Ricardo Bernardi Soder

Spine Abnormalities Depicted by Magnetic Resonance Imaging in Adolescent Rowers

Background: Most lesions of the spine of athletes, which often are detected incidentally, do not cause important symptoms or make the athletes discontinue their physical activities. To better understand the significance of these lesions, new imaging studies have been conducted with asymptomatic athletes in several sports, aiming to detect potentially deleterious and disabling abnormalities. Purpose: To compare the magnetic resonance imaging (MRI) lumbar spine findings in a group of asymptomatic adolescent rowers and in a control group of adolescents matched according to age and sex who do not practice any regular physical activity. Study Design: Cohort study (prevalence); Level of evidence, 3. Methods: Our study evaluated 44 asymptomatic adolescent boys distributed in 2 groups of 22 rowers and 22 control subjects. All the examinations were performed using a 0.35-T open-field MRI unit and evaluated by 2 experienced radiologists blinded to the study groups. Each MRI scan was analyzed for the presence of disc degeneration/desiccation, herniated or bulging disc, pars interarticularis stress reaction, and spondylolysis. The Student t test and the Fisher exact test were used for statistical analyses. Results: Nine rowers (40.9%) had at least 1 abnormality detected by MRI in the lumbar spine, whereas only 2 participants (9.1%) in the control group had at least 1 MRI abnormality (P = .03). Seven disc changes (31.8%) and 6 pars abnormalities (27.3%) were found in the group of elite rowers. In the control group, 3 disc changes (13.6%) and no pars abnormalities were found in the MR scans. The comparison between groups showed statistically significant differences in stress reaction of the pars articularis. Conclusion: Disc disease and pars interarticularis stress reaction are prevalent abnormalities of the lumbar spine of high-performance rowers.

MRI of the knee joint in asymptomatic adolescent soccer players: a controlled study.

OBJECTIVE The knee is the joint that is most frequently injured in boys 12-15 years old who practice soccer, and MRI is an accurate method of diagnosing sports-related injuries. The objective of this cross-sectional case-control study was to evaluate the knees of asymptomatic adolescent soccer players using open MRI. SUBJECTS AND METHODS We evaluated 56 knees of 28 asymptomatic male adolescents 14-15 years old. Participants were divided into two groups and paired by age and weight: soccer players (28 knees) and control subjects (28 knees). All the examinations were performed using a 0.35-T open-field MRI unit and were evaluated by two experienced radiologists blinded to study groups. Bone marrow signal, articular cartilage, meniscus, and fat pad abnormalities and the amount of fluid were assessed. RESULTS In the group of soccer players, 18 knees (64.3%) had one or more MRI abnormalities, whereas in the control group nine knees (32.1%) had at least one MRI abnormality (p = 0.03). The prevalence of bone marrow edema was much greater in the group of soccer players (14 knees, 50%), whereas the same abnormality was found in only one knee (3.6%) in the control group (p = 0.0001). Other abnormalities that were not statistically significant with regard to study group were also found in the two groups: infrapatellar fat pad edema, popliteal cysts, and ganglion cysts. CONCLUSION Bone marrow edema is a prevalent abnormal finding on MRI scans of knees of asymptomatic adolescent soccer players. MRI findings should be interpreted cautiously and in close correlation with clinical findings.

MRI of the knee in asymptomatic adolescent swimmers: a controlled study

Background Swimming is a widespread sporting activity generally regarded as an ideal form of exercise, which has little or no impact on the knees. However, overuse or repetitive microtrauma injuries may often affect the knee joint of young competitive swimmers. These early lesions are frequently asymptomatic for a considerable period of time before causing discomfort or joint pain. Purpose The aim of the present study is to use MRI to evaluate the knee joints of asymptomatic young elite swimmers and to compare them with age- and sex-matched controls who do not practice any impact sports regularly. Study design Cross-sectional case–control study. Material and methods The authors performed a cross-sectional controlled study to evaluate 54 knees of 27 asymptomatic male adolescents aged 14–15 years, paired by age and weight. Participants were divided in two groups: 13 elite swimmers and 14 control adolescents. The authors performed all the exams using a 0.35-T open-field MRI unit and evaluated by two experienced radiologists blinded to study groups. The images were evaluated to detect the presence or absence of abnormalities. Results One or more imaging abnormalities were detected in 18 knees in the group of swimmers (69.2%; p=0.013). The most prevalent findings in the athletes were infrapatellar fat pad edema (53.8%; p=0.049), followed by bone marrow edema (26.9%; p=0.022), edema of prefemoral fat pad (19%; p=0.022) and joint effusion (15.3%; p=0.047). Conclusion Significantly more MRI abnormalities were found in the knee joints of asymptomatic adolescent elite swimmers. This high prevalence of positive imaging findings in swimmers may correspond to benign changes or preclinical lesions, which should be evaluated in a follow-up study.

Selective posterior callosotomy for drop attacks: A new approach sparing prefrontal connectivity

Objective: To evaluate a novel approach to control epileptic drop attacks through a selective posterior callosotomy, sparing all prefrontal interconnectivity. Methods: Thirty-six patients with refractory drop attacks had selective posterior callosotomy and prospective follow-up for >4 years. Falls, episodes of aggressive behavior, and IQ were quantified. Autonomy in activities of daily living, axial tonus, and speech generated a functional score ranging from 0 to 13. Subjective effect on patient well-being and caregiver burden was also assessed. Results: Median monthly frequency of drop attacks decreased from 150 to 0.5. Thirty patients (83%) achieved either complete or >90% control of the falls. Need for constant supervision decreased from 90% to 36% of patients. All had estimated IQ below 85. Median functional score increased from 7 to 10 (p = 0.03). No patient had decrease in speech fluency or hemiparesis. Caregivers rated the effect of the procedure as excellent in 40% and as having greatly improved functioning in another 50%. Clinical, EEG, imaging, and cognitive variables did not correlate with outcome. Conclusions: This cohort study with objective outcome assessment suggests that selective posterior callosotomy is safe and effective to control drop attacks, with functional and behavioral gains in patients with intellectual disability. Results are comparable to historical series of total callosotomy and suggest that anterior callosal fibers may be spared. Classification of evidence: This study provides Class III evidence that selective posterior callosotomy reduces falls in patients with epileptic drop attacks.

Posterior Reversible Encephalopathy Syndrome Associated with FOLFOX Chemotherapy

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity characterized by headaches, altered mental status, seizures, visual loss, and characteristic imaging pattern in brain MRI. The cause of PRES is not yet understood. We report a case of a 27-year-old woman that developed PRES after the use of FOLFOX 5 (oxaliplatin/5-Fluoracil/Leucovorin) chemotherapy for a colorectal cancer.

Accuracy of computer-aided ultrasound as compared with magnetic resonance imaging in the evaluation of nonalcoholic fatty liver disease in obese and eutrophic adolescents

Objective To compare the accuracy of computer-aided ultrasound (US) and magnetic resonance imaging (MRI) by means of hepatorenal gradient analysis in the evaluation of nonalcoholic fatty liver disease (NAFLD) in adolescents. Materials and Methods This prospective, cross-sectional study evaluated 50 adolescents (aged 11–17 years), including 24 obese and 26 eutrophic individuals. All adolescents underwent computer-aided US, MRI, laboratory tests, and anthropometric evaluation. Sensitivity, specificity, positive and negative predictive values and accuracy were evaluated for both imaging methods, with subsequent generation of the receiver operating characteristic (ROC) curve and calculation of the area under the ROC curve to determine the most appropriate cutoff point for the hepatorenal gradient in order to predict the degree of steatosis, utilizing MRI results as the gold-standard. Results The obese group included 29.2% girls and 70.8% boys, and the eutrophic group, 69.2% girls and 30.8% boys. The prevalence of NAFLD corresponded to 19.2% for the eutrophic group and 83% for the obese group. The ROC curve generated for the hepatorenal gradient with a cutoff point of 13 presented 100% sensitivity and 100% specificity. As the same cutoff point was considered for the eutrophic group, false-positive results were observed in 9.5% of cases (90.5% specificity) and false-negative results in 0% (100% sensitivity). Conclusion Computer-aided US with hepatorenal gradient calculation is a simple and noninvasive technique for semiquantitative evaluation of hepatic echogenicity and could be useful in the follow-up of adolescents with NAFLD, population screening for this disease as well as for clinical studies.

Quantification of Abdominal Fat in Obese and Healthy Adolescents Using 3 Tesla Magnetic Resonance Imaging and Free Software for Image Analysis

Background and Aims Computed tomography, which uses ionizing radiation and expensive software packages for analysis of scans, can be used to quantify abdominal fat. The objective of this study is to measure abdominal fat with 3T MRI using free software for image analysis and to correlate these findings with anthropometric and laboratory parameters in adolescents. Methods This prospective observational study included 24 overweight/obese and 33 healthy adolescents (mean age 16.55 years). All participants underwent abdominal MRI exams. Visceral and subcutaneous fat area and percentage were correlated with anthropometric parameters, lipid profile, glucose metabolism, and insulin resistance. Student’s t test and Mann-Whitney’s test was applied. Pearson’s chi-square test was used to compare proportions. To determine associations Pearson’s linear correlation or Spearman’s correlation were used. Results In both groups, waist circumference (WC) was associated with visceral fat area (P = 0.001 and P = 0.01 respectively), and triglycerides were associated with fat percentage (P = 0.046 and P = 0.071 respectively). In obese individuals, total cholesterol/HDL ratio was associated with visceral fat area (P = 0.03) and percentage (P = 0.09), and insulin and HOMA-IR were associated with visceral fat area (P = 0.001) and percentage (P = 0.005). Conclusions 3T MRI can provide reliable and good quality images for quantification of visceral and subcutaneous fat by using a free software package. The results demonstrate that WC is a good predictor of visceral fat in obese adolescents and visceral fat area is associated with total cholesterol/HDL ratio, insulin and HOMA-IR.

Posterior Reversible Encephalopathy Syndrome: Clinical Differences in Patients with Exclusive Involvement of Posterior Circulation Compared to Anterior or Global Involvement

INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic syndrome not yet fully understood and characterized by transient neurologic symptoms in addition to typical radiological findings. There are only a few articles that describe the clinical differences between patients with PRES that involve carotid and vertebrobasilar circulations. Our study aims to further evaluate the differences between predominantly anterior and posterior circulation PRES. METHODS We review 54 patients who had received the diagnosis of PRES from 2009 to 2015. The patients were divided into 2 groups: (1) exclusively in posterior zones; and (2) anterior plus posterior zones or exclusively anterior zones. Several clinical characteristics were evaluated, including the following: age, sex, previous diseases, the neurologic manifestations, the highest blood pressure in the first 48 hours of presentation, highest creatinine level during symptoms, and the neuroimaging alterations in brain magnetic resonance imaging. RESULTS Mean age at diagnosis was 28.5 years old (9 men and 45 women) and mean systolic blood pressure among patients with lesions only in posterior zones was 162.1 mmHg compared to 179.2 mmHg in the anterior circulation. The most common symptoms in the 2 groups were headache and visual disturbances. DISCUSSION PRES may have several radiological features. A higher blood pressure seems to be 1 of the factors responsible for developing widespread PRES, with involvement of carotid vascular territory. This clinical-radiological difference probably occurs because of the larger number of autonomic receptors in the carotid artery in comparison to the vertebral-basilar system.

Cow's milk allergy: color Doppler ultrasound findings in infants with hematochezia.

OBJECTIVE ultrasound (US) has been an important diagnostic tool to identify several causes of gastrointestinal bleeding. Infants with cows milk allergy (CMA) may present hematochezia and the confirmation of the diagnosis can be difficult. The aim of this study is to describe grayscale and color Doppler ultrasound findings in patients with CMA. METHODS we retrospectively studied 13 infants with CMA. All infants presented severe hematochezia and abdominal pain. All underwent an US study with the diagnosis of allergic colitis. This diagnosis was based on clinical findings, recovery after infant or mother exclusion diets in the case of exclusive breastfeeding and positive oral challenge test. RESULTS the mean age ranged from 1 to 6 months (mean=3.53). Seven out of 13 infants (53.8%) had grayscale and color Doppler sonographic repeated after exclusion diet. Twelve out of 13 (92,3%) showed abnormalities at US and CDUS at beginning. The positive findings suggesting colitis were thickened bowel walls and increased vascularity, especially in the descending and sigmoid colon. Colonoscopy and histopathological findings were compatible with allergic colitis. After a diet change the 13 infants recovered and their oral challenge tests were positive. CONCLUSION Doppler US may be very useful in diagnosing secondary colitis, such as CMA, and to exclude several other abdominal diseases that can emulate this disease.

PRES with asymptomatic spinal cord involvement. Is this scenario more common than we know

Introduction:Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by neurologic symptoms such as headaches, altered mental status, seizures and visual changes, and it is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain.Case report:A 19-year-old patient developed PRES after the use of chemotherapy for a testicular teratocarcinoma and after the development of a blood pressure elevation.Discussion:Few cases described the involvement of the spinal cord in this syndrome. In the majority of these cases, the spinal cord involvement was asymptomatic or with few symptoms of spinal cord disease.