Dany Jasinowodolinski

Pulmonary artery distensibility in pulmonary arterial hypertension: an MRI pilot study

Pulmonary arterial hypertension (PAH) is a disease of the small vessels in which there is a substantial increase in pulmonary vascular resistance leading to right ventricle failure and death. Invasive haemodynamic evaluation is mandatory not only for diagnosis confirmation but also to address prognosis and eligibility for the use of calcium-channel blockers through an acute vasodilator challenge. Noninvasive surrogate response markers to the acute vasodilator test have been sought. In the present study, the relationship between pulmonary artery distensibility, assessed using magnetic resonance imaging (MRI), and response to acute vasodilator tests was investigated. In total, 19 patients diagnosed with idiopathic PAH without any specific treatment were evaluated. Within a 48-h window after pulmonary artery catheterisation, patients underwent cardiac MRI. Cardiac index, calculated after the determination (invasively and noninvasively) of cardiac output, showed excellent correlation, as did right atrial pressure and right ventricle ejection fraction. Pulmonary artery distensibility was significantly higher in responders. A receiver operating characteristic curve analysis has shown that 10% distensibility was able to differentiate responders from nonresponders with 100% sensitivity and 56% specificity. The present findings suggest that magnetic resonance imaging and pulmonary artery distensibility may be useful noninvasive tools for the evaluation of patients with pulmonary hypertension.

Thoracic Manifestations of Collagen Vascular Diseases

Collagen vascular diseases are a diverse group of immunologically mediated systemic disorders that often lead to thoracic changes. The collagen vascular diseases that most commonly involve the lung are rheumatoid arthritis, progressive systemic sclerosis, systemic lupus erythematosus, polymyositis and dermatomyositis, mixed connective tissue disease, and Sjögren syndrome. Interstitial lung disease and pulmonary arterial hypertension are the main causes of mortality and morbidity among patients with collagen vascular diseases. Given the broad spectrum of possible thoracic manifestations and the varying frequency with which different interstitial lung diseases occur, the interpretation of thoracic images obtained in patients with collagen vascular diseases can be challenging. The task may be more difficult in the presence of treatment-related complications such as drug toxicity and infections, which are common in this group of patients. Although chest radiography is most often used for screening and monitoring of thoracic alterations, high-resolution computed tomography can provide additional information about lung involvement in collagen vascular diseases and may be especially helpful for differentiating specific disease patterns in the lung. General knowledge about the manifestations of thoracic involvement in collagen vascular diseases allows radiologists to provide better guidance for treatment and follow-up of these patients.

O papel dos exames de imagem na avaliação da circulação pulmonar

Knowledge of the structure and function of pulmonary circulation has evolved considerably in the last few decades. The use of non-invasive imaging techniques to assess the anatomy and function of the pulmonary vessels and heart has taken on added importance with the recent advent of novel therapies. Imaging findings not only constitute a diagnostic tool but have also proven to be essential for prognosis and treatment follow-up. This article reviews the myriad of imaging methods currently available for the assessment of pulmonary circulation, from the simple chest X-ray to techniques that are more complex and promising, such as electrical impedance tomography.

Diagnóstico auxiliado por computador na detecção de nódulos pulmonares pela tomografia computadorizada com múltiplos detectores: estudo preliminar de 24 casos

OBJECTIVES To evaluate the performance of a computer program designed to facilitate the detection of pulmonary nodules using multidetector computed tomography (MDCT) scans of the chest. METHODS We evaluated 24 consecutive MDCT scans of the chest at the Fleury Diagnostic Imaging Center during the period from October 7 to October 19 of 2006, using a 64-channel CT scanner. The study comprised 12 females and 12 males, ranging from 35 to 77 years of age (mean, 57.9 years). Double reading and a computer-aided diagnosis (CAD) system were used in order to perform two independent analyses of the data. The nodules found using both methods were recorded, and the data were compared. RESULTS The total sensitivity of CAD for the detection of nodules was 16.5%, increasing to 55% when nodules <4 mm in diameter were excluded. Sensitivity by diameter was 6.5% for nodules <4 mm, 45% for nodules of 4-6 mm, 100% for nodules of 6 mm-10 cm, and 0% for nodules >1 cm. More than 99% of true nodules detected by CAD were registered in the image double reading process. CONCLUSIONS In this preliminary 24-case study, the sensitivity of computer program tested was not significantly greater than that of the double-reading process that is routinely performed in this facility.

Sarcoidose pulmonar: achados na tomografia computadorizada de alta resolução

A sarcoidose e uma doenca sistemica de causa indeterminada, caracterizada por granulomas nao-caseosos. Embora possa afetar qualquer orgao, esta doenca tem sua morbi-mortalidade relacionada principalmente ao acometimento pulmonar, presente em 80% a 90% dos pacientes. Este artigo ilustra as principais manifestacoes pulmonares da sarcoidose na tomografia computadorizada de alta resolucao, incluindo as formas tipicas e atipicas.

Iron overload measurements by CMR in patients with suspected hemochromatosis - comparison of methods for T2* calculation in myocardium and liver

Introduction Iron tissue overload can be detected non-invasively by CMR using T2* measurements techniques. Hemochromatosis is a disorder of iron metabolism that results in excess iron accumulation in tissues and organs. If left undiagnosed and untreated, iron overload can cause serious, sometimes fatal health problems. Early detection of iron overload and hemochromatosis treatment can prevent complications and prolong life.

Perguntamos: qual o diagnóstico?

pela inalacaode algumas substâncias quimicas.Embora, na maioria das vezes, seja causada pela inala-cao de actinomicetos termofilicos (inicialmente descritocomo “pulmao do fazendeiro”) e de proteinas oriundasdas secrecoes de passaros (“pulmao dos criadores de pas-saros”), ha, atualmente, grande quantidade de antigenosorgânicos que podem causar