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Papers by vaiva dabravolskaite

BMC Cancer, Nov 2, 2016

Background: To investigate whether very low mammographic breast density (VLD), HER2, and hormone ... more Background: To investigate whether very low mammographic breast density (VLD), HER2, and hormone receptor status holds any prognostic significance within the different prognostic categories of the widely used Nottingham Prognostic Index (NPI). We also aimed to see whether these factors could be incorporated into the NPI in an effort to enhance its performance. Methods: This study included 270 patients with newly diagnosed invasive breast cancer. Patients with mammographic breast density of <10 % were considered as VLD. In this study, we compared the performance of NPI with and without VLD, HER2, ER and PR. Cox multivariate analysis, time-dependent receiver operating characteristic curve (tdROC), concordance index (c-index) and prediction error (0.632+ bootstrap estimator) were used to derive an updated version of NPI. Results: Both mammographic breast density (VLD) (p < 0.001) and HER2 status (p = 0.049) had a clinically significant effect on the disease free survival of patients in the intermediate and high risk groups of the original NPI classification. The incorporation of both factors (VLD and HER2 status) into the NPI provided improved patient outcome stratification by decreasing the percentage of patients in the intermediate prognostic groups, moving a substantial percentage towards the low and high risk prognostic groups. Conclusions: Very low density (VLD) and HER2 positivity were prognostically significant factors independent of the NPI. Furthermore, the incorporation of VLD and HER2 to the NPI served to enhance its accuracy, thus offering a readily available and more accurate method for the evaluation of patient prognosis.

PLOS ONE, Jul 6, 2016

To prospectively compare the diagnostic performance and the visualization of the upper urinary tr... more To prospectively compare the diagnostic performance and the visualization of the upper urinary tract (UUT) using a comprehensive 3.0T-magnetic resonance urography (MRU) protocol versus triple-phase computed tomography urography (CTU). During the study period (January-2014 through December-2015), all consecutive patients in our tertiary university hospital scheduled by a urologist for CTU to exclude UUT malignancy were invited to participate. Diagnostic performance and visualization scores of 3.0T-MRU were compared to CTU using Wilcoxon matched-pairs test. Twenty patients (39 UUT excreting units) were evaluated. 3.0T-MRU and CTU achieved equal diagnostic performances. The benign etiology of seven UUT obstructions was clarified equally with both methods. Another two urinary tract malignant tumors and one benign extraurinary tumor were detected and confirmed. Diagnostic visualization was slightly better in the intrarenal cavity areas with CTU but worsened towards distal ureter. MRU showed consistently slightly better visualization of the ureter. In the comparison, full 100% visualizations were detected in all areas in 93.6% (with 3.0T-MRU) and 87.2% (with CTU) and >75% visualization in 100% (3.0T-MRU) and 93.6% (CTU). Mean CTU effective radiation dose was 9.2 mSv.

Artefacts encountered during imaging

The hydration protocol incorporated into the computed tomography resulted in better dila... more The hydration protocol incorporated into the computed tomography resulted in better dilatation of the renal cavities as seen in image A (axial CT) compared to magnetic resonance excretory urography (MRU, image B), but occasionally at the expense of a contrast layering effect (Area between arrows). A susceptibility artefact due to the presence of a metallic sterilization clip in the MRU (image C, arrow) results in a void signal area. The clip produced no artefacts at CT (image D, thick arrow) and thin arrows show the position of distal ureters. The artefact at MRU impaired the visibility of a short ureteral segment as seen in the volume reconstruction MRU image E (arrow).</p

Diameter measurement of the renal pelvis and ureter

Diameter measurement of the renal pelvis and ureter.</p

Percentage visualization of the upper urinary tract

Percentage visualization of the upper urinary tract.</p

Visualization scores

Visualization scores.</p

MR urography achieves comparable performance compared to CT urography

Three-dimensional Volume Rendering reconstruction of the urinary tract against a faded b... more Three-dimensional Volume Rendering reconstruction of the urinary tract against a faded background from the images obtained with CT urography (A) and MR urography (B) excretory phases.MR urography achieved a comparable diagnostic performance.</p

Flow chart

Flow chart of study patients, indications for imaging and results as determined by clini... more Flow chart of study patients, indications for imaging and results as determined by clinical evaluation, the results of imaging studies and the final histopathological diagnosis. (UC = Urothelial carcinoma; RCC = Renal Cell Carcinoma).</p

Visualisation of tumors at CT and MR urography

A 78 year old female patient presented with macroscopic hematuria. Axial contrast enhanc... more A 78 year old female patient presented with macroscopic hematuria. Axial contrast enhanced MRI (A) and CT (B) images at the level of the right renal pelvis showed an enhancing intraluminal mass (arrows) with no tumor extension outside the renal pelvis wall. A tumorous filling defect was also well visualized in the excretory phase MRU (C) and CTU (D) images and the presence of a small synchronous tumor on the opposite wall (arrowheads) was better recognized in the excretory phase images. The tumor filled the renal pelvic cavity (E, Arrow) resulting in subtotal occlusion with associated intrarenal-cavity dilatation as visualized on a postero-anterior three-dimensional volume rendering MRU. The tumor area showed restricted diffusion as estimated via the diffusion weighted imaging (F; b = 800; Arrow) with ADC values of 0.78 × 10−3 mm2/s (not shown). Final histopathology revealed a grade 2 pT1 urothelial carcinoma.</p

Magnetic Resonance (MR) and Computed Tomography (CT) Urography Imaging protocols

Magnetic Resonance (MR) and Computed Tomography (CT) Urography Imaging protocols.</p

The value of MR imaging at different time intervals

MR urography maximum intensity projections at 5 min (A), 10 min (B) and 15 min intervals... more MR urography maximum intensity projections at 5 min (A), 10 min (B) and 15 min intervals after the administration of contrast show no difference in visualization of the upper urinary tract (UUT) at MR-combined different time intervals. Different segments can be better visualized at different time intervals therefore improving the overall UUT visibility and provided comparable performance with CT urography (D, volume rendering reconstruction).</p

BMC cancer, Nov 2, 2016

To investigate whether very low mammographic breast density (VLD), HER2, and hormone receptor sta... more To investigate whether very low mammographic breast density (VLD), HER2, and hormone receptor status holds any prognostic significance within the different prognostic categories of the widely used Nottingham Prognostic Index (NPI). We also aimed to see whether these factors could be incorporated into the NPI in an effort to enhance its performance. This study included 270 patients with newly diagnosed invasive breast cancer. Patients with mammographic breast density of <10 % were considered as VLD. In this study, we compared the performance of NPI with and without VLD, HER2, ER and PR. Cox multivariate analysis, time-dependent receiver operating characteristic curve (tdROC), concordance index (c-index) and prediction error (0.632+ bootstrap estimator) were used to derive an updated version of NPI. Both mammographic breast density (VLD) (p < 0.001) and HER2 status (p = 0.049) had a clinically significant effect on the disease free survival of patients in the intermediate and hi...

PLOS ONE, 2016

European Heart Journal - Case Reports, Dec 27, 2022

Journal of clinical medicine, Feb 29, 2024

Background: Minimally Invasive Staged Segmental Artery Coil Embolization (MIS 2 ACE) is a novel t... more Background: Minimally Invasive Staged Segmental Artery Coil Embolization (MIS 2 ACE) is a novel technique of spinal cord preconditioning used to reduce the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. In this study, we report our experience with MIS 2 ACE, including both degenerative and post-dissection TAAA, while we attempt to systematically summarize relevant data available in the literature. Design: single-center observational study with systematic review of the literature and meta-analysis. Methods: Initial retrospective analysis of 7 patients undergoing MIS 2 ACE over 12 sessions with a subsequent systematic review of the literature and meta-analysis of the available published data (PROSPERO protocol number: CRD42023477411). Baseline patient and aneurysm characteristics, along with procedural technique and outcomes, were analyzed. One-arm pooling of proportions was used to summarize available published data. Results: We treated seven patients (5 males, 71%) with a median age of 69 years (IQR 55,69). According to the Crawford classification, five patients (1%) had extent II TAAA, and two (29%) had extent III TAAA. Five patients (71%) had post-dissection -TAAA; four of them were after Stanford type A dissection, and one had a chronic type B dissection. Three patients (43%) had connective tissue disease. Of the seven patients, six (86%) underwent previous aortic surgery, while the median aneurysm diameter was 58 mm (IQR 55,58). MIS 2 ACE was successful in 11 sessions (92%). The median number of embolized arteries was 4 (IQR 1,4). There were no periprocedural complications in any embolization. The median embolization-operation time interval was 37.0 days (IQR 31,78). Two patients had open and five endovascular treatment. There were no events of spinal cord ischemia either after MIS 2 ACE or after the aortic repair. Out of the 432 initially retrieved articles, we included two studies in the meta-analysis, including patients with MIS 2 ACE for spinal cord preconditioning in addition to our cohort. The prevalence of pooled postoperative spinal cord ischemia among MIS 2 ACE patients is 1.9% (95% CI -0.028 to 0.066, p = 0.279; 3 studies; 81 patients, 127 coiling sessions). Conclusions: While the current published data is limited, our study further confirms that MIS 2 ACE is a technically feasible and safe option for spinal cord preconditioning.

European Heart Journal - Case Reports

Background Coronary subclavian steal syndrome (CSSS) is an often easily overlooked cause of angin... more Background Coronary subclavian steal syndrome (CSSS) is an often easily overlooked cause of angina that may occur after a coronary artery bypass graft (CABG) procedure. The onset of CSSS several years after coronary revascularization has been described in case reports, and in the few retrospective reviews that compare the endovascular approach with surgical treatment. Subclavian stenosis can naturally coincide with coronary artery disease and may already be present during the initial CABG. Case summary A 59-year-old male with a history of three-vessel disease who had a left internal mammary artery (LIMA) bypass graft, exhibited a gradual worsening of angina that coincided with numbness and impaired function of the left fingers, hand, and arm. Myocardial perfusion imaging showed reversible ischaemia, and coronary angiography suggested a thrombotic lesion proximal to the LIMA ostium. Calcified and partially thrombosed proximal left subclavian artery (LSA) aneurysm was visualized using...

Clinical Interventions in Aging

The aim of the present study was to describe and analyze changes in the incidences of lower extre... more The aim of the present study was to describe and analyze changes in the incidences of lower extremity amputations (LEAs), patient characteristics, vascular history of amputees and survival in Southwest Finland. Patients and Methods: This is a retrospective patient study in the Hospital District of Southwest Finland. All consecutive patients with atherosclerosis and diabetes-caused LEA, between 1st January 2007 and 31st December 2017, were included. The annual incidences of major LEA patients were statistically standardized. Patients' diagnoses, functional status, previous revascularizations and minor amputations were recorded, and survival was analyzed. Results: During the 11-year-period major LEAs were performed on 891 patients, 118 (13.2%) were urgent operations. The overall incidence of major LEA was 17.2/100 000 and was age-dependent (3.1 for ≤64 years, 34.3 for 65-74 years, 81.5 for 75-84 years, 216 for ≥85 years). A decrease in incidence was detected in the <65 year-age-group (incidence 4.98 in 2007 and 1.88 in 2017; p = 0.0018). Among older age groups, there was no significant change. Half (50.6%) of all amputees were diabetics. Altogether, 472 patients (53.0%) had a history of revascularization before LEA. 80.1% of index amputations were transfemoral and 19.9% transtibial. Resurgery was performed on 94 (10.5%) patients. The 1-, 3-and 5-year overall survival were 56%, 30%, and 18%, respectively. Conclusion: Our results suggest that in an aging population, despite good availability of vascular services, a significant number of patients are not fit for active revascularization, and LEA is the only feasible treatment for critical limb ischemia.