Alexandre Sérgio de Araújo Bezerra

Differentiating Cirrhosis and Chronic Hepatosplenic Schistosomiasis Using MRI

OBJECTIVE The objective of our study was to identify which imaging features may be used to differentiate between cirrhosis and chronic hepatosplenic schistosomiasis and to assess image interpretation agreement for MRI findings. MATERIALS AND METHODS Retrospective review of 27 patients with alcoholic or virus-induced cirrhosis and 24 patients with chronic hepatosplenic schistosomiasis who underwent MRI (1.5 T) of the abdomen was performed. Images were interpreted independently by two radiologists evaluating the following MRI features: hepatic fissure widening, irregularity of hepatic contours, periportal fibrosis, hepatic parenchyma heterogeneity, and splenic siderotic nodules. Left, right, and caudate hepatic lobe measurements were obtained, and the splenic index was measured. The Fishers exact test, chi-square test, and Students t test were used to compare both groups, and regression analysis was performed. Observer agreement was measured using kappa and intraclass correlation tests. RESULTS Periportal fibrosis, heterogeneity of hepatic parenchyma, and splenic siderotic nodules were more frequent in the group with schistosomiasis (p < 0.05), with periportal fibrosis showing the largest difference in presence and distribution (peripheral greater than central). The transverse diameter of the right hepatic lobe, caudate lobe-right lobe ratio, and splenic index were larger in patients with chronic schistosomiasis (p < 0.001). At multiple regression analysis, splenic siderotic nodules, splenic index, and caudate lobe-right lobe ratio were predictive of schistosomiasis. Observer agreement was substantial or almost perfect for almost all variables analyzed (kappa or r = 0.81-1.00). CONCLUSION The presence of peripheral periportal fibrosis, heterogeneity of hepatic parenchyma, and splenic siderotic nodules, and the splenic index and caudate lobe-right lobe ratio are useful features for differentiating alcoholic or virus-induced cirrhosis from chronic schistosomiasis using MRI.

Calcificações hepáticas: freqüência e significado

PURPOSE: To determine the frequency and etiology of intrahepatic calcifications diagnosed on abdominal computed tomography (CT) studies. MATERIALS AND METHODS: A retrospective study of 1,362 consecutive CT scans of the abdomen was carried out to determine the presence of intrahepatic calcifications. The clinical and laboratorial data of all patients with liver calcifications were reviewed in order to establish the etiology of the lesions. RESULTS: Intrahepatic calcifications were found in 3.6% (49/1,362) of the patients, and were predominantly seen in women (57.2%) than in men (42.8%). The population age ranged from 18 to 92 years (mean 59.4 years; median 63.5 years). Calcifications were considered residual and without clinical repercussion in most cases (39/49; 79.5%) whereas in 14.4% (7/49) of the patients calcifications were associated with metastatic disease and in 6.1% (3/49) with cystic lesions. The primary tumors in the seven patients with calcified liver metastases were colon carcinoma (five patients), sarcoma (one patient) and malignant ovarian teratoma (one patient). Two of these patients presented calcifications only after chemotherapy. CONCLUSION: Intrahepatic calcifications are infrequent findings on routine abdominal CT scans (< 5%) and are mostly related to previous inflammatory and/or infectious diseases.

Estudo da circulação hepatomesentérica pela angiografia por ressonância magnética com gadolínio: comparação entre doses simples e dupla no estudo de pacientes esquistossomóticos

OBJECTIVE: To evaluate the visibility of hepatomesenteric vascular segments by 3D gadolinium-enhanced magnetic resonance (MR) angiography and to compare the method effectiveness between two different gadolinium doses (single and double doses). MATERIALS AND METHODS: A prospective study was performed with 36 schistosomiasis patients who were submitted to 3D contrast-enhanced MR angiography. Scans were performed in a high-field equipment (1.5 T), with body coil and power injector for intravenous contrast administration. Contrast double doses (Gd-DTPA 0.2 mmol/kg) and single doses (0.1 mmol/kg) were randomly used respectively in 21 and 15 patients. Studies were interpreted by consensus between two observers who have rated the visualization degree of 25 proximal vascular segments without knowing the dose used. RESULTS: Proximal and calibrous vascular segments have presented higher visualization degree in the greatest part of the sample studied. The celiac trunk, common hepatic artery, splenic artery, proximal and medium third of superior mesenteric artery, portal vein, splenic vein and superior mesenteric vein have presented grade 2 visualization in more than 70% of the sample studied. As regards comparison between different doses, there was no significant difference (p < 0.05) in the visualization degree of several structures evaluated, between double dose and single dose groups, except for an isolate case of evaluation of right hepatic artery (p = 0.008) in which the single dose group has presented a higher frequency of grade 2 visualization with statistical significance. CONCLUSION: The visualization degree of hepatomesenteric vascular segments by 3D gadolinium-enhanced MR angiography is high, especially in the proximal and calibrous segments. The comparison between groups using single and double contrast doses has demonstrated similar results.

Angiografia por ressonância magnética: aspectos técnicos de um método de estudo vascular não-invasivo

Early magnetic resonance angiography techniques used flow-sensitive sequences to obtain contrast of the vascular structures. Three techniques are based on this approach: phase-contrast, time-of-flight and black blood techniques. However, these acquisition methods are time-consuming and more susceptible to movement artifacts, flow-related artifacts and signal loss due to stenotic lesions. They also present low sensitivity for slow flow detection. The use of paramagnetic contrast medium in magnetic resonance angiography studies provides a simple and quick way of obtaining vascular enhancement. Image contrast is based on vascular enhancement in opposition to background suppression. Important factors for the technical improvement of gadolinium-enhanced magnetic resonance angiography include modern techniques of central k-space ordering that are responsible for high image contrast, and implementation of appropriate timing injection. Gadolinium-enhanced magnetic resonance angiography is a useful diagnostic tool for investigation of anatomical anomalies, stenotic and occlusive disease, and surgical complications, particularly in patients with organ transplants. Gadolinium-enhanced magnetic resonance angiography has the advantage of a noninvasive method since it does not require ionizing radiation or an iodine contrast medium, and allows the evaluation of parenchymatous structures for additional diagnostic information.

Medidas do tendão do calcâneo no primeiro ano de vida

OBJECTIVE: To determine the thickness and width of the calcaneal tendon (Achilles tendon) in both male and female, eutrophic children at 2, 6, 9 and 12 months of age. MATERIALS AND METHODS: The present prospective and descriptive study included 38 boys and 31 girls. Measurements of the tendons were performed by means of ultrasonography, with a linear, 14-MHz probe, at the level of the medial malleolus. RESULTS: Tendon thicknesses observed in the boys were 2.4 mm, 2.3 mm, 2.4 mm, and 2.4 mm, respectively at 2, 6, 9 and 12 months. Widths were, respectively, 6.0 mm, 6.4 mm, 6.7 mm and 7.1 mm. In the girls, the tendon thicknesses observed at 2, 6 and 9 months were 2.4 mm, and 2.5 mm at 12 months. Widths were, respectively, 5.7 mm, 6.2 mm, 6.5 mm and 6.5 mm. CONCLUSION: No difference was observed in the calcaneal tendon thickness between boys and girls along the first year of their lives; however, width measurements demonstrated differences.