OR 2.92 ; CI 1.33-6.42). At our hospital, we currently perform MRI scans for preoperative morphological assessments but not for cancer diagnosis. However, based on the results obtained, we aim to proactively utilize MRI for preoperative malignant screening, in addition to PSA.
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  • 文章类型: Case Reports
    背景技术肾上腺血管瘤是由腺体的血管内皮引起的罕见良性非功能性肿瘤。肾上腺血管瘤在临床上很少见,经常在不相关的诊断调查中偶然发现。案例报告一名39岁的男子,增强4.56×4.24×3.9厘米的肿块,起源于右肾上腺的侧肢,在计算机断层扫描(CT)上偶然发现以研究肾绞痛。他被常规随访2年,连续CT扫描;与基线相比,肿块表现出相当大的增长,具有相对稳定的外观,具有高密度的软组织成分,脂肪,和钙化灶。地塞米松抑制试验显示抑制皮质醇反应,表示非功能性质量。因此,进行了腹腔镜右肾上腺切除术,由于骨髓脂肪瘤的术前诊断和肿块大小的良性性质。病人恢复顺利,无围手术期并发症。切除肿块大小5×4×4cm,重30g。组织病理学证实肾上腺血管瘤。连续切片显示具有异质固体和囊性表面的包裹性病变。光学显微镜检查显示扩张和充血的血管通道被扁平的内皮衬里。可见局灶性成熟脂肪组织。结论肾上腺血管瘤的罕见发生及其非特异性临床和放射学表现导致相当大的诊断挑战,经常,误诊。手术切除通常是必要的,以排除恶性疾病。缓解压力相关症状,并降低腹膜后出血的风险。这些病变与良好的预后相关。本报告的局限性之一是缺乏对偶然肾上腺肿块的术前肾上腺磁共振成像。
    BACKGROUND Hemangiomas of the adrenal gland are rare benign non-functional tumors arising from the gland\'s vascular endothelium. Adrenal hemangiomas are rare in clinical settings, often discovered incidentally during an unrelated diagnostic investigation. CASE REPORT A 39-year-old man presented with a heterogeneous, enhancing 4.56×4.24×3.9-cm mass originating from the right adrenal gland\'s lateral limb, discovered incidentally on computed tomography (CT) to investigate renal colic. He was routinely followed up for 2 years with serial CT scans; the mass exhibited considerable growth compared with baseline, with a relatively stable appearance with hyperdense soft tissue component, fat, and foci of calcification. Dexamethasone suppression test demonstrated suppressed cortisol response, indicating a non-functional mass. Therefore, laparoscopic right adrenalectomy was performed, owing to the benign nature of the preoperative diagnosis of myelolipoma and mass size. The patient experienced an uneventful recovery, with no perioperative complications. The resected mass was 5×4×4 cm in size and weighed 30 g. Histopathology confirmed adrenal hemangioma. Serial sectioning revealed an encapsulated lesion with heterogeneous solid and cystic surfaces. Light microscopy examination showed dilated and congested vascular channels lined by flattened endothelium. Focal mature adipose tissue was seen. CONCLUSIONS The infrequent occurrence of adrenal hemangiomas and their nonspecific clinical and radiological presentation results in a considerable diagnostic challenge and, often, misdiagnosis. Surgical resection is usually necessary to exclude malignant disease, alleviate pressure-related symptoms, and decrease risk of retroperitoneum hemorrhage. These lesions are associated with a good prognosis. One limitation of this report is the lack of preoperative adrenal magnetic resonance imaging of the incidental adrenal mass.
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  • 文章类型: Journal Article
    由于先进和更敏感的成像方式,肾上腺偶发瘤增加了,他们的利用率提高了,和人口老龄化。大多数肾上腺偶发瘤是非功能性和良性的,但部分患者患有功能性和/或恶性肿瘤。肾上腺偶发瘤患者的评估涉及两个临床问题:(1)肿瘤是否有功能?(2)肿瘤是否恶性?仔细的病史和体格检查集中在肾上腺功能性肿瘤的体征和症状上,生化检测,影像学特征是评估肾上腺偶发瘤患者的基础。
    Adrenal incidentalomas have increased due to advanced and more sensitive imaging modalities, their increased utilization, and the aging population. Most adrenal incidentalomas are nonfunctional and benign, but a subset of patients has functional and/or malignant tumors. The evaluation of patients with an adrenal incidentaloma involves addressing 2 clinical questions: (1) Is the tumor functional? (2) Is the tumor malignant? A careful history and physical examination focused on signs and symptoms of adrenal functional tumors, biochemical testing, and imaging features are the cornerstone in the evaluation of patients with an adrenal incidentaloma.
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  • 文章类型: Journal Article
    甲状腺结节广泛流行,经常偶然发现。偶发甲状腺结节的恶性率低,无论诊断如何,总体结局都是有利的。甲状腺结节患者应进行TSH水平评估,然后对甲状腺和颈部淋巴结进行超声检查。重要的是要识别可疑甲状腺恶性肿瘤的超声特征,并根据主要社会指南进行活检。Bethesda甲状腺细胞病理学报告系统以及分子检测可以帮助指导有关甲状腺结节的管理决策。手术切除等新兴技术对于需要介入治疗的甲状腺结节是安全有效的。
    Thyroid nodules are widely prevalent, and often discovered incidentally. Malignancy rates are low for incidental thyroid nodules, and overall outcomes are favorable regardless of diagnosis. Patients with thyroid nodules should be evaluated with TSH levels followed by ultrasound of the thyroid and cervical lymph nodes. It is important to recognize sonographic features suspicious for thyroid malignancy and obtain biopsies when indicated according to major society guidelines. The Bethesda System for Reporting Thyroid Cytopathology along with molecular testing can help guide management decisions regarding thyroid nodules. Surgical resection and other emerging technologies are safe and effective for the treatment of thyroid nodules needing intervention.
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  • 文章类型: Journal Article
    目的:评估临床和影像学特征是否可以预测激素亚型,增长,和肾上腺切除术治疗偶发性肾上腺皮质腺瘤(ACA)。
    方法:单中心队列研究。
    方法:2000年至2016年连续诊断为偶发ACA的成年患者。
    结果:在1516例附带ACA患者中(中位年龄59岁,62%的女性),699(46%)患有无功能腺瘤(NFA),482例(31%)有轻度自主皮质醇分泌(MACS),62(4%)患有原发性醛固酮增多症(PA),39人(3%)患有库欣综合征(CS),18(1%)患有PA和MACS(PA-MACS),和226(15%)有不完整的检查。年龄,性别,肿瘤大小,和肿瘤侧向性,但不是未增强的计算机断层扫描Hounsfield单位(HU),与荷尔蒙亚型有关。在多变量分析中,≥1cm的增长与年龄较小相关(每5年增长的比值比,OR=0.8,P=0.0047)和更长的影像学随访(OR=1.2/年,P<.0001)。355例(23%)患者进行了肾上腺切除术,包括38%的MACS和15%的NFA。NFA和MACS的肾上腺切除术在年轻患者中更为常见(OR=0.79/5年增加,P=0.002),较大的初始肿瘤大小(OR=2.3每增加1厘米,P<.0001),生长≥1cm(OR=15.3,P<0.0001),和较高的后地塞米松皮质醇(OR=6.6>5vs<1.8mcg/dL,P=0.002)。
    结论:年龄,性别,肿瘤大小,和侧向性与ACA激素亚型相关,可指导诊断和治疗.随着年龄的增长和随访时间的延长,肿瘤的生长更为常见。未增强的HU不能预测激素亚型或生长。MACS和NFA的肾上腺切除术主要在肿瘤较大的年轻患者中进行,增长,地塞米松后皮质醇升高。
    OBJECTIVE: The aim of this study is to assess whether clinical and imaging characteristics are associated with the hormonal subtype, growth, and adrenalectomy for incidental adrenal cortical adenomas (ACAs).
    METHODS: This is a single-center cohort study.
    METHODS: Consecutive adult patients with incidental ACA were diagnosed between 2000 and 2016.
    RESULTS: Of the 1516 patients with incidental ACA (median age 59 years, 62% women), 699 (46%) had nonfunctioning adenomas (NFAs), 482 (31%) had mild autonomous cortisol secretion (MACS), 62 (4%) had primary aldosteronism (PA), 39 (3%) had Cushing syndrome, 18 (1%) had PA and MACS, and 226 (15%) had incomplete work-up. Age, sex, tumor size, and tumor laterality, but not unenhanced computed tomography Hounsfield units (HU), were associated with hormonal subtypes. In a multivariable analysis, ≥1 cm growth was associated with younger age (odds ratio [OR] = 0.8 per 5-year increase, P = .0047) and longer imaging follow-up (OR = 1.2 per year, P < .0001). Adrenalectomy was performed in 355 (23%) patients, including 38% of MACS and 15% of NFA. Adrenalectomy for NFA and MACS was more common in younger patients (OR = 0.79 per 5-year increase, P = .002), larger initial tumor size (OR = 2.3 per 1 cm increase, P < .0001), ≥1 cm growth (OR = 15.3, P < .0001), and higher postdexamethasone cortisol (OR = 6.6 for >5 vs <1.8 μg/dL, P = .002).
    CONCLUSIONS: Age, sex, tumor size, and laterality were associated with ACA hormonal subtype and can guide diagnosis and management. Tumor growth was more common with younger age and longer follow-up. Unenhanced HU did not predict hormonal subtype or growth. Adrenalectomy for MACS and NFA was mainly performed in younger patients with larger tumor size, growth, and elevated postdexamethasone cortisol.
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