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Marçal PC, Braggion-Santos MF, Wada DT, Santos MK, Moreira HT, Volpe GJ, Schmidt A. Cardiac Magnetic Resonance as an Etiological Diagnosis Tool in Recovered Sudden Cardiac Death or Unstable Ventricular Arrhythmia Patients. Arq Bras Cardiol 2023; 120:e20220411. [PMID: 37098988 PMCID: PMC10263419 DOI: 10.36660/abc.20220411] [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: 06/13/2022] [Revised: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) has an increasing diagnostic relevance in survivors of sudden cardiac death (SCD) or unstable ventricular arrhythmia (UVA) in developed countries. OBJECTIVE To evaluate retrospectively the additional role of CMR in a developing country where few resources are available, and should be used more effectively. METHODS The study included SCD or UVA survivors admitted between 2009 and 2019 at a tertiary academic institution referred to CMR. Demographic, clinical, and laboratory data were collected from the medical records. CMR images and reports were reviewed and their impact on the final etiological diagnosis was determined. A descriptive analysis was performed and p<0.05 established as significant. RESULTS Sixty-four patients, 54.9±15.4 years old, and 42 (71.9%) males. Most events (81.3%) were out of the hospital and ventricular tachycardia was the most common rhythm. Cardiovascular medications were previously used by 55 patients, and beta-blockers were the most used medications (37.5%). Electrocardiogram had electrical inactive areas in 21.9% and all of them had fibrosis at CMR. Mean left ventricular ejection fraction (LVEF) was 44±14%, with 60.9% ≤50% and only 29.7% ≤35%. Late gadolinium enhancement was identified in 71.9%, with a transmural pattern in 43.8%. Chagas cardiomyopathy was the most common etiology (28.1%), followed by ischemic cardiomyopathy (17.2%). Among 26 without a previously identified etiology, CMR could define it (15 patients - 57%). CONCLUSION In accordance with previous studies in developed countries, CMR was capable of increasing etiological diagnosis and identifying the arrhythmogenic substrate, allowing better care in half of the underdiagnosed patients.
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Affiliation(s)
- Paula C. Marçal
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - Maria Fernanda Braggion-Santos
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - Danilo Tadao Wada
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoDepartamento de Imagens Médicas, Hematologia e OncologiaRibeirão PretoSPBrasilHospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – Departamento de Imagens Médicas, Hematologia e Oncologia, Ribeirão Preto, SP – Brasil
| | - Marcel Koenigkam Santos
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoDepartamento de Imagens Médicas, Hematologia e OncologiaRibeirão PretoSPBrasilHospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – Departamento de Imagens Médicas, Hematologia e Oncologia, Ribeirão Preto, SP – Brasil
| | - Henrique Turin Moreira
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - Gustavo Jardim Volpe
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - André Schmidt
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
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Batah SS, Benatti MN, Siyuan L, Telini WM, Barboza JO, Menezes MB, Nadai TR, Sá KSG, Vaswani CM, Gupta S, Zamboni DS, Wada DT, Calado RT, Oliveira RDR, Louzada‐Junior P, Auxiliadora‐Martins M, Veras FP, Cunha LD, Cunha TM, Luppino‐Assad R, Balancin ML, Morais SS, Martins RB, Arruda E, Chahud F, Santos MK, Cetlin AA, Cunha FQ, dos Santos C, Capelozzi VL, Fukuoka J, Achcar RD, Fabro AT. COVID‐19 bimodal clinical and pathological phenotypes. Clin Transl Med 2022; 12:e648. [PMID: 35075808 PMCID: PMC8787021 DOI: 10.1002/ctm2.648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 02/06/2023] Open
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da Silva THG, Gastaldi AC, Santos MK, de Martinis BS, Baddini-Martinez J. Induced sputum abnormalities in gas station attendants. Int Arch Occup Environ Health 2021; 95:341-349. [PMID: 34435248 DOI: 10.1007/s00420-021-01755-2] [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: 02/05/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate inflammatory changes in the induced sputum (IS) of gas station attendants (GSAs) at risk of exposure to fuel vapors through inhalation and susceptible to respiratory complaints and impaired lung function. METHODS Hypertonic saline-IS was collected from 52 GSAs who had never smoked (42 men, age = 35.9 ± 8.9 years) and had no known comorbidities. A group of 22 non-smokers (11 men, age = 30.5 ± 5.1 years) selected from the University staff served as control. The GSAs answered a questionnaire and underwent spirometry and chest tomography. A total of 15 inflammatory biomarkers associated with inflammation, including cytokines, chemokines, and mediators of immunological response, were also measured. RESULTS The most common symptoms of GSAs were coughing (42.3%) and dyspnea (59.6%) based on the New York Heart Association (NYHA; Class II) classification. Significant elevations (p < 0.05) in forced vital capacity and forced expiratory volume within the first second were observed in the GSAs relative to those in the controls (GSA vs. control: 99 ± 12% vs. 90 ± 9% and 94 ± 11% vs. 87 ± 10%, respectively). The GSAs had a lower percentage of IS lymphocytes than that in the control group (4.5 ± 5.7% vs. 7.7 ± 9.8%). The GSAs also had significantly lower concentrations of IL-4, IL-5, IL-10, IL-12P70, IFN-γ, and MIP-1α, but IL-3 levels were higher. No differences were observed in the airway thickness and the amount of emphysema between the GSAs and the controls. CONCLUSION Despite normal lung function and absence of abnormalities on HRCT, GSAs have a higher frequency of respiratory complaints, with evidence of impairment of lymphocytic activity in the airways.
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Affiliation(s)
- Tiago Henrique Garcia da Silva
- Internal Medicine Department. Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirao Preto, SP, 14048-900, Brazil
| | - Ada Clarice Gastaldi
- Department of Health Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - Marcel Koenigkam Santos
- Department of Medical Imaging, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - Bruno Spinosa de Martinis
- Department of Chemistry, Faculty of Philosophy, Science and Languages of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - José Baddini-Martinez
- Internal Medicine Department. Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirao Preto, SP, 14048-900, Brazil.
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Fabro AT, Machado-Rugolo J, Baldavira CM, Prieto TG, Farhat C, Rotea ManGone FR, Batah SS, Cruvinel HR, Aldá MA, Monteiro JS, Pádua AI, Morais SS, Antônio de Oliveira R, Santos MK, Baddini-Martinez JA, Setubal JC, Rainho CA, Yoo HHB, Silva PL, Nagai MA, Capelozzi VL. Circulating Plasma miRNA and Clinical/Hemodynamic Characteristics Provide Additional Predictive Information About Acute Pulmonary Thromboembolism, Chronic Thromboembolic Pulmonary Hypertension and Idiopathic Pulmonary Hypertension. Front Pharmacol 2021; 12:648769. [PMID: 34122072 PMCID: PMC8194827 DOI: 10.3389/fphar.2021.648769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/01/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Idiopathic pulmonary artery hypertension (IPAH), chronic thromboembolic pulmonary hypertension (CTEPH), and acute pulmonary embolism (APTE) are life-threatening cardiopulmonary diseases without specific surgical or medical treatment. Although APTE, CTEPH and IPAH are different pulmonary vascular diseases in terms of clinical presentation, prevalence, pathophysiology and prognosis, the identification of their circulating microRNA (miRNAs) might help in recognizing differences in their outcome evolution and clinical forms. The aim of this study was to describe the APTE, CTEPH, and IPAH-associated miRNAs and to predict their target genes. The target genes of the key differentially expressed miRNAs were analyzed, and functional enrichment analyses were carried out. The miRNAs were detected using RT-PCR. Finally, we incorporated plasma circulating miRNAs in baseline and clinical characteristics of the patients to detect differences between APTE and CTEPH in time of evolution, and differences between CTEPH and IPAH in diseases form. We found five top circulating plasma miRNAs in common with APTE, CTEPH and IPAH assembled in one conglomerate. Among them, miR-let-7i-5p expression was upregulated in APTE and IPAH, while miRNA-320a was upregulated in CTEP and IPAH. The network construction for target genes showed 11 genes regulated by let-7i-5p and 20 genes regulated by miR-320a, all of them regulators of pulmonary arterial adventitial fibroblasts, pulmonary artery endothelial cell, and pulmonary artery smooth muscle cells. AR (androgen receptor), a target gene of hsa-let-7i-5p and has-miR-320a, was enriched in pathways in cancer, whereas PRKCA (Protein Kinase C Alpha), also a target gene of hsa-let-7i-5p and has-miR-320a, was enriched in KEGG pathways, such as pathways in cancer, glioma, and PI3K-Akt signaling pathway. We inferred that CTEPH might be the consequence of abnormal remodeling in APTE, while unbalance between the hyperproliferative and apoptosis-resistant phenotype of pulmonary arterial adventitial fibroblasts, pulmonary artery endothelial cell and pulmonary artery smooth muscle cells in pulmonary artery confer differences in IPAH and CTEPH diseases form. We concluded that the incorporation of plasma circulating let-7i-5p and miRNA-320a in baseline and clinical characteristics of the patients reinforces differences between APTE and CTEPH in outcome evolution, as well as differences between CTEPH and IPAH in diseases form.
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Affiliation(s)
- Alexandre Todorovic Fabro
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Juliana Machado-Rugolo
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Health Technology Assessment Center (NATS), Clinical Hospital (HCFMB), Medical School of São Paulo State University (UNESP), Botucatu, Brazil
| | - Camila Machado Baldavira
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Tabatha Gutierrez Prieto
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Cecília Farhat
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Flavia Regina Rotea ManGone
- Laboratory of Molecular Genetics, Center for Translational Research in Oncology, Cancer Institute of São Paulo (ICESP), São Paulo, Brazil
| | - Sabrina Setembre Batah
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Heloísa Resende Cruvinel
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Maiara Almeida Aldá
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Jhonatas Sirino Monteiro
- Bioinformatic Laboratory, Institute of Chemistry, University of São Paulo (USP), São Paulo, Brazil
| | - Adriana Inacio Pádua
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Rogério Antônio de Oliveira
- Department of Biostatistics, Plant Biology, Parasitology and Zoology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Marcel Koenigkam Santos
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - José Antônio Baddini-Martinez
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - João Carlos Setubal
- Bioinformatic Laboratory, Institute of Chemistry, University of São Paulo (USP), São Paulo, Brazil
| | - Claudia Aparecida Rainho
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Hugo Hyung Bok Yoo
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil.,National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil
| | - Maria Aparecida Nagai
- Laboratory of Molecular Genetics, Center for Translational Research in Oncology, Cancer Institute of São Paulo (ICESP), São Paulo, Brazil.,Department of Radiology and Oncology, Medical School of São Paulo State University (UNESP), São Paulo, Brazil
| | - Vera Luiza Capelozzi
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Soriano L, Santos MK, Wada DT, Vilalva K, Castro TT, Weinheimer O, Muglia VF, Pazin Filho A, Miranda CH. Pulmonary Vascular Volume Estimated by Automated Software is a Mortality Predictor after Acute Pulmonary Embolism. Arq Bras Cardiol 2020; 115:809-818. [PMID: 33295442 PMCID: PMC8452195 DOI: 10.36660/abc.20190392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
Fundamento: A embolia pulmonar aguda (EPA) tem desfecho clínico variável. A angiotomografia computadorizada (angio-CT) é considerada o padrão-ouro para o diagnóstico. Objetivo: Avaliar se o volume vascular pulmonar (VVP) quantificado por software automatizado é um preditor de mortalidade após EPA. Métodos: Estudo de coorte retrospectivo no qual a imagem da angio-CT de 61 pacientes com EPA foi reanalisada. O VVP e o volume pulmonar (VP) foram estimados automaticamente pelo software Yacta. Calculamos o VVP ajustado pela razão: VVP(cm3)/VP(litros). Parâmetros prognósticos clássicos da angio-CT (carga embólica; razão do diâmetro do ventrículo direito/ventrículo esquerdo; razão do diâmetro da artéria pulmonar/aorta; desvio do septo interventricular; infarto pulmonar e refluxo de contraste na veia hepática) foram avaliados. A mortalidade em 1 mês foi o desfecho analisado. Consideramos um valor de p <0,05 como estatisticamente significativo. Resultados: Sete mortes (11%) ocorreram entre os 61 pacientes durante 1 mês de seguimento. O VVP ajustado <23cm3/L foi um preditor independente de mortalidade na análise univariada (odds ratio [OR]: 26; intervalo de confiança de 95% [IC95%]: 3-244; p=0,004) e na análise multivariada (OR ajustado: 19 [IC95%: 1,3-270]; p=0,03). Os parâmetros clássicos da angio-CT não foram associados à mortalidade em 1 mês nesta amostra. O VVP ajustado <23cm3/L apresentou sensibilidade de 86%, especificidade de 82%, valor preditivo negativo de 94% e valor preditivo positivo de 64% para identificação dos pacientes que morreram. Conclusão: VVP ajustado <23cm3/L foi um preditor independente de mortalidade após EPA. Esse parâmetro mostrou melhor desempenho prognóstico do que os outros achados clássicos da angio-CT. (Arq Bras Cardiol. 2020; 115(5):809-818)
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Affiliation(s)
- Leonardo Soriano
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brasil
| | - Marcel Koenigkam Santos
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Radiologia do Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Ribeirão Preto, SP - Brasil
| | - Danilo Tadeu Wada
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Radiologia do Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Ribeirão Preto, SP - Brasil
| | - Kelvin Vilalva
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brasil
| | - Talita Tavares Castro
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brasil
| | - Oliver Weinheimer
- University Hospital Heidelberg - Department of Diagnostic and Interventional Radiology and Translational Lung Research Centre Heidelberg (TLRC) - German Lung Research Centre (DZL), Heidelberg - Alemanha
| | - Valdair Francisco Muglia
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Radiologia do Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Ribeirão Preto, SP - Brasil
| | - Antonio Pazin Filho
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brasil
| | - Carlos Henrique Miranda
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, Ribeirão Preto, SP - Brasil
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Batah SS, Alda MA, Machado‐Rugulo JR, Felix RG, Nascimento E, Martinez R, de Pádua AI, Bagagli E, Hrycyk MF, Salgado HC, Castania JA, Sbragia L, Santos MK, Baddini‐Martinez JA, Morais SS, Capelozzi VL, Achcar RD, Fabro AT. Pulmonary paracoccidioidomycosis-induced pulmonary hypertension. Clin Transl Med 2020; 10:e213. [PMID: 33252858 PMCID: PMC7678439 DOI: 10.1002/ctm2.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sabrina Setembre Batah
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Maiara Almeida Alda
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | | | - Renato Gonçalves Felix
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Erika Nascimento
- Division of Infectious and Tropical DiseasesInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Roberto Martinez
- Division of Infectious and Tropical DiseasesInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Adriana Ignácio de Pádua
- Pulmonary DivisionInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Eduardo Bagagli
- Institute of Biosciences, Botucatu Medical SchoolSão Paulo State UniversityBotucatuBrazil
| | | | - Hélio Cesar Salgado
- Department of PhysiologyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Jaci Airton Castania
- Department of PhysiologyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Lourenço Sbragia
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Marcel Koenigkam Santos
- Department of Medical Imaging, Hematology and Clinical OncologyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - José Antônio Baddini‐Martinez
- Pulmonary DivisionInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Sirlei Siani Morais
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Vera Luiza Capelozzi
- Department of PathologyFaculty of MedicineUniversity of São PauloSão PauloBrazil
| | | | - Alexandre Todorovic Fabro
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
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Colombo Filho ME, Mello Galliez R, Andrade Bernardi F, de Oliveira LL, Kritski A, Koenigkam Santos M, Alves D. Preliminary Results on Pulmonary Tuberculosis Detection in Chest X-Ray Using Convolutional Neural Networks. Lecture Notes in Computer Science 2020. [PMCID: PMC7303695 DOI: 10.1007/978-3-030-50423-6_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Tuberculosis (TB), is an ancient disease that probably affects humans since pre-hominids. This disease is caused by bacteria belonging to the mycobacterium tuberculosis complex and usually affects the lungs in up to 67% of cases. In 2019, there were estimated to be over 10 million tuberculosis cases in the world, in the same year TB was between the ten leading causes of death, and the deadliest from a single infectious agent. Chest X-ray (CXR) has recently been promoted by the WHO as a tool possibly placed early in screening and triaging algorithms for TB detection. Numerous TB prevalence surveys have demonstrated that CXR is the most sensitive screening tool for pulmonary TB and that a significant proportion of people with TB are asymptomatic in the early stages of the disease. This study presents experimentation of classic convolutional neural network architectures on public CRX databases in order to create a tool applied to the diagnostic aid of TB in chest X-ray images. As result the study has an AUC ranging from 0.78 to 0.84, sensitivity from 0.76 to 0.86 and specificity from 0.58 to 0.74 depending on the network architecture. The observed performance by these metrics alone are within the range of metrics found in the literature, although there is much room for metrics improvement and bias avoiding. Also, the usage of the model in a triage use-case could be used to validate the efficiency of the model in the future.
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Leite De Barros Filho A, Moreira HT, Santos MK, Schmidt A, Santana RC, Rodrigues AJ, Maciel BC, Marin-Neto JA, Romano MMD. P187 Multimodality in tuberculous constrictive pericarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
CASE PRESENTATION
K.C.P., a 26 y.o. female, presenting dizziness and progressive dyspnea since 9 months ago. Physical examination showed hepatomegaly at 2 centimeters below the right inferior costal border, but without edema, cardiac murmurs or other findings. Electrocardiogram showed atria overload and diffuse ventricular repolarization abnormality. Chest X-ray revealed normal sized cardiac silhouette but with signs of pericardial calcification. Transthoracic echocardiogram revealed: enlargement of both atria, no signs of myocardial left ventricular (LV) hypertrophy; dilated inferior vena cava with minimal respiratory variation; septal bounce; septal e´= 17.20 cm/s, lateral e´= 6.09 cm/s; E/e" septal ratio = 3.9; E deceleration time = 144 ms; thickening and hyper-refringence of the pericardium with calcification adjacent to the lateral and inferior walls of the LV and the free wall of the right ventricle. For evaluation of thickness and extent of pericardial involvement, computed tomography (CT) was performed, showing gross calcifications of the pericardium, mainly in basal and lower portions, without pericardial effusion. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement revealed areas suggestive of active inflammation adjacent to the basal wall of the LV. With this evidence of active inflammatory activity, the patient was treated empirically against the etiologic agent for tuberculosis. Because of progressively severe edema and dyspnea pericardiectomy was warranted providing relief of symptoms. DISCUSSION: The echocardiogram is the initial image exam for diagnosis and monitoring of pericardial conditions. It is a widely available, low-cost method that does not use ionizing radiation and allows a complete morphological and functional evaluation of the heart. However, in up to 20% of cases, pericardial thickening may not be detectable at echocardiography. CT allows a more accurate assessment of pericardial thickening, while CMR allows detection of active inflammatory process. CONCLUSION: A typical and illustrative clinical case of constrictive pericarditis is presented, where the multimodality of cardiac imaging was decisive for the diagnostic and therapeutic delineation.
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Affiliation(s)
- A Leite De Barros Filho
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - H T Moreira
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - M K Santos
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - A Schmidt
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - R C Santana
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - A J Rodrigues
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - B C Maciel
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - J A Marin-Neto
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
| | - M M D Romano
- Medical School of Ribeirao Preto, University of Sao Paulo, Cardiology, Ribeirao Preto, Brazil
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9
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Santos MK, Ferreira Júnior JR, Wada DT, Tenório APM, Barbosa MHN, Marques PMDA. Artificial intelligence, machine learning, computer-aided diagnosis, and radiomics: advances in imaging towards to precision medicine. Radiol Bras 2019; 52:387-396. [PMID: 32047333 PMCID: PMC7007049 DOI: 10.1590/0100-3984.2019.0049] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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] [Indexed: 02/08/2023] Open
Abstract
The discipline of radiology and diagnostic imaging has evolved greatly in recent years. We have observed an exponential increase in the number of exams performed, subspecialization of medical fields, and increases in accuracy of the various imaging methods, making it a challenge for the radiologist to "know everything about all exams and regions". In addition, imaging exams are no longer only qualitative and diagnostic, providing now quantitative information on disease severity, as well as identifying biomarkers of prognosis and treatment response. In view of this, computer-aided diagnosis systems have been developed with the objective of complementing diagnostic imaging and helping the therapeutic decision-making process. With the advent of artificial intelligence, "big data", and machine learning, we are moving toward the rapid expansion of the use of these tools in daily life of physicians, making each patient unique, as well as leading radiology toward the concept of multidisciplinary approach and precision medicine. In this article, we will present the main aspects of the computational tools currently available for analysis of images and the principles of such analysis, together with the main terms and concepts involved, as well as examining the impact that the development of artificial intelligence has had on radiology and diagnostic imaging.
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Affiliation(s)
- Marcel Koenigkam Santos
- Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - José Raniery Ferreira Júnior
- Escola de Engenharia de São Carlos da Universidade de São Paulo (EESC-USP), São Carlos, SP, Brazil.,Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Danilo Tadao Wada
- Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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10
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de Souza Simoni LH, dos Santos DO, de Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute Effects of Oscillatory PEP and Thoracic Compression on Secretion Removal and Impedance of the Respiratory System in Non–Cystic Fibrosis Bronchiectasis. Respir Care 2019; 64:818-827. [DOI: 10.4187/respcare.06025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Hochhegger B, Zanon M, Altmayer S, Pacini GS, Balbinot F, Francisco MZ, Dalla Costa R, Watte G, Santos MK, Barros MC, Penha D, Irion K, Marchiori E. Advances in Imaging and Automated Quantification of Malignant Pulmonary Diseases: A State-of-the-Art Review. Lung 2018; 196:633-642. [DOI: 10.1007/s00408-018-0156-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
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12
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Santos MK, Fabro AT, Baddini-Martinez J. Diagnostic criteria for idiopathic pulmonary fibrosis. Lancet Respir Med 2018; 6:e5. [PMID: 29413088 DOI: 10.1016/s2213-2600(18)30019-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/09/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Marcel Koenigkam Santos
- Interstitial Lung Disease Multidisciplinary Group, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto SP 14110000, Brazil.
| | - Alexandre Todorovic Fabro
- Interstitial Lung Disease Multidisciplinary Group, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto SP 14110000, Brazil
| | - Jose Baddini-Martinez
- Interstitial Lung Disease Multidisciplinary Group, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto SP 14110000, Brazil
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13
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Wada DT, de Pádua AI, Lima Filho MO, Marin Neto JA, Elias Júnior J, Baddini-Martinez J, Santos MK. Use of computed tomography and automated software for quantitative analysis of the vasculature of patients with pulmonary hypertension. Radiol Bras 2017; 50:351-358. [PMID: 29307924 PMCID: PMC5746878 DOI: 10.1590/0100-3984.2016.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 12/17/2022] Open
Abstract
Objective To perform a quantitative analysis of the lung parenchyma and pulmonary
vasculature of patients with pulmonary hypertension (PH) on computed
tomography angiography (CTA) images, using automated software. Materials and Methods We retrospectively analyzed the CTA findings and clinical records of 45
patients with PH (17 males and 28 females), in comparison with a control
group of 20 healthy individuals (7 males and 13 females); the mean age
differed significantly between the two groups (53 ± 14.7 vs. 35
± 9.6 years; p = 0.0001). Results The automated analysis showed that, in comparison with the controls, the
patients with PH showed lower 10th percentile values for lung density,
higher vascular volumes in the right upper lung lobe, and higher vascular
volume ratios between the upper and lower lobes. In our quantitative
analysis, we found no differences among the various PH subgroups. We
inferred that a difference in the 10th percentile values indicates areas of
hypovolemia in patients with PH and that a difference in pulmonary vascular
volumes indicates redistribution of the pulmonary vasculature and an
increase in pulmonary vasculature resistance. Conclusion Automated analysis of pulmonary vessels on CTA images revealed alterations
and could represent an objective diagnostic tool for the evaluation of
patients with PH.
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Affiliation(s)
- Danilo Tadao Wada
- MSc, Attending Physician at the Centro de Ciências das Imagens e Física Médica (CCIFM) of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Adriana Ignácio de Pádua
- PhD, Attending Physician in the Pulmonology Department of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Moyses Oliveira Lima Filho
- PhD, Attending Physician in the Cardiology Department of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - José Antonio Marin Neto
- PhD, Professor in the Department of Internal Medicine of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Elias Júnior
- PhD, Professor in the Department of Internal Medicine of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - José Baddini-Martinez
- PhD, Professor in the Department of Internal Medicine of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcel Koenigkam Santos
- PhD, Collaborating Professor in the Department of Internal Medicine of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
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Guimarães MD, Noschang J, Teixeira SR, Santos MK, Lederman HM, Tostes V, Kundra V, Oliveira AD, Hochhegger B, Marchiori E. Whole-body MRI in pediatric patients with cancer. Cancer Imaging 2017; 17:6. [PMID: 28187778 PMCID: PMC5303228 DOI: 10.1186/s40644-017-0107-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 09/30/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
Cancer is the leading cause of natural death in the pediatric populations of developed countries, yet cure rates are greater than 70% when a cancer is diagnosed in its early stages. Recent advances in magnetic resonance imaging methods have markedly improved diagnostic and therapeutic approaches, while avoiding the risks of ionizing radiation that are associated with most conventional radiological methods, such as computed tomography and positron emission tomography/computed tomography. The advent of whole-body magnetic resonance imaging in association with the development of metabolic- and function-based techniques has led to the use of whole-body magnetic resonance imaging for the screening, diagnosis, staging, response assessment, and post-therapeutic follow-up of children with solid sporadic tumours or those with related genetic syndromes. Here, the advantages, techniques, indications, and limitations of whole-body magnetic resonance imaging in the management of pediatric oncology patients are presented.
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Affiliation(s)
- Marcos Duarte Guimarães
- Department of Imaging, AC Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, Liberdade, São Paulo/SP, 01509-010, Brazil.,Universidade Federal do Vale do São Francisco (UNIVASF), Av. José de Sá Maniçoba, Petrolina, PE, 56304-917, Brazil
| | - Julia Noschang
- Department of Imaging, AC Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, Liberdade, Sao Paulo/SP, 01509-010, Brazil.
| | - Sara Reis Teixeira
- Division of Radiology, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900, Ribeirao Preto/ SP, 14049-090, Brazil
| | - Marcel Koenigkam Santos
- Division of Radiology, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900, Ribeirao Preto/ SP, 14049-090, Brazil
| | - Henrique Manoel Lederman
- Universidade Federal de São Paulo, Departamento de Diagnóstico Por Imagem, Disciplina de Diagnóstico por Imagem em Pediatria, Rua Napoleão de Barros, 800, Vila Clementino, Sao Paulo/SP, 04024002, Brazil
| | - Vivian Tostes
- Universidade Federal de São Paulo, Centro de Diagnóstico por Imagem do Instituto de Oncologia Pediátrica e Médica Radiologista do Centro de Diagnóstico por Imagem do Instituto de Oncologia Pediátrica, Rua Napoleão de Barros, 800, Vila Clementino, Sao Paulo/SP, 04024002, Brazil
| | - Vikas Kundra
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Alex Dias Oliveira
- Department of Imaging, AC Camargo Cancer Center, Rua Prof. Antônio Prudente, 211, Liberdade, Sao Paulo/SP, 01509-010, Brazil
| | - Bruno Hochhegger
- Department of Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Professor Anes Dias, 285, Centro Histórico, Porto Alegre/RS, 90020-090, Brazil
| | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaíso, Petrópolis/RJ, 25685-129, Brazil
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15
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Trad HS, Gali AMA, Santos MK, Braggion-Santos MF, Volpe GJ, Maciel BC, Schmidt A. Aortic Regurgitation Quantification using Cardiac Magnetic Resonance. Is there a best imaging plane for flow quantification? A single center clinical trial. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032757 DOI: 10.1186/1532-429x-18-s1-p340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Trad HS, Gali AMA, Santos MK, Braggion-Santos MF, Volpe GJ, Maciel BC, Schmidt A. Late gadolinium enhancement is not related to the severity of aortic regurgitation. A single center study. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032339 DOI: 10.1186/1532-429x-18-s1-q55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Santos MK, Cruvinel DL, de Menezes MB, Teixeira SR, Vianna EDO, Elias Júnior J, Martinez JAB. Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity. Radiol Bras 2016; 49:351-357. [PMID: 28100929 PMCID: PMC5238409 DOI: 10.1590/0100-3984.2015.0145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Indexed: 11/24/2022] Open
Abstract
Objective To perform a quantitative analysis of the airways using automated software,
in computed tomography images of patients with cystic fibrosis, correlating
the results with spirometric findings. Materials and Methods Thirty-four patients with cystic fibrosis were studied-20 males and 14
females; mean age 18 ± 9 years-divided into two groups according to
the spirometry findings: group I (n = 21), without severe
airflow obstruction (forced expiratory volume in first second [FEV1] >
50% predicted), and group II (n = 13), with severe
obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial
tree parameters were obtained automatically: bronchial diameter, area,
thickness, and wall attenuation. Results On average, 52 bronchi per patient were studied. The number of bronchi
analyzed was higher in group II. The correlation with spirometry findings,
especially between the relative wall thickness of third to eighth bronchial
generation and predicted FEV1, was better in group I. Conclusion Quantitative analysis of the airways by computed tomography can be useful for
assessing disease severity in cystic fibrosis patients. In patients with
severe airflow obstruction, the number of bronchi studied by the method is
higher, indicating more bronchiectasis. In patients without severe
obstruction, the relative bronchial wall thickness showed a good correlation
with the predicted FEV1.
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Affiliation(s)
- Marcel Koenigkam Santos
- PhD, MD, Radiologist, Collaborating Professor at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Danilo Lemos Cruvinel
- MD, Radiology Specialist at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcelo Bezerra de Menezes
- PhD, MD, Attending Pulmonologist in the Pulmonology Sector of the Department of Clinical Medicine of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Sara Reis Teixeira
- PhD, MD, Attending Radiologist at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Elcio de Oliveira Vianna
- PhD, MD, Pulmonologist, Professor in the Pulmonology Sector of the Department of Clinical Medicine of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Elias Júnior
- PhD, MD, Radiologist, Professor at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - José Antonio Baddini Martinez
- PhD, MD, Pulmonologist, Professor in the Pulmonology Sector of the Department of Clinical Medicine of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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18
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Maia CP, Gali LG, Schmidt A, de Almeida Filho OC, Santos MK, Saraiva LAL, Rodrigues AJ, Maciel BC, Romano MMD. A Challenging Differential Diagnosis: Distinguishing between Endomyocardial Fibrosis and Apical Hypertrophic Cardiomyopathy. Echocardiography 2016; 33:1080-4. [DOI: 10.1111/echo.13244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Cintia Prado Maia
- Internal Medical Department; Cardiology Center; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
| | - Luís Gustavo Gali
- Internal Medical Department; Cardiology Center; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
| | - André Schmidt
- Internal Medical Department; Cardiology Center; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
| | - Oswaldo César de Almeida Filho
- Internal Medical Department; Cardiology Center; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
| | - Marcel Koenigkam Santos
- Internal Medicine Department; Image and Medical Physics Center; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
| | | | - Alfredo José Rodrigues
- Cardiovascular and Thoracic Surgery Group; Surgery Department; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
| | - Benedito Carlos Maciel
- Internal Medical Department; Cardiology Center; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
| | - Minna Moreira Dias Romano
- Internal Medical Department; Cardiology Center; Medicine School of Ribeirão Preto; São Paulo University; Ribeirão Preto Brazil
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19
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Hochhegger B, de Souza VVS, Marchiori E, Irion KL, Souza AS, Elias Junior J, Rodrigues RS, Barreto MM, Escuissato DL, Mançano AD, Araujo Neto CA, Guimarães MD, Nin CS, Santos MK, Silva JLPE. Chest magnetic resonance imaging: a protocol suggestion. Radiol Bras 2016; 48:373-80. [PMID: 26811555 PMCID: PMC4725399 DOI: 10.1590/0100-3984.2014.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 11/25/2022] Open
Abstract
In the recent years, with the development of ultrafast sequences, magnetic
resonance imaging (MRI) has been established as a valuable diagnostic modality
in body imaging. Because of improvements in speed and image quality, MRI is now
ready for routine clinical use also in the study of pulmonary diseases. The main
advantage of MRI of the lungs is its unique combination of morphological and
functional assessment in a single imaging session. In this article, the authors
review most technical aspects and suggest a protocol for performing chest MRI.
The authors also describe the three major clinical indications for MRI of the
lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and
investigation of pulmonary abnormalities in patients who should not be exposed
to radiation.
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Affiliation(s)
- Bruno Hochhegger
- PhD, Associate Professor, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Klaus Loureiro Irion
- PhD, Consultant Radiologist, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Arthur Soares Souza
- PhD, Professor, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Jorge Elias Junior
- PhD, Associate Professor, Centro de Ciências das Imagens e Física Médica (CCIFM) - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor, Department of Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | | | | | - Marcos Duarte Guimarães
- PhD, Professor, Program of Post-graduation stricto sensu, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Carlos Schuler Nin
- MD, Resident in Radiology and Imaging Diagnosis, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marcel Koenigkam Santos
- PhD, Attending Physician at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Luiz Pereira E Silva
- PhD, Associate Professor, Department of Medicine and Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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20
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Guimaraes MD, Hochhegger B, Santos MK, Santana PRP, Sousa AS, Souza LS, Marchiori E. Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art. Radiol Bras 2015. [PMID: 25798006 PMCID: PMC4366027 DOI: 10.1590/0100-3984.2013.1921] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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] [Indexed: 12/15/2022] Open
Abstract
Magnetic resonance imaging (MRI) has several advantages in the evaluation of cancer
patients with thoracic lesions, including involvement of the chest wall, pleura,
lungs, mediastinum, esophagus and heart. It is a quite useful tool in the diagnosis,
staging, surgical planning, treatment response evaluation and follow-up of these
patients. In the present review, the authors contextualize the relevance of MRI in
the evaluation of thoracic lesions in cancer patients. Considering that MRI is a
widely available method with high contrast and spatial resolution and without the
risks associated with the use of ionizing radiation, its use combined with new
techniques such as cine-MRI and functional methods such as perfusion- and
diffusion-weighted imaging may be useful as an alternative tool with performance
comparable or complementary to conventional radiological methods such as radiography,
computed tomography and PET/CT imaging in the evaluation of patients with thoracic
neoplasias.
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Affiliation(s)
- Marcos Duarte Guimaraes
- PhD, Radiologist, Specialist in Internal Medicine, Responsible for Chest Imaging Units at Hospital Heliópolis and A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Bruno Hochhegger
- PhD, Associate Professor at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Marcel Koenigkam Santos
- PhD, Radiologist at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Pablo Rydz Pinheiro Santana
- MD, Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Thoracic Radiologist at Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Arthur Soares Sousa
- PhD, Professor and Post-graduation Advisor, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Luciana Soares Souza
- MD, Radiologist, Faculdade de Medicina São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Edson Marchiori
- PhD, Adjunct Coordinator of Post-Graduation, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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21
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Affiliation(s)
- Marcel Koenigkam Santos
- Attending Physician at Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP-USP), MD, Radiologist at MED - Medicina Diagnóstica, Ribeirão Preto, SP, Brazil. E-mail:
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22
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Teixeira SR, Elias Junior J, Nogueira-Barbosa MH, Guimarães MD, Marchiori E, Santos MK. Whole-body magnetic resonance imaging in children: state of the art. Radiol Bras 2015; 48:111-20. [PMID: 25987752 PMCID: PMC4433302 DOI: 10.1590/0100-3984.2014.0005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 02/03/2014] [Accepted: 03/24/2014] [Indexed: 11/22/2022] Open
Abstract
Whole-body imaging in children was classically performed with radiography,
positron-emission tomography, either combined or not with computed tomography, the
latter with the disadvantage of exposure to ionizing radiation. Whole-body magnetic
resonance imaging (MRI), in association with the recently developed metabolic and
functional techniques such as diffusion-weighted imaging, has brought the advantage
of a comprehensive evaluation of pediatric patients without the risks inherent to
ionizing radiation usually present in other conventional imaging methods. It is a
rapid and sensitive method, particularly in pediatrics, for detecting and monitoring
multifocal lesions in the body as a whole. In pediatrics, it is utilized for both
oncologic and non-oncologic indications such as screening and diagnosis of tumors in
patients with genetic syndromes, evaluation of disease extent and staging, evaluation
of therapeutic response and post-therapy follow-up, evaluation of non neoplastic
diseases such as multifocal osteomyelitis, vascular malformations and syndromes
affecting multiple regions of the body. The present review was aimed at describing
the major indications of whole-body MRI in pediatrics added of technical
considerations.
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Affiliation(s)
- Sara Reis Teixeira
- PhD, Attending Physician at Centro de Ciências das Imagens e Física Médica (CCIFM) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Elias Junior
- PhD, Associate Professor, Division of Radiology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- PhD, Professor, Division of Radiology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcos Duarte Guimarães
- PhD, Attending Physician at Hospital Heliópolis and A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Edson Marchiori
- PhD, Full Professor, Division of Radiology, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Marcel Koenigkam Santos
- PhD, Attending Physician at Centro de Ciências das Imagens e Física Médica (CCIFM) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
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Koenigkam Santos M, Muley T, Warth A, de Paula WD, Lederlin M, Schnabel PA, Schlemmer HP, Kauczor HU, Heussel CP, Puderbach M. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: Impact on prognosis and comparison with adenocarcinomas. Eur J Radiol 2014; 83:1275-1281. [DOI: 10.1016/j.ejrad.2014.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/19/2014] [Accepted: 04/19/2014] [Indexed: 12/31/2022]
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Volpe GJ, Moreira HT, Trad HS, Wu K, Braggion-Santos MF, Santos MK, Maciel BC, Pazin AT, Marin-Neto JA, Lima JA, Schmidt A. Presence of scar by late gadolinium enhancement is a strong predictor of events in Chagas Heart Disease. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044384 DOI: 10.1186/1532-429x-16-s1-p343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Santos MK, Barreto ARF, Chagas Neto FA, Muglia VF, Elias Júnior J. Tumores neuroendócrinos do pulmão: principais achados radiológicos em uma série de 22 casos com confirmação anatomopatológica. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000400003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever os principais achados de imagem em uma série de casos de tumores neuroendócrinos primários do pulmão (TNPs), destacando as alterações na tomografia computadorizada. MATERIAIS E MÉTODOS: Exames de 22 pacientes (12 homens, idade média de 60 anos) avaliados nos últimos cinco anos em nosso serviço, com confirmação histopatológica, foram retrospectivamente revistos por dois médicos radiologistas e os achados foram descritos em consenso, focando as alterações tomográficas. RESULTADOS: Descrevemos 5 carcinoides típicos, 3 carcinoides atípicos, 3 carcinomas neuroendócrinos de grandes células (CNGCs) e 11 cânceres pulmonares de pequenas células (CPPCs). Apenas um carcinoide típico apresentou aspecto característico de nódulo endobrônquico central com atelectasia pulmonar distal, enquanto os demais foram nódulos ou massas pulmonares. Os carcinoides atípicos eram massas pulmonares periféricas e heterogêneas. Um CNGC era massa periférica delimitada e homogênea, enquanto os demais eram mal delimitados e heterogêneos. Os 11 CPPCs eram massas centrais, infiltrativas e heterogêneas, com alterações pleuropulmonares secundárias. Calcificações estavam ausentes nos CNGCs e CPPCs. Metástases foram vistas inicialmente ou no seguimento de todos os CNGCs e CPPCs. CONCLUSÃO: Apesar de alguns aspectos semelhantes nos exames de imagem, os achados radiológicos, quando integrados às informações clínicas, podem constituir critérios importantes na diferenciação dos tipos histológicos de TNPs.
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Santos MK, Elias J, Mauad FM, Muglia VF, Trad CS. Magnetic resonance imaging of the chest: current and new applications, with an emphasis on pulmonology. J Bras Pneumol 2011; 37:242-58. [PMID: 21537662 DOI: 10.1590/s1806-37132011000200016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 09/03/2010] [Indexed: 11/22/2022] Open
Abstract
The objective of the present review study was to present the principal applications of magnetic resonance imaging (MRI) of the chest, including the description of new techniques. Over the past decade, this method has evolved considerably because of the development of new equipment, including the simultaneous interconnection of phased-array multiple radiofrequency receiver coils and remote control of the table movement, in addition to faster techniques of image acquisition, such as parallel imaging and partial Fourier acquisitions, as well as the introduction of new contrast agents. All of these advances have allowed MRI to gain ground in the study of various pathologies of the chest, including lung diseases. Currently, MRI is considered the modality of choice for the evaluation of lesions in the mediastinum and in the chest wall, as well as of superior sulcus tumors. However, it can also facilitate the diagnosis of lung, pleural, and cardiac diseases, as well as of those related to the pulmonary vasculature. Pulmonary MRI angiography can be used in order to evaluate various pulmonary vascular diseases, and it has played an ever greater role in the study of thromboembolism. Because cardiac MRI allows morphological and functional assessment in the same test, it has also become part of the clinical routine in the evaluation of various cardiac diseases. Finally, the role of MRI has been extended to the identification and characterization of pulmonary nodules, the evaluation of airway diseases, and the characterization of pleural effusion.
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Affiliation(s)
- Marcel Koenigkam Santos
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
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Santos MK, Polezi MB, Engel EE, Pastorello MT, Simão MN, Elias Junior J, Nogueira-Barbosa MH. Apresentações incomuns no diagnóstico por imagem do pseudotumor intraósseo do hemofílico. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Este estudo tem como objetivo descrever apresentações incomuns do pseudotumor do hemofílico no diagnóstico por imagem. MATERIAIS E MÉTODOS: Estudo retrospectivo com avaliação de cinco pseudotumores ósseos do hemofílico em dois pacientes. Os achados de imagem em dois pacientes hemofílicos tipo A foram avaliados em consenso por dois radiologistas musculoesqueléticos. Foram estudados exames de radiografia simples, tomografia computadorizada e ressonância magnética. RESULTADOS: Em uma das lesões analisadas a fase pós-contraste intravenoso da tomografia computadorizada mostrou áreas de reforço heterogêneo e de aspecto sólido no interior da lesão da coxa direita. Este aspecto foi confirmado no exame anatomopatológico da lesão em questão. Outro achado raro foi a identificação de dois pseudotumores intraósseos no úmero, separados por segmento de osso normal. E, por fim, também um pseudotumor do fêmur com extensão para partes moles e transarticular, com conseqüente acometimento da tíbia e patela. CONCLUSÃO: Os achados de diagnóstico por imagem acima descritos não são comumente relatados para os pseudotumores ósseos do hemofílico. É importante que o radiologista tenha conhecimento dessas apresentações mais raras.
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Abstract
OBJETIVO: Rever e avaliar os padrões de alterações encontrados em exames de imagem de pacientes com comprometimento pulmonar da esclerose sistêmica. MATERIAIS E MÉTODOS: Foram retrospectivamente estudados os exames de radiografia simples e tomografia computadorizada de alta resolução de 23 pacientes com esclerose sistêmica. RESULTADOS: Na radiografia simples, o padrão reticular em bases pulmonares foi predominante, tendo sido verificado em 18 pacientes (78,2%). A tomografia computadorizada de alta resolução evidenciou lesão pulmonar em todos os pacientes estudados, encontrando-se faveolamento em nove pacientes (39,1%), opacidades em vidro fosco associadas a opacidades reticulares em oito (34,7%), predomínio de opacidades reticulares em cinco (21,7%) e vidro fosco em um paciente (4,3%). CONCLUSÃO: O padrão de anormalidades tomográficas possui boa correlação com os achados histopatológicos, diferenciando padrões predominantemente inflamatórios de fibróticos, com os padrões inflamatórios estando associados a uma resposta superior ao tratamento. Dessa maneira, observou-se alteração sugestiva de fibrose na maior parte dos casos (faveolamento e opacidades reticulares somando 60,8%), porém com boa parte apresentando padrões sugestivos de processo inflamatório.
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