Pedro Teixeira Castro

Dilatação fluxo-mediada da artéria braquial em mulheres com artrite reumatóide

OBJETIVO: Avaliar a funcao endotelial em pacientes com artrite reumatoide, pela dilatacao fluxo-mediada da arteria braquial. MATERIAIS E METODOS: Sessenta e oito pacientes, sendo 32 com artrite reumatoide e 36 do grupo controle, foram avaliadas pela dilatacao fluxo-mediada da arteria braquial (metodo ultra-sonografico, no modo B, de avaliacao de risco cardiovascular). Em um segundo tempo, foi avaliada a correlacao entre a dilatacao fluxo-mediada da arteria braquial, a proteina C reativa e o tempo de doenca em pacientes com artrite reumatoide. RESULTADOS: A dilatacao fluxo-mediada da arteria braquial na artrite reumatoide foi igual a 5,6 ± 9,69% e no grupo controle foi igual a 23,24 ± 5,65%, diferenca estatisticamente significante (p < 0,00001). A proteina C-reativa teve resultado de 4,8 ± 9,1 mg/l. A correlacao entre a idade, a dilatacao fluxo-mediada da arteria braquial e a proteina C reativa nas pacientes com artrite reumatoide nao mostrou resultado estatisticamente significante. CONCLUSAO: Mulheres com artrite reumatoide apresentam importante disfuncao endotelial quando comparadas com mulheres normais.

Monochorionic diamniotic quadruplet pregnancy: physical models from prenatal three‐dimensional ultrasound and magnetic resonance imaging data

H. WERNER1, P. CASTRO1, P. DALTRO1, J. LOPES DOS SANTOS2, G. RIBEIRO2, G. TONNI3, S. CAMPBELL4 and E. ARAUJO JÚNIOR5 1Department of Radiology, Clı́nica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil; 2Department of Arts and Design, Pontifı́cia Universidade Católica (PUC Rio), Rio de Janeiro, Brazil; 3Department of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Italy; 4Create Health Clinic, London, UK; 5Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil

P16.06: Maternal-fetal attachment in blind women using physical model from 3D ultrasound and MRI: Poster discussion hub abstracts

Objectives: To present an interactive bidirectional actuated human-machine interface experiment developed by the combination of a haptic device system (force-feedback technology) and a non-invasive medical image technology. Methods: US scans were performed using a high-resolution electronic probe with harmonic imaging (Voluson E10, GE Medical Systems). MRI examination was performed using a 1.5-T scanner MR 450w (GE, Waukesha, USA). The haptic device adopted was the touch 3D stylus system from the American company 3D Systems. The 3D files of the fetus’ body tested on the experiment were modelled through the superimposition of the several slices obtained from MRI and fetal face from 3DUS. Results: Once the 3D shape was obtained, its virtual characteristics and the womb ambience were then created considering illumination, color textures, shades, positioning, bumpiness among others. We manipulate the physical responses of the device when the fetus shape is virtually touched. To complement the physical interaction, we introduced visual effects such as shape deformation based on the properties of the involved area and animations to simulate fetus motion. Conclusions: Advances in the technology of haptic devices open new opportunities in medical evaluation. The experiment here presented is part of the study involving additive manufacturing models of fetuses and virtual reality technologies to generate immersive 3D in fetal medicine. After the initial period of tests, the team aims to improve the experiment using new haptic devices, such as a haptic glove device in order to provide a more realistic experience of touching the fetuses.

EP11.06: The comparison of 3D fetal images obtained by ultrasound and magnetic resonance imaging in the third trimester: Electronic Poster Abstracts

Objectives: The objective here is to compare 3D fetal images obtained by US and MRI at the same day in the third trimester. Methods: 56 fetuses with external malformations. MRI reinforced the previous preliminary 3DUS findings, and diagnosis were confirmed postnatally. The pathologies evaluated were: holoprosencephaly, Chiari II, craniosynostosis, cervical teratoma, cervical lymphangioma, cleft lip, gastroschisis, limb body wall complex, limb reduction, ectrodactily, achondroplasia, BeckwithWiedemann syndrome, Down syndrome, Apert syndrome, sacrococcygeal teratoma, club feet, conjoined twins.

OP23.04: Cervical lymphangioma: prenatal evaluation by MRI and long-term outcomes: Short oral presentation abstracts

Objectives: At two metropolitan Australian hospitals offering fetal medicine and genetic services 1) Investigate how often referrals for isolated CPC/EIF are made at a local level, comparing 2014-16 referrals with earlier epochs 2) Audit the consequence of CPC/EIF referrals in terms of consultations undergone, further investigations performed, and ultimate pregnancy outcome. Methods: Retrospective audit of women referred to genetic counsellor and/or fetal medicine services at St George Hospital (SGH) and the Royal Hospital for Women (RHW) in metropolitan Australia with CPC and/or EIF from January 1st 2006 to December 31st 2016 inclusive. Data collected included demographics, prior screening, ultrasonic findings, consultations/investigations after CPC/EIF diagnosis, and pregnancy outcome. Findings were compared by hospital and 3 time periods; 2006-2009, 2010-2013, 2014-2016. Low risk women with isolated EIF/CPC were also compared to those at high risk or with multiple signs. Results: Of the 208 women, 118 (57%) were referred to specialist services for isolated CPC and/or EIF, and 102 (49%) were low-risk for aneuploidy prior to morphology ultrasound. Significantly more women had undergone combined first trimester screening in the 2014 to 2016 epoch versus previous years at both SGH (p=0.032) and RHW (p=0.004). However, the number of women referred for CPC and EIF remained constant at SGH (p=0.814) and RHW (p=0.731).Despite no fetus being born with a major structural or chromosomal abnormality in the group of low-risk women with isolated signs, 18% were referred to both genetic counselling and fetal medicine services, 7% had NIPT after morphology, 14% had amniocentesis and 33% had additional ultrasound(s). Conclusions: Despite advances in screening technology, low-risk women are still referred to specialist services for these 2 soft signs and undergoing unnecessary follow up, NIPT and amniocentesis.

EP21.01: Confocal microtomography (micro-CT) analysis and three-dimensional (3D) reconstruction of pathological conditions affecting the human fallopian tube (FT): Electronic Poster Abstracts

Methods: Eight specimens of FT affected by pathological conditions, from elective and emergency surgeries were selected, three Ectopic pregnancies (EP) from emergency surgeries and five remnants of FT (RFT) from surgical sterilization. The specimens were fixed in formalin for 24h and stained in Lugol solution for 72h. The micro-CT studies were conducted using protocols adapted from biological studies and the specimens were evaluated by traditional microscopy. Conclusion: Micro-CT is able to demonstrate many previously described characteristics of pathological FT in 3D, with good tissue contrast and can help guiding traditional histopathological sectioning of specimens.

OC22.05: Semi-automatic analysis of vascular volume along the fallopian tube and impact of the ovarian fimbria on fallopian tube vascularisation using confocal microtomography

Methods: Eight healthy women, with a natural regular cycle, underwent 4-minute TVUS during the menses (M), late follicular (LF), early luteal (EL) and late luteal (LL) phase of the cycle. Strain mapping based on optical flow was applied to calculate and visualise strain variations. The obtained strain maps were rendered with suitable colour maps; red for relaxation (negative strain) and blue for contraction (positive strain). Statistical analysis based on Kruskal–Wallis test and Dunn’s test were applied to evaluate the differences in contraction frequency between the phases. Results: 2D-strain maps were created for all phases in transversal direction (figure1). Statistical analysis showed significant differences in contraction frequency between M-LF (P=0.002), M-EL (P=0.003), LF-LL (P=0.034) and EL-LL (P=0.048) phase. Conclusions: The results show that we can accurately strain-map the non-pregnant uterus, and that we can objectively classify contraction frequency in different phases of the menstrual cycle. Future work will focus on three-dimensional strain analysis to provide more accurate results in multiple directions.

Avaliação do abdome fetal por ressonância magnética. Parte 2: malformações da parede abdominal e tumores

Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.

Avaliação do abdome fetal por ressonância magnética. Parte 1: malformações da cavidade abdominal

Although ultrasound continues to be the mainstay modality for the evaluation of fetal disorders, fetal magnetic resonance imaging (MRI) has often been used as a valuable adjunct in recent years. The exponential growth of the use of fetal MRI has been facilitated by technological advancements such as ultrafast T2-weighted sequences and diffusion-weighted imaging. Fetal MRI can achieve results that are comparable to or better than those of ultrasound, particularly in cases of maternal obesity, severe oligohydramnios, or abnormal fetal position. Because of its superior soft tissue contrast, wide field of view, and multiplanar imaging, fetal MRI is able to evaluate the large fetal organs, such as the lungs, liver, bowel, and kidneys. In addition, fetal MRI allows large or complex malformations to be examined, facilitating the understanding of the malformation within the context of the body as a whole. Initial fetal MRI studies were focused on the central nervous system. With advances in software and hardware, fetal MRI gained importance in the evaluation of the fetal abdomen. The purpose of this article is to review the recent literature and developments in MRI evaluation of the fetal abdomen, with an emphasis on imaging aspects, protocols, and common clinical indications.

Tuboperitoneal fistula, ectopic pregnancy, and remnants of fallopian tube: a confocal microtomography analysis and 3D reconstruction of human fallopian tube pathologies

Abstract Objective: The aim of this study was to provide a three-dimensional (3D) microscopic reconstruction of morphological modifications of the fallopian tube (FT) following surgical sterilization (including tuboperitoneal fistula) and ectopic pregnancy (EP) using confocal microtomography (micro-CT). Methods: Six specimens of FT from elective and emergency surgeries were selected: three remnants of the FT (RFT) from surgical sterilization, including one presenting tuboperitoneal fistula, and three FTs with EP. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies. Results: Three RFTs from surgical sterilization and three FTs affected by EPs were successfully scanned using micro-CT. There was good contrast impregnation, allowing tissue segmentation and analysis of different sections of the FTs. Three FT specimens from EP exhibited considerable distortion of the tubal anatomy, mainly from the blood clot in the tubal abortion. Three RFT specimens exhibited some features observed in traditional microscopy, such as tubal distension and loss of normal anatomical characteristics of a normal FT, and indicated the presence of a tuboperitoneal fistula in one of the three specimens. Conclusion: Micro-CT can identify morphological characteristics of FT pathologies previously described in a microscopic scale, with tissue contrast and the possibility of 3D reconstruction. Micro-CT is also useful in guiding traditional sectioning of specimens for histopathological studies.