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Toker M, Forelli N, Wind O, Khanna U, Jaller JA, Fischer S, Mardakhaev E, Wu B. Histopathology and radiologic imaging for the confirmation of calciphylaxis in a diverse population: A retrospective cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00503-6. [PMID: 38513831 DOI: 10.1016/j.jaad.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Michelle Toker
- Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Nicholas Forelli
- Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Olivia Wind
- Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Urmi Khanna
- Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jose A Jaller
- Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sarah Fischer
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Edward Mardakhaev
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Benedict Wu
- Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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van Kol K, Ebisch R, Beugeling M, Cnossen J, Nederend J, van Hamont D, Coppus S, Piek J, Bekkers R. Comparing Methods to Determine Complete Response to Chemoradiation in Patients with Locally Advanced Cervical Cancer. Cancers (Basel) 2023; 16:198. [PMID: 38201625 PMCID: PMC10778528 DOI: 10.3390/cancers16010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES There is no consensus on the most reliable procedure to determine remission of cervical cancer after chemoradiotherapy (CRT). Therefore, this study aims to assess the diagnostic performance of two different imaging techniques, MRI and 18F[FDG]-PET/CT, in determining the presence of locoregional residual disease after CRT in patients with locally advanced cervical cancer. METHODS Patients diagnosed with locally advanced cervical cancer (FIGO 2009) treated with CRT were retrospectively identified from a regional cohort. The accuracy of MRI and 18F[FDG]-PET/CT in detecting locoregional residual disease was assessed with histology as the reference standard. RESULTS The negative predictive value (NPV) and positive predictive value (PPV) for locoregional residual disease detection of MRI and 18F[FDG]-PET/CT combined were 84.2% (95% CI 73.2-92.1), and 70.4% (95% CI 51.8-85.2), respectively. The NPV and PPV of MRI alone were 80.2% (95% CI 71.2-87.5) and 47.7% (95% CI 35.8-59.7), respectively, and values of 81.1% (95% CI 72.2-88.3) and 55.8 (95% CI 42.2-68.7), respectively, were obtained for 18F[FDG]-PET/CT alone. CONCLUSION In this study, the reliability of MRI and 18F[FDG]-PET/CT in detecting locoregional residual disease was limited. Combining MRI and 18F[FDG]-PET/CT did not improve predictive values. Routine use of both MRI and 18F[FDG]-PET/CT in the follow-up after CRT should be avoided. MRI during follow-up is the advised imaging technique. Pathology confirmation of the presence of locoregional residual disease before performing salvage surgery is warranted.
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Affiliation(s)
- Kim van Kol
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (J.P.)
- Department of Obstetrics and Gynecology GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Renée Ebisch
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Maaike Beugeling
- Department of Radiation Oncology, Institute Verbeeten (BVI), 5042 SB Tilburg, The Netherlands
| | - Jeltsje Cnossen
- Department of Radiation Oncology, Catharina Cancer Institute, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Cancer Institute, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynecology, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Sjors Coppus
- Department of Obstetrics and Gynecology, Maxima Medical Center, 5631 BM Veldhoven, The Netherlands
| | - Jurgen Piek
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (J.P.)
| | - Ruud Bekkers
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands (J.P.)
- Department of Obstetrics and Gynecology GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
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Kirn V, Bors S, Fridrich C, Schumacher C, Thangarajah F. Staging for Breast Cancer: A Comparison Between Old and New Approaches. Cancer Diagn Progn 2023; 3:673-677. [PMID: 37927808 PMCID: PMC10619575 DOI: 10.21873/cdp.10271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023]
Abstract
Background/Aim Staging for breast cancer in advanced stages or prior to neoadjuvant chemotherapy is recommended to be performed with CT scan of the chest and abdomen and a bone scan. This recommendation is valid since 2012, when conventional staging with chest x-ray and ultrasound of the abdomen was replaced by the more sensitive CT scan. However, it remains unclear if this approach improves patient outcome and prognosis. Patients and Methods We identified patients who were treated for breast cancer at the breast center of the St. Elisabeth Hospital, Cologne, in 2012 and 2014. Clinical information such as age at diagnosis, stage, tumor biology, grading, and the applied method for staging was abstracted from the patient chart. We also looked for local or distant recurrence and data of survival. Results A total of 1,122 patients were identified. Of those, 104 patients developed local or distant recurrence and 54 died. Conventional staging with chest x-ray, abdominal ultrasound and a bone scan was more often in 2012 (482 cases) than in 2014 (135), but CT-staging was more often in 2014 (180 vs. 29 cases). In general, less patients were staged in 2014 than in 2012. There were no significant survival differences between the two groups. Conclusion Staging habits changed in 2012 compared to 2014 according to the changes in guidelines. This change did not affect disease-free survival.
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Affiliation(s)
- Verena Kirn
- Medical Faculty of the University of Cologne, Cologne, Germany
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Sarah Bors
- Medical Faculty of the University of Cologne, Cologne, Germany
| | - Claudius Fridrich
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Claudia Schumacher
- Breast Center St. Elisabeth Hospital/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
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Yasmin T, Younis MN, Ameer K, Farooq A, Shahid A. 68Ga-PSMA PET-CT and PSMA score affecting therapeutic decision-making in high-risk prostatic carcinoma. Pol J Radiol 2023; 88:e331-e337. [PMID: 37576382 PMCID: PMC10415808 DOI: 10.5114/pjr.2023.130196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose This research study was conducted to evaluate the impact of (68Ga)-tagged prostatic-specific membrane antigen (68Ga-PSMA) positron emission tomography and computed tomography (PET-CT), compare its role with conventional radiology in early staging of high-risk prostate cancer, and calculate the PSMA score evaluating its usefulness in 68Ga-PSMA PET-CT reporting in our patient population. Material and methods 68Ga-PSMA PET-CT of 65 high-risk cases of prostate cancer was performed for staging purpo-ses. Any change in disease stage was noted after 68Ga-PSMA PET-CT findings and PSMA score leading to a change in the management plan. Results Change in disease stage post-PSMA imaging was seen in 39% cases, high PSMA score (03) was noted in > 80% of upstaged cases, while low score (0) and (1) was seen in 65% and 35% down-staged individuals, respectively. Change in therapeutic decision-making was observed in 32% (21) of patients. Conclusions 68Ga-PSMA PET-CT scans have a significant influence on the planned clinical management of high-risk prostate cancer patients; hence, they can be utilized as a replacement for radiological imaging tools, particularly in the detection of pelvic nodal and distant metastatic disease. PSMA score can be considered as an effective tool in standardized reporting of 68Ga-PSMA imaging.
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Affiliation(s)
- Tahira Yasmin
- Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan
| | | | - Khalid Ameer
- Department of Orthopaedics, District Headquarter (DHQ) Hospital, Chakwal, Punjab, Pakistan
| | - Ahmed Farooq
- Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan
| | - Abubaker Shahid
- Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan
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Gibson FT, Murad F, Granger E, Schmults CD, Ruiz ES. Perioperative imaging for high-stage cutaneous squamous cell carcinoma helps guide management in nearly a third of cases: A single-institution retrospective cohort. J Am Acad Dermatol 2023; 88:1209-1211. [PMID: 36681240 DOI: 10.1016/j.jaad.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Affiliation(s)
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Granger
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Stamell Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Liu CH, Yang ST, Chao WT, Lin JC, Lee NR, Chang WH, Chen YJ, Wang PH. Pretreatment Radiologically Enlarged Lymph Nodes as a Significant Prognostic Factor in Clinical Stage IIB Cervical Cancer: Evidence from a Taiwanese Tertiary Care Center in Reaching Consensus. Diagnostics (Basel) 2022; 12. [PMID: 35626385 DOI: 10.3390/diagnostics12051230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
The incidence of lymph node (LN) involvement and its prognostic value based on radiological imaging in stage IIB cervical cancer (CC) remains unclear, and evidence regarding oncological outcomes of patients with stage IIB CC with LN metastases is limited. In this study we retrospectively reviewed the incidence and prognostic significance of pretreatment radiologic LN status in 72 patients with clinical stage IIB CC (FIGO 2009), with or without radiologic evidence of LN enlargement. An enlarged LN was defined as a diameter > 10 mm on CT/MRI. Progression-free survival (PFS) and overall survival (OS) were assessed. Radiologic LN enlargement of >10 mm was observed in 45.8% of patients with stage IIB CC. PFS (p = 0.0088) and OS rates (p = 0.0032) were significantly poorer in the LN group (n = 33) than in the non-LN group (n = 39). Univariate Cox analysis revealed that LN > 10 mm contributed to a higher rate of recurrence and mortality. In conclusion, nearly half of the patients with clinical stage IIB CC had enlarged LNs (>10 mm) identified during pretreatment radiologic evaluation, which negatively impacted prognosis. Our findings highlight the need to incorporate CT- or MRI-based LN assessment before treatment for stage IIB CC.
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Mayel M, Nejad MA, Khabaz MS, Bazrafshani MS, Mohajeri E. Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial. Turk J Emerg Med 2020; 20:168-174. [PMID: 33089024 PMCID: PMC7549517 DOI: 10.4103/2452-2473.297461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/21/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES: Prevention and reduction of pain, anxiety, and fear during medical procedures is one of the most important factors that should be considered in pediatric emergencies. The aim of this study was to compare the efficacy of oral versus intranasal midazolam in sedation during radiologic imaging in the largest province of Iran, Kerman. MATERIALS AND METHODS: Eighty children were enrolled in this single-blind clinical trial based on convenience sampling and were divided into two groups receiving 0.5 mg/kg midazolam in oral route administration and 0.2 mg/kg midazolam in intranasal route administration. Finally, 75 patients remained for evaluating medication acceptability, sedation level, onset time of sedation, additional sedative dose, adverse effects of sedation, and provider satisfaction. RESULTS: Children in the intranasal group accepted medication more easily (89.8% vs. 36.9%; P ≤ 0.001), while these children received a lower sedation dose, but the sedation level in both methods was similar (P = 0.72). Our findings showed that children in the intranasal sedation group had a faster onset of sedation compared to the oral group (17.94 ± 8.99 vs. 34.50 ± 11.45; P ≤ 0.001). The frequency of midazolam side effects had no difference between the groups (29.7% vs. 15.8%; P = 0.15). CONCLUSION: Intranasal midazolam with a lower sedation dose induces a faster onset and better acceptance. Intranasal midazolam can be used as an effective sedative method for pediatric patients, especially in emergency wards.
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Affiliation(s)
- Masoud Mayel
- Department of Emergency Medicine, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Ahmadi Nejad
- Department of Anesthesiology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Sadeghi Khabaz
- Department of Emergency Medicine, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ehsan Mohajeri
- Department of Pharmaceutics, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
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Barnes BC, Kamat PP, McCracken CM, Santore MT, Mallory MD, Simon HK, Sulton CD. Radiologic Imaging in Trauma Patients with Cervical Spine Immobilization at a Pediatric Trauma Center. J Emerg Med 2019; 57:429-436. [PMID: 31591076 DOI: 10.1016/j.jemermed.2019.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/21/2019] [Accepted: 06/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric trauma patients with cervical spine (CS) immobilization using a cervical collar often require procedural sedation (PS) for radiologic imaging. The limited ability to perform airway maneuvers while CS immobilized with a cervical collar is a concern for emergency department (ED) staff providing PS. OBJECTIVE To describe the use of PS and analgesia for radiologic imaging acquisition in pediatric trauma patients with CS immobilization. METHODS Retrospective medical record review of all trauma patients with CS immobilization at a high-volume pediatric trauma center was performed. Patient demographics, imaging modality, PS success, sedative and analgesia medications, and adverse events were analyzed. Patients intubated prior to arrival to the ED were excluded. RESULTS A total of 1417 patients with 1898 imaging encounters met our inclusion criteria. A total of 398 patients required more than one radiographic imaging procedure. The median age was 8 years (range 3.8-12.75 years). Computed tomography of the head was used in 974 of the 1898 patients (51.3%). A total of 956 of the 1898 patients (50.4%) required sedatives or analgesics for their radiographic imaging, with 875 (91.5%) requiring a single sedative or analgesic agent, and 81 (8.5%) requiring more than one medication. Airway obstruction was the most common adverse event, occurring in 5 of 956 patients (0.3%). All imaging procedures were successfully completed. CONCLUSION Only 50% of CS immobilized, nonintubated patients required a single sedative or analgesic medication for their radiologic imaging. Procedural success was high, with few adverse events.
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Affiliation(s)
- Brandi C Barnes
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Pradip P Kamat
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Courtney M McCracken
- Division of Biostatistics, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew T Santore
- Department of Pediatrics, Division of Pediatric Surgery, Department of Pediatric Trauma, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michael D Mallory
- Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia
| | - Harold K Simon
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Carmen Denease Sulton
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
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Cerci ZC, Sakarya DK, Yetimalar MH, Bezircioglu I, Kasap B, Baser E, Yucel K. Computed tomography as a predictor of the extent of the disease and surgical outcomes in ovarian cancer. Ginekol Pol 2018; 87:326-32. [PMID: 27304646 DOI: 10.5603/gp.2016.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the present study is to determine the predictive value of Computed Tomography (CT), alone or in combination with serum CA-125 levels, for preoperative staging, detection of the extent of the disease, and surgical complications in patients with ovarian carcinoma. MATERIAL AND METHODS One hundred and fourteen patients diagnosed with ovarian carcinoma following an exploratory laparotomy with a preoperative CT scan, performed between January 2007 and June 2013, were enrolled in the study. Preoperative CT and intraoperative surgical findings were compared using 14 parameters and predictions of CT for gas-trointestinal, genitourinary, and cardiovascular complications. All radiological features and clinical characteristics were analyzed statistically. RESULTS CT and surgical findings correlated (sensitivity/ specificity) as follows: uterine and tubal spread (66%/89%), cervical involvement (100%/80%), peritoneal nodulesincreased density-carcinomatosis (57%/93%), omental involvement (68%/95%), retroperitoneal involvement (25%/84%), ascites (85%/87%), perirectal and perivesical fat plan obliteration (43%/94%), liver metastasis (50%/91%), small and large bowel involvement (47%/95%), adnexal mass (94%/70%), and other metastases (47%/86%). Also, CT findings were found to be statistically insignificant for prediction of mesenteric involvement, bladder metastasis, and diaphragmatic involvement. The overall CT sensitivity and specificity at detecting intraoperative findings was 91% and 71%, respectively. We found a statistically significant correlation between intestinal involvement on CT and the necessity of additional surgical procedures. CONCLUSIONS CT is a widely used imaging method in the preoperative evaluation of ovarian cancer. However, its predictive value, sensitivity and specificity differ, depending on the anatomical region.
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Affiliation(s)
- Zeynep Ceren Cerci
- Department of Obstetrics and Gynecology, Sandıklı State Hospital, Afyon, Turkey.
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Halasz CL, Munger DP, Frimmer H, Dicorato M, Wainwright S. Calciphylaxis: Comparison of radiologic imaging and histopathology. J Am Acad Dermatol 2017; 77:241-246.e3. [PMID: 28285781 DOI: 10.1016/j.jaad.2017.01.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The current gold standard for diagnosis of calciphylaxis is a skin biopsy specimen demonstrating calcification of small-caliber arteries or arterioles. OBJECTIVE The aim of this study is to compare diameters of calcified vessels seen in skin biopsy specimens and radiology images of patients with calciphylaxis. METHODS We conducted a retrospective study of patients with known calciphylaxis from 2009 to 2016 at a community hospital who had both skin biopsy specimens and radiology images taken as part of their routine care. Vascular calcification was compared in skin biopsy specimens and radiology images. RESULTS Seven patients were identified. Small-vessel calcification as fine as 0.1 to 0.3 mm was identified on plain films in 3 patients; 0.1 to 0.2 mm by mammography in 3 patients, and 0.1 to 0.2 mm by computed tomography imaging in 1 patient, nearly as fine a resolution as on histopathology. LIMITATIONS This was a single-center study with limited sample size. CONCLUSION Radiologic imaging might enable more rapid diagnosis of calciphylaxis when skin biopsy specimen is pending or not available.
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Affiliation(s)
- Charles L Halasz
- Department of Dermatology, Columbia University Medical Center, New York, New York; Department of Medicine, Norwalk Hospital, Norwalk, Connecticut.
| | - David P Munger
- Department of Radiology, Norwalk Hospital, Norwalk, Connecticut
| | - Heather Frimmer
- Department of Radiology, Norwalk Hospital, Norwalk, Connecticut
| | | | - Sandra Wainwright
- Department of Department of Hyperbaric Medicine and Wound Healing, Greenwich Hospital, Greenwich, Connecticut
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