José Eduardo Mourão Santos

Reprodutibilidade da classificação ultra-sonográfica de Niamey na avaliação da fibrose periportal na esquistossomose mansônica

OBJETIVO: Medir a concordância intra- e interobservador da classificacao ultra-sonografica qualitativa para graduar a fibrose periportal adotada no encontro de Niamey em 1996. MATERIAIS E METODOS: No periodo de fevereiro de 2005 a marco de 2006 foi realizado estudo prospectivo, observacional e transversal em 30 pacientes esquistossomoticos, sem outras hepatopatias associadas, submetidos a ultra-sonografia abdominal e classificados segundo os criterios de Niamey. Os exames foram realizados por dois radiologistas de forma independente em diferentes momentos: durante o exame dinâmico (primeiro momento) e 30 e 90 dias depois (segundo e terceiro momentos) do exame, por meio da documentacao fotografica analisada em estacao de trabalho. A concordância intra- e interobservador foi avaliada pelo teste kappa. RESULTADOS: A concordância intra-observador medida pelo teste kappa foi 0,43 para o observador 1 e 0,57 para o observador 2. A concordância interobservador durante o estudo dinâmico e na avaliacao fotografica foi, respectivamente, de 0,46 e 0,71. CONCLUSAO: O uso do ultra-som para classificar a fibrose periportal segundo o protocolo de Niamey apresentou uma reprodutibilidade que variou de moderada a substancial.

Avaliação ultra-sonográfica de nódulos sideróticos esplênicos em pacientes esquistossomóticos com hipertensão portal

OBJETIVO: Medir a sensibilidade e a reprodutibilidade da ultra-sonografia na deteccao de nodulos sideroticos esplenicos em pacientes esquistossomoticos, tendo a ressonância magnetica como padrao de referencia. MATERIAIS E METODOS: Na primeira fase do trabalho, 21 pacientes portadores de esquistossomose na forma hepatoesplenica com diagnostico de nodulos sideroticos a ressonância magnetica foram submetidos a avaliacao ultra-sonografica para a determinacao da sensibilidade do metodo. Na segunda fase, com o objetivo de avaliar a reprodutibilidade da ultra-sonografia na deteccao e na quantificacao de nodulos sideroticos (A: 1-5 nodulos; B: 6-20 nodulos; C: mais de 20 nodulos), outros 30 pacientes esquistossomoticos foram submetidos a avaliacao ultra-sonografica de forma cega e independente por dois observadores. A reprodutibilidade foi medida por meio da concordância entre os observadores e do teste kappa. RESULTADOS: A sensibilidade da ultra-sonografia foi de 95,2% (intervalo de confianca a 95% [77,3%; 99,2%]). A concordância entre ultra-sonografia e ressonância magnetica para a deteccao de nodulos sideroticos foi de 96,7% (intervalo de confianca a 95% [82,8%; 99,9%]). Para a classificacao dos nodulos conforme a sua quantificacao, o indice kappa demonstrou concordância interobservador substancial (kappa = 0,67). CONCLUSAO: A ultra-sonografia e um metodo que apresenta elevada sensibilidade e boa precisao para a avaliacao de nodulos sideroticos esplenicos.

Mensuração do volume de fluxo portal em pacientes esquistossomóticos: avaliação da reprodutibilidade do ultra-som Doppler

OBJECTIVE: To evaluate the reproducibility of Doppler ultrasonography in the measurement of portal blood flow volume in schistosomal patients. MATERIALS AND METHODOS: Prospective, transversal, observational and self-paired study evaluating 21 patients with hepatosplenic schistosomiasis submitted to Doppler ultrasonography performed by three independent observers for measurement of portal blood flow. Pairwise interobserver agreement was calculated by means of the intraclass correlation coefficient, paired t-test and Pearsons correlation coefficient. RESULTS: Interobserver agreement was excellent. Intraclass correlation ranged from 80.6% to 93.0% (IC at 95% [65.3% ; 95.8%]), with the Pearsons correlation coefficient ranging between 81.6% and 92.7% with no statistically significant interobserver difference regarding the mean portal blood flow volume measured by Doppler ultrasonography (p = 0.954 / 0.758 / 0.749). CONCLUSION: Doppler ultrasonography has demonstrated to be a reliable method for measuring the portal blood flow volume in patients with portal hypertension secondary to schistosomiasis, with a good interobserver agreement.

Avaliação do volume de fluxo portal em pacientes esquistossomóticos: estudo comparativo entre ressonância magnética e ultrassom Doppler

OBJECTIVE: To evaluate the agreement between Doppler ultrasonography and magnetic resonance imaging as well as the interobserver reproducibility of both methods in the measurement of portal blood flow in schistosomal patients. MATERIALS AND METHODS: A cross-sectional, observational, self-paired study evaluated 21 patients with schistosomiasis mansoni submitted to measurement of portal blood flow with phase-contrast magnetic resonance imaging and Doppler ultrasonography. RESULTS: A poor intermethod agreement was observed (intraclass correlation coefficient: 34.5% [CI 95%]). On the other hand, the interobserver reproducibility was excellent in the evaluation by magnetic resonance imaging (intraclass correlation coefficient: 99.2% [CI 95%] / Pearsons correlation coefficient: 99.2% / portal blood flow = 0.806) and by Doppler ultrasonography (intraclass correlation coefficient: 80.6 to 93.0% [CI 95%] / Pearsons correlation coefficient: 81.6% to 92.7% / portal blood flow = 0.954, 0.758 and 0.749). CONCLUSION: There is a poor intermethod agreement in the measurement of portal blood flow. Nevertheless, contrast-phase magnetic resonance imaging and Doppler ultrasonography demonstrated to be reproducible methods presenting excellent interobserver agreement in the quantification of portal blood flow in patients with hepatosplenic schistosomiasis-related portal hypertension

Avaliação da concordância entre ressonância magnética de ultra-sonografia na classificação de fibrose periportal em esquitossomóticos, segundo a classificação de Niamey

OBJECTIVE: To evaluate the reproducibility of magnetic resonance imaging and the agreement between ultrasound and magnetic resonance imaging in the classification of periportal fibrosis in patients with schistosomiasis based on Niameys qualitative criteria. MATERIALS AND METHODS: A prospective, double-blinded study was conducted between February 2005 and June 2006 with 20 patients (10 men and 10 women, with ages ranging between 24 and 60 years, mean age 42.7 years) diagnosed with schistosomiasis mansoni. Both ultrasound and magnetic resonance images were independently evaluated by two experienced observers. Interobserver agreement was evaluated for findings of periportal fibrosis on magnetic resonance images and in a comparison between magnetic resonance and ultrasound images. RESULTS: The analysis of magnetic resonance images showed total interobserver agreement in 14 patients (70%). The comparison between ultrasound and magnetic resonance imaging showed agreement between images in only six cases (30%) by observer 1, and in eight cases (40%) by observer 2. CONCLUSION: Magnetic resonance imaging presents a good reproducibility in the evaluation of periportal fibrosis in later stages of schistosomiasis, however, the correlation between magnetic resonance imaging and ultrasound is poor.

Interobserver variability of ultrasound parameters in portal hypertension

The aim of this study was to assess interobserver agreement of ultrasound parameters for portal hypertension in hepatosplenic mansonic schistosomiasis. Spleen size, diameter of the portal, splenic and superior mesenteric veins and presence of thrombosis and cavernous transformation were determined by three radiologists in blinded and independent fashion in 30 patients. Interobserver agreement was measured by the kappa index and intraclass correlation coefficient. Interobserver agreement was considered substantial (kappa = 0.714-0.795) for portal vein thrombosis and perfect (kappa = 1) for cavernous transformation. Interobserver agreement measured by the intraclass correlation coefficient was excellent for longitudinal diameter of the spleen (r = 0.828-0.869) and splenic index (r = 0.816-0.905) and varied from fair to almost perfect for diameter of the portal (r = 0.622-0.675), splenic (r = 0.573-0.913) and superior mesenteric (r = 0.525-0.607) veins. According to the results, ultrasound is a highly reproducible method for the main morphological parameters of portal hypertension in schistosomiasis patients.

Correlação interobservador das alterações morfológicas das vias biliares em pacientes com esquistossomose mansoni pela colangiorressonância magnética

OBJECTIVE: To describe changes of the biliary tree demonstrated by magnetic resonance cholangiography (MRC) in patients with the hepatosplenic presentation of schistosomiasis mansoni, and evaluating the interobserver agreement in the detection of schistosomal cholangiopathy. MATERIALS AND METHODS: Prospective, cross-sectional study involving 24 patients with hepatosplenic schistosomiasis and 6 healthy patients (control group) submitted to biliary tree evaluation by MRC. The following changes of the biliary tree were considered: distortion, thinning, stenosis, dilation and irregularity. The interobserver agreement in the detection of biliary tree changes was calculated with the McNemars test and the kappa index of agreement (κ). RESULTS: The interobserver agreement in the detection of distortion and thinning of the biliary tree was almost perfect (κ = 0.867; confidence interval [CI] 95% [0.512-1.0] and κ = 0.865; CI 95% [0.51-1.0], respectively). There was a substantial agreement for stenosis (κ = 0.78; CI 95% [0.424-1.0]), moderate agreement for dilation (κ = 0.595; CI 95% [0.247-0.942]) and mild agreement for thinning (κ = 0.229; CI 95% [0.095-0.552]). CONCLUSION: In a decreasing order of frequency, the changes of the biliary tree were observed: distortion, thinning, stenosis, dilation and irregularity. The interobserver agreement for signs of schistosomal cholangiopathy was almost perfect for distortion and thinning, and substantial for stenosis.

Patologias do compartimento iliopsoas: avaliação radiológica

The iliopsoas compartment, a posterior boundary of the retroperitoneum, is comprised of the psoas major, psoas minor and iliac muscles. The symptoms picture in patients presenting with pathological involvement of this compartment may show a wide range of nonspecific clinical presentations that may lead to delayed diagnosis. However, in the search of an etiological diagnosis, it is already known that inflammation, tumors, and hemorrhages account for almost all the lesions affecting the iliopsoas compartment. By means of a retrospective analysis of radiological studies in patients with iliopsoas compartment lesions whose diagnosis was confirmed by anatomopathological evaluation or clinical follow-up, we have reviewed its anatomy as well as the main forms of involvement, with the purpose of identifying radiological signs that may help to narrow down the potential differential diagnoses. As each lesion is approached we will discuss the main radiological findings such as presence of gas in pyogenic abscesses, bone destruction and other bone changes of vertebral bodies in lesions secondary to tuberculosis, involvement of fascial planes in cases of neoplasms, and differences in signal density and intensity of hematomas secondary to hemoglobin degradation, among others. So, we have tried to present cases depicting the most frequent lesions involving the iliopsoas compartment, with emphasis on those signs that can lead us to a more specific etiological diagnosis.Limite posterior do retroperitonio, o compartimento iliopsoas localiza-se externamente ao mesmo, sendo composto dos musculos psoas maior, psoas menor e iliaco. O quadro de sintomas dos pacientes com acometimento patologico deste compartimento e amplo e inespecifico, podendo haver importante atraso no diagnostico. Entretanto, na busca do diagnostico etiologico das alteracoes do compartimento iliopsoas, sabemos que as infeccoes, os tumores e as hemorragias respondem pela quase totalidade das lesoes. Por meio da avaliacao retrospectiva de exames radiologicos de pacientes com patologias do iliopsoas e que tiveram o diagnostico confirmado por exame anatomopatologico ou acompanhamento clinico, revisamos a anatomia deste compartimento, assim como as suas principais formas de acometimento, identificando sinais que auxiliem na diferenciacao dos potenciais diagnosticos diferenciais. Na abordagem de cada patologia discutiremos os principais sinais radiologicos, como a presenca de gas em abscessos piogenicos, alteracoes osseas em corpos vertebrais nas lesoes secundarias a tuberculose, comprometimento dos planos fasciais nas lesoes tumorais e diferencas na densidade e intensidade de sinal dos hematomas nas diferentes fases de degradacao da hemoglobina, entre outros. Dessa forma, procuramos apresentar casos que exemplifiquem as doencas mais frequentes do compartimento iliopsoas, destacando a importância dos seus diferentes sinais, aproximando-nos de um diagnostico etiologico especifico.

Avaliação do ângulo ano-retal por meio de defecograma em voluntárias assintomáticas nulíparas e multíparas

OBJECTIVE: We developed a protocol to compare the measurements of the anorectal angle in nulliparous and multiparous asymptomatic volunteers in three different situations. SUBJECTS AND METHODS: Defecograms were carried out in 30 women (15 nulliparous and 15 multiparous) from May, 1997 to December, 1998. After rectal administration of texturized barium contrast media, lateral radiographic views of the rectum were obtained at rest, during contraction of the puborectal muscle and during defecation. A repeated measures model was used for the statistical analysis. RESULTS: There were no significant differences between the mean anorectal angles of nulliparous and multiparous volunteers. Measurements were as follows: 92.9° at rest, 78.8° during the contraction of the puborectal muscle and 117.9° during defecation for the nulliparous volunteers; 94.3° at rest, 79.7° during the contraction of the puborectal muscle and 121.4° during defecation for the multiparous volunteers. A significant difference was observed between the anorectal angle measurements at rest, during contraction of the puborectal muscle and during defecation. CONCLUSION: There were no significant differences between the anorectal angle measurements of the two groups of volunteers examined.

Avaliação da função ventricular esquerda pela sequência de ressonância magnética sem apneia e com múltiplas excitações

OBJETIVO: Avaliar a eficacia da sequencia de ressonância magnetica com tres excitacoes, para obtencao de volumes e massas ventriculares, em individuos com respiracao livre, sem apneia. MATERIAIS E METODOS: Em 32 voluntarios sadios, foram comparados os volumes e massas do ventriculo esquerdo, obtidos por meio de duas sequencias de ressonância magnetica em modo cine. A primeira, tradicionalmente utilizada e considerada padrao, em apneia e com excitacao unica, e a segunda, em respiracao livre e com tres excitacoes. Tres leitores, com diferentes niveis de experiencia, testaram a concordância e a reprodutibilidade. Para a analise estatistica foram utilizados o coeficiente de correlacao intraclasse, o teste t-pareado, os graficos de Bland-Altman e o teste do sinal. RESULTADOS: Para os dois observadores mais experientes, os coeficientes de correlacao intraclasse foram superiores a 0,913, assim como os niveis descritivos do teste t-pareado acima de 0,05, os graficos de Bland-Altman com as diferencas distribuidas aleatoriamente em torno do zero e o teste do sinal com seu nivel descritivo superior a 0,05. CONCLUSAO: A sequencia testada apresenta otima concordância e reprodutibilidade em relacao a sequencia padrao, podendo ser aplicada em individuos com limitacoes respiratorias.