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Apesar de não muito frequente, nos últimos 20 anos, houve um aumento significativo dos relatos sobre rotura do peitoral maior, normalmente associadas à prática de atividade física em que ocorre contração intensa e/ou uso de cargas pesadas exercendo resistência sobre o músculo. Neste relato de caso temos um paciente de 51 anos referindo dor no tórax à direita e no braço direito há 3 dias após tentar consertar o guidão da moto. Apresentava assimetria dos peitorais, perda de força do membro superior direito, dificuldade de movimentação e hematoma. A ressonância magnética demonstrou rotura completa da junção miotendínea do peitoral maior, com tendinopatia com fissuras insercionais e intrasubstanciais infraespinhal e tendinopatia com rotura parcial do tendão subescapular. Foi indicado por médico ortopedista o acompanhamento com o uso de medicação analgésica.
Although not very common, in the last 20 years, there has been a significant increase in reports of rupture of the pectoralis major, normally associated with the practice of physical activity in which intense contraction occurs and/or the use of heavy loads exerting resistance on the muscle. In this case report we have a 51-year-old patient reporting pain in his right chest and right arm for 3 days after trying to fix his motorcycle's handlebars. He had asymmetry of the pectorals, loss of strength in the right upper limb, difficulty moving and hematoma. Magnetic resonance imaging demonstrated complete rupture of the myotendinous junction of the pectoralis major, with tendinopathy with insertional and intrasubstantial infraspinatus fissures and tendinopathy with partial rupture of the subscapularis tendon. An orthopedic doctor recommended follow-up with the use of analgesic medication.
Aunque no es muy común, en los últimos 20 años se ha observado un aumento significativo en los reportes de rotura del pectoral mayor, normalmente asociado a la práctica de actividad física en la que se produce una contracción intensa y/o al uso de cargas pesadas ejerciendo resistencia sobre el mismo. el músculo. En este caso clínico tenemos un paciente de 51 años que refiere dolor en el pecho derecho y en el brazo derecho durante 3 días después de intentar arreglar el manillar de su motocicleta. Presentó asimetría de pectorales, pérdida de fuerza en miembro superior derecho, dificultad de movimiento y hematoma. La resonancia magnética demostró rotura completa de la unión miotendinosa del pectoral mayor, con tendinopatía con fisuras de inserción e intrasustancial del infraespinoso y tendinopatía con rotura parcial del tendón subescapular. Un médico ortopédico recomendó seguimiento con el uso de medicación analgésica.
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Humanos , Masculino , Pessoa de Meia-Idade , Músculos Peitorais/lesões , Músculos Peitorais/diagnóstico por imagem , Extremidade Superior/lesões , Extremidade Superior/diagnóstico por imagem , Junção Miotendínea/lesões , Junção Miotendínea/diagnóstico por imagemRESUMO
PURPOSE: To validate the Barcelona magnetic resonance imaging predictive model (BCN-MRI PM) in men with pre-biopsy multiparametric MRI (mpMRI) reported with the Prostate Imaging Reporting and Data System (PI-RADS) v2.1, followed by transrectal and transperineal prostate biopsies. MATERIALS AND METHODS: Prospective analysis of 3,264 men with PSA >3.0 ng/mL and/or abnormal digital rectal examination who were referred to ten participant centers in the csPCa early detection program of Catalonia (Spain), between 2021 and 2023. MpMRI was reported with the PI-RADS v2.1, and 2- to 4-core MRI-transrectal ultrasound (TRUS) fusion-targeted biopsy of suspected lesions and/or 12-core systematic biopsy were conducted. 2,295 (70.3%) individuals were referred to six centers for transrectal prostate biopsies, while 969 (39.7%) were referred to four centers for transperineal prostate biopsies. CsPCa was classified whenever the International Society of Urologic Pathology grade group was 2 or higher. RESULTS: CsPCa was detected in 41% of transrectal prostate biopsies and in 45.9% of transperineal prostate biopsies (p < 0.016). Both BCN-MRI PM calibration curves were within the ideal correlation between predicted and observed csPCa. Areas under the curve and 95% confidence intervals were 0.847 (0.830-0.857) and 0.830 (0.823-0.855), respectively (p = 0.346). Specificities corresponding to 95% sensitivity were 37.6 and 36.8%, respectively (p = 0.387). The Net benefit of the BCN-MRI PM was similar with both biopsy methods. CONCLUSIONS: The BCN-MRI PM has been successfully validated when mpMRI was reported with the PI-RADS v2.1 and prostate biopsies were conducted via the transrectal and transperineal route.
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Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética Multiparamétrica , Próstata , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Estudos Prospectivos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Idoso , Pessoa de Meia-Idade , Próstata/patologia , Próstata/diagnóstico por imagem , Períneo/diagnóstico por imagem , Períneo/patologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Imageamento por Ressonância Magnética/métodosRESUMO
PURPOSE: There is an unmet clinical need for non-invasive imaging biomarkers that could replace liver biopsy in the management of patients with autoimmune hepatitis (AIH). In this study, we sought to evaluate the diagnostic accuracy of a simple uncorrected, non-contrast T1 mapping for detecting fibrosis and inflammation in AIH patients using histopathology as a reference standard. MATERIAL AND METHODS: Over 3 years, 33 patients with AIH were prospectively studied using a multiparametric liver MRI protocol which included T1 mapping. Biopsies were performed up to 3 months before imaging, and a standardized histopathological score for fibrosis (F0-F4) and inflammatory activity (PPA0-4) was used as a reference. Statistical analysis included independent t test, Mann-Whitney U-test, and ROC (receiver operating characteristic) analysis. RESULTS: T1 mapping values were significantly higher in patients with advanced fibrosis (F0-2 vs. F3-4; p < 0.015), significant fibrosis (F0-1 vs. F2-4; p < 0.005), and significant inflammatory activity (PPA 0-1 vs. PPA 2-4 p = 0.048). Moreover, the technique demonstrated a good diagnostic performance in detecting significant (AUC 0.856) and advanced fibrosis (AUC 0.835), as well as significant inflammatory activity (AUC 0.763). CONCLUSION: A rapid, simple, uncorrected, non-contrast T1 mapping sequence showed satisfactory diagnostic performance in comparison with histopathology for detecting significant tissue inflammation and fibrosis in AIH patients, being a potential non-invasive imaging biomarker for monitoring disease activity in such individuals.
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Hepatite Autoimune , Cirrose Hepática , Imageamento por Ressonância Magnética , Humanos , Hepatite Autoimune/diagnóstico por imagem , Hepatite Autoimune/patologia , Estudos Prospectivos , Feminino , Masculino , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Biópsia , Padrões de Referência , Inflamação/diagnóstico por imagemRESUMO
BACKGROUND: Education influences brain health and dementia. However, its impact across regions, specifically Latin America (LA) and the United States (US), is unknown. METHODS: A total of 1412 participants comprising controls, patients with Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD) from LA and the US were included. We studied the association of education with brain volume and functional connectivity while controlling for imaging quality and variability, age, sex, total intracranial volume (TIV), and recording type. RESULTS: Education influenced brain measures, explaining 24%-98% of the geographical differences. The educational disparities between LA and the US were associated with gray matter volume and connectivity variations, especially in LA and AD patients. Education emerged as a critical factor in classifying aging and dementia across regions. DISCUSSION: The results underscore the impact of education on brain structure and function in LA, highlighting the importance of incorporating educational factors into diagnosing, care, and prevention, and emphasizing the need for global diversity in research. HIGHLIGHTS: Lower education was linked to reduced brain volume and connectivity in healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). Latin American cohorts have lower educational levels compared to the those in the United States. Educational disparities majorly drive brain health differences between regions. Educational differences were significant in both conditions, but more in AD than FTLD. Education stands as a critical factor in classifying aging and dementia across regions.
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Arachnoid cysts (ACs) are cerebrospinal fluid collections between the two layers of the normal arachnoid membrane. Although they are often asymptomatic with a stationary course, eventual complications may occur. Herein, we report the case of a 9-year-old boy who developed bilateral papilloedema secondary to spontaneous rupture of an AC in the left middle cranial fossa. Although the papilloedema worsened during follow-up, his visual field remained bilaterally stable, supporting the expectant management and obviating the potential morbidity associated with neurosurgical intervention. This case report highlights the importance of a multidisciplinary approach to patients with secondary intracranial hypertension, including serial ophthalmological examinations, which provide a useful guide to surgical decision-making.
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Purpose: This paper explores different machine learning (ML) algorithms for analyzing diffusion nuclear magnetic resonance imaging (dMRI) models when analytical fitting shows restrictions. It reviews various ML techniques for dMRI analysis and evaluates their performance on different b-values range datasets, comparing them with analytical methods. Materials and Methods: After standard fitting for reference, four sets of diffusion-weighted nuclear magnetic resonance images were used to train/test various ML algorithms for prediction of diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and kurtosis (K). ML classification algorithms, including extra-tree classifier (ETC), logistic regression, C-support vector, extra-gradient boost, and multilayer perceptron (MLP), were used to determine the existence of diffusion parameters (D, D*, f, and K) within single voxels. Regression algorithms, including linear regression, polynomial regression, ridge, lasso, random forest (RF), elastic-net, and support-vector machines, were used to estimate the value of the diffusion parameters. Performance was evaluated using accuracy (ACC), area under the curve (AUC) tests, and cross-validation root mean square error (RMSECV). Computational timing was also assessed. Results: ETC and MLP were the best classifiers, with 94.1% and 91.7%, respectively, for the ACC test and 98.7% and 96.3% for the AUC test. For parameter estimation, RF algorithm yielded the most accurate results The RMSECV percentages were: 8.39% for D, 3.57% for D*, 4.52% for f, and 3.53% for K. After the training phase, the ML methods demonstrated a substantial decrease in computational time, being approximately 232 times faster than the conventional methods. Conclusions: The findings suggest that ML algorithms can enhance the efficiency of dMRI model analysis and offer new perspectives on the microstructural and functional organization of biological tissues. This paper also discusses the limitations and future directions of ML-based dMRI analysis.
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Precise annotations for large medical image datasets can be time-consuming. Additionally, when dealing with volumetric regions of interest, it is typical to apply segmentation techniques on 2D slices, compromising important information for accurately segmenting 3D structures. This study presents a deep learning pipeline that simultaneously tackles both challenges. Firstly, to streamline the annotation process, we employ a semi-automatic segmentation approach using bounding boxes as masks, which is less time-consuming than pixel-level delineation. Subsequently, recursive self-training is utilized to enhance annotation quality. Finally, a 2.5D segmentation technique is adopted, wherein a slice of a volumetric image is segmented using a pseudo-RGB image. The pipeline was applied to segment the carotid artery tree in T1-weighted brain magnetic resonance images. Utilizing 42 volumetric non-contrast T1-weighted brain scans from four datasets, we delineated bounding boxes around the carotid arteries in the axial slices. Pseudo-RGB images were generated from these slices, and recursive segmentation was conducted using a Res-Unet-based neural network architecture. The model's performance was tested on a separate dataset, with ground truth annotations provided by a radiologist. After recursive training, we achieved an Intersection over Union (IoU) score of (0.68 ± 0.08) on the unseen dataset, demonstrating commendable qualitative results.
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Brain abscesses in ruminants often arise from primary infection foci, leading to an unfavorable prognosis for affected animals. This highlights the need for comprehensive studies on brain abscesses across different ruminant species. We retrospectively investigated medical records of epidemiological, clinical, neuroimaging, anatomopathological, and bacteriological findings in six ruminants (three goats, two cows, and one sheep) diagnosed with brain abscesses. All animals studied were female. Apathy (50%), compulsive walking (33%), decreased facial sensitivity (33%), head pressing (33%), seizures (33%), semicomatous mental status (33%), strabismus (33%), unilateral blindness (33%), and circling (33%) represented the most common neurologic signs. Leukocytosis and neutrophilia were the main findings in the hematological evaluation. Cerebrospinal fluid (CSF) analysis revealed predominant hyperproteinorrachia and pleocytosis. In three cases, computed tomography or magnetic resonance imaging were used, enabling the identification of typical abscess lesions, which were subsequently confirmed during postmortem examination. Microbiological culture of the abscess samples and/or CSF revealed bacterial coinfections in most cases. Advanced imaging examinations, combined with CSF analysis, can aid in diagnosis, although confirmation typically relies on postmortem evaluation and isolation of the causative agent. This study contributes to clinicopathological aspects, neuroimages, and bacteriological diagnosis of brain abscesses in domestic ruminants.
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Acute calcific periarthritis (ACP) is defined as periarticular inflammation associated with intra-articular deposits of hydroxyapatite and other basic calcium phosphate crystals. Patients with ACP present with a sudden onset of pain, together with localized swelling, as well as erythema, tenderness, and reduced range of motion. Familiarity with the clinical and radiological manifestations of ACP aids in the diagnosis and helps differentiate it from other conditions, particularly infectious or inflammatory pathologies such as septic arthritis and gout, thereby reducing the number of unnecessary diagnostic and therapeutic procedures. The objective of this pictorial essay is to illustrate the imaging findings of ACP in various joints, with an emphasis on the findings obtained by magnetic resonance imaging.
A periartrite cálcica aguda (PCA) é uma inflamação periarticular aguda associada a depósitos justa-articulares de hidroxiapatita e outros cristais básicos de fosfato de cálcio. Os pacientes apresentam início súbito de dor, edema localizado, eritema, sensibilidade e redução da amplitude de movimentos. A familiaridade com as manifestações clínicas e radiológicas da PCA facilita o diagnóstico e permite diferenciá-la de outras entidades, em particular, com doenças infecciosas ou inflamatórias, como artrite séptica e gota, reduzindo procedimentos diagnósticos e terapêuticos desnecessários. O objetivo deste ensaio iconográfico é ilustrar os achados de imagem de PCA em algumas articulações, com ênfase na ressonância magnética.
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Objective: To compare information on highly complex radiological procedures-computed tomography (CT) and magnetic resonance imaging (MRI)-between the public and private health care systems, across the five regions of Brazil, in terms of the numbers of radiological devices and examinations performed, between 2015 and 2021. Materials and Methods: This was a descriptive time series analysis of secondary data in the public domain, available from the Information Technology Department of the Brazilian Unified Health Care System, an entity of the Brazilian National Ministry of Health (NMH) that is responsible for collecting and storing health-related information in Brazil. The analysis included the numbers of CT and MRI scanners; the volumes and types of examinations; the type of institution (public or private); the regions of the country; and the years (2015 to 2021). Results: Progressive increases in the numbers of CT and MRI devices, as well as in the volumes of examinations, were observed over the years in all regions of the country. The private sector showed higher rates of equipment acquisition and of growth in the number of examinations. However, the public health care system did not reach the equipment targets set by the NMH, whereas the private health care system surpassed those targets. A greater number of examinations were performed in the private sector than in the public sector. Conclusion: During the period evaluated, the public health care system did not meet the equipment or examination targets recommended by the NMH, in any of the regions of the country, unlike the private health care system, which exceeded both in all of the regions.
Objetivo: Comparar informações sobre procedimentos radiológicos de alta complexidade tomografia computadorizada (TC) e ressonância magnética (RM) , considerando o número de aparelhos e o quantitativo de exames nas esferas pública e privada nas cinco regiões brasileiras entre 2015 e 2021. Materiais e Métodos: Trata-se de um estudo descritivo de série temporal que utilizou dados secundários do Departamento de Informática do Sistema Único de Saúde, órgão do Ministério da Saúde (MS) responsável pela coleta e armazenamento das informações relacionadas à saúde no Brasil. Analisamos os números de aparelhos e de exames de TC e RM, considerando os tipos de aparelhos e exames, instituição (pública ou privada), região brasileira e ano (2015 a 2021). Resultados: Houve aumento de aparelhos e exames de TC e RM em todas as regiões ao longo dos anos. A esfera privada apresentou maior aquisição desses aparelhos e crescimento no número de exames. O sistema público não atingiu o número de aparelhos preconizado pelo MS, enquanto o sistema privado superou a recomendação. Observou-se maior número de exames na esfera privada quando comparada à pública. Conclusão: O sistema público não atendeu aos números de aparelhos e exames realizados preconizados pelo MS, diferentemente da esfera privada, em todas as regiões no período estudado.
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Objective: To investigate clinical, pathology, and imaging findings associated with inguinal lymph node (LN) metastases in patients with prostate cancer (PCa). Materials and Methods: This was a retrospective single-center study of patients with PCa who underwent imaging and inguinal LN biopsy between 2000 and 2023. We assessed the following aspects on multimodality imaging: inguinal LN morphology; extrainguinal lymphadenopathy; the extent of primary and recurrent tumors; and non-nodal metastases. Imaging, clinical, and pathology features were compared between patients with and without metastatic inguinal LNs. Results: We evaluated 79 patients, of whom 38 (48.1%) had pathology-proven inguinal LN metastasis. Certain imaging aspects- short-axis diameter, prostate-specific membrane antigen uptake on positron-emission tomography, membranous urethra involvement by the tumor, extra-inguinal lymphadenopathy, and distant metastases-were associated with pathology-proven inguinal LN metastases (p < 0.01 for all). Associations with long-axis diameter, fatty hilum, laterality, and uptake of other tracers on positronemission tomography were not significant (p = 0.09-1.00). The patients with metastatic inguinal LNs had higher prostate-specific antigen levels and more commonly had castration-resistant PCa (p < 0.01), whereas age, histological grade, and treatment type were not significant factors (p = 0.07-0.37). None of the patients had inguinal LN metastasis in the absence of locally advanced disease with membranous urethra involvement or distant metastasis. Conclusion: Several imaging, clinical, and pathology features are associated with inguinal LN metastases in patients with PCa. Isolated metastasis to inguinal LNs is extremely rare and unlikely to occur in the absence of high-risk imaging, clinical, or pathology features.
Objetivo: Investigar achados clinicopatológicos e de imagem associados a metástases linfonodais inguinais em pacientes com câncer de próstata (CaP). Materiais e Métodos: Estudo retrospectivo de uma única instituição de pacientes com CaP submetidos a exames de imagem e biópsia inguinal de linfonodos em 20002023. A imagem multimodalidade foi avaliada para morfologia inguinal do linfonodo, linfadenopatia fora da região inguinal, extensão do CaP primário/recorrente e sítios metastáticos não nodais. Características de imagem e clinicopatológicas foram comparadas entre pacientes com e sem linfonodos inguinais metastáticos pela patologia. Resultados: Entre 79 pacientes estudados, 38 (48,1%) apresentaram metástase inguinal de linfonodo comprovada patologicamente. Certos achados de imagem diâmetro do eixo curto, captação do antígeno de membrana prostático específico na tomografia por emissão de pósitrons, envolvimento da uretra membranosa pelo tumor, linfadenopatia fora da região inguinal e metástases a distância foram associados com metástases inguinais no linfonodo pela patologia (p < 0,01). Diâmetro de eixo longo, hilo gorduroso, lateralidade, captação em outros traçadores de tomografia por emissão de pósitrons não foram significativos (p = 0,091,00). Clinicopatologicamente, os pacientes com linfonodos inguinais metastáticos apresentaram maior antígeno prostático específico e foram mais resistentes à castração (p < 0,01); idade, grau histológico e tipo de tratamento não foram estatisticamente significantes (p = 0,070,37). Nenhum paciente apresentou metástase inguinal isolada no linfonodo na ausência de doença localmente avançada com envolvimento da uretra membranosa ou metástase a distância. Conclusão: Várias características de imagem e clinicopatológicas foram associadas a metástases em LNs inguinais em pacientes com CaP. A metástase isolada para os LNs inguinais é extremamente rara e é improvável que ocorra na ausência de características de imagem e clinicopatológicas de alto risco.
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Objective: To evaluate the diagnostic accuracy of multi-echo Dixon magnetic resonance imaging (MRI) in hepatic fat quantification, in comparison with that of magnetic resonance spectroscopy (MRS), on 3.0-T MRI. Materials and Methods: Fifty-five adults with no known liver disease underwent MRI in a 3.0-T scanner for determination of the hepatic fat fraction, with two techniques: multi-echo Dixon, in a manually drawn region of interest (ROI) and in the entire liver parenchyma (automated segmentation); and MRS. The diagnostic accuracy and cutoff value for multi-echo Dixon were determined, with MRS being used as the reference standard. Results: The mean fat fraction obtained by multi-echo Dixon in the manually drawn ROI and in the entire liver was 5.2 ± 5.8% and 6.6 ± 5.2%, respectively, whereas the mean hepatic fat fraction obtained by MRS was 5.7 ± 6.4%. A very strong positive correlation and good agreement were observed between MRS and multi-echo Dixon, for the ROI (r = 0.988, r2 = 0.978, p < 0.001) and for the entire liver parenchyma (r = 0.960, r2 = 0.922, p < 0.001). A moderate positive correlation was observed between the hepatic fat fraction and body mass index of the participants, regardless of the fat estimation technique employed. Conclusion: For hepatic fat quantification, multi-echo Dixon MRI demonstrated a very strong positive correlation and good agreement with MRS (often considered the gold-standard noninvasive technique). Because multi-echo Dixon MRI is more readily available than is MRS, it can be used as a rapid tool for hepatic fat quantification, especially when the hepatic fat distribution is not homogeneous.
Objetivo: Avaliar a acurácia diagnóstica da técnica multieco Dixon na quantificação da gordura hepática em comparação com a espectroscopia por ressonância magnética (ERM), em exames de RM 3.0-T. Materiais e Métodos: Cinquenta e cinco participantes adultos sem doença hepática conhecida foram submetidos a RM 3.0-T para determinação da fração de gordura hepática, usando duas técnicas: multieco Dixon (em ROI desenhada manualmente e em segmentação automatizada para todo o parênquima hepático) e ERM. A precisão diagnóstica e o valor de corte para multieco Dixon foram determinados usando a ERM como padrão de referência. Resultados: A fração de gordura média usando multieco Dixon na ROI desenhada manualmente e na segmentação automatizada do fígado inteiro foi 5,2 ± 5,8% e 6,6 ± 5,2%, respectivamente. A fração de gordura hepática média usando ERM foi 5,7 ± 6,4%. Correlação positiva muito alta e forte concordância foram observadas entre ERM e multieco Dixon, tanto para ROI (r = 0,988, r2 = 0,978, p < 0,001) quanto para todo o parênquima hepático (r = 0,960, r2 = 0,922, p < 0,001). Correlação positiva moderada foi observada entre a fração de gordura hepática e o índice de massa corpórea dos participantes usando ambas as técnicas de estimativa de gordura. Conclusão: Multieco Dixon demonstrou correlação positiva muito alta e concordância com a ERM (muitas vezes considerada padrão de referência não invasivo) para quantificação de gordura hepática. Uma vez que o multieco Dixon está mais prontamente disponível do que a ERM, pode ser usado como uma ferramenta rápida para a quantificação da gordura hepática, especialmente na distribuição não homogênea da gordura.
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The majority of central nervous system diseases show high signal intensity on T2-weighted magnetic resonance imaging. Diseases of the central nervous system with low signal intensity are less common, which makes it a finding that helps narrow the differential diagnosis. This was a retrospective analysis of brain and spine magnetic resonance imaging examinations in which that finding was helpful in the diagnostic investigation. We selected the cases of patients examined between 2015 and 2022. All diagnoses were confirmed on the basis of the clinical-radiological correlation or the histopathological findings. We obtained images of 14 patients with the following central nervous system diseases: arteriovenous malformation; cavernous malformation; metastasis from lymphoma; medulloblastoma; embryonal tumor; metastasis from melanoma; Rathke's cleft cyst; Erdheim-Chester disease; aspergillosis; paracoccidioidomycosis; tuberculosis; syphilis; immunoglobulin G4-related disease; and metastasis from a pulmonary neuroendocrine tumor. We described lesions of different etiologies in which the T2-weighted imaging profile helped narrow the differential diagnosis and facilitated the definitive diagnosis.
A grande maioria das doenças do sistema nervoso central apresenta alto sinal em ponderações T2 na ressonância magnética. As alterações com baixo sinal são menos comuns, de forma que essa característica permite estreitar o diagnóstico diferencial. Analisamos, retrospectivamente, pacientes com imagens de ressonância magnética de crânio e/ou coluna em que este achado foi útil na investigação diagnóstica. Os pacientes foram selecionados no período entre 2015 e 2022 e todos tiveram seus diagnósticos confirmados por estudo clinicorradiológico ou por estudo histopatológico. Obtivemos imagens de 14 pacientes com as seguintes afecções: malformação arteriovenosa, cavernoma, metástase de linfoma, meduloblastoma, tumor embrionário, metástase de melanoma, cisto da bolsa de Rathke, doença de Erdheim-Chester, aspergilose, paracoccidioidomicose, tuberculose, sífilis, doença relacionada à IgG4 e metástase de tumor neuroendócrino de pulmão. Descrevemos lesões de diversas origens etiológicas que, a partir de suas características nas imagens ponderadas em T2, foi possível reduzir o quadro de diagnósticos diferenciais e chegar mais facilmente à hipótese final.
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Objective: To evaluate the indications for and results of magnetic resonance imaging (MRI) examinations for breast cancer screening at a cancer center in Brazil. Materials and Methods: This was a retrospective observational study, based on electronic medical records, of patients undergoing MRI for breast cancer screening at a cancer center in Brazil. Results: We included 597 patients between 19 and 82 years of age. The main indications for MRI screening were a personal history of breast cancer, in 354 patients (59.3%), a family history of breast cancer, in 102 (17.1%), and a confirmed genetic mutation, in 67 (11.2%). The MRI result was classified, in accordance with the categories defined in the Breast Imaging Reporting and Data System, as benign (category 1 or 2), in 425 patients (71.2%), probably benign (category 3), in 143 (24.0%), or suspicious (category 4 or 5), in 29 (4.9%). On MRI, 11 malignant tumors were identified, all of which were invasive carcinomas. Among those 11 carcinomas, six (54.5%) were categorized as minimal cancers (< 1 cm), and the axillary lymph nodes were negative in 10 (90.9%). The cancer detection rate was 18.4/1,000 examinations, and the positive predictive value for suspicious lesions submitted to biopsy was 37.9%. Conclusion: In our sample, the main indication for breast MRI screening was a personal history of breast cancer. The results indicate that MRI is a highly accurate method for the early detection of breast neoplasms in this population.
Objetivo: Avaliar as indicações e resultados de exames de ressonância magnética (RM) para rastreamento de câncer de mama em um centro oncológico no Brasil. Materiais e Métodos: Estudo observacional, realizado mediante análise retrospectiva de pacientes submetidos a RM das mamas para rastreamento de câncer de mama, por meio de revisão do prontuário eletrônico em um centro oncológico. Resultados: Foram incluídas 597 pacientes com idade variando de 19 a 82 anos. As principais indicações para rastreamento foram história pessoal de câncer de mama em 354 (59,3%) pacientes, história familiar em 102 (17,1%) e mutação genética confirmada em 67 (11,2%). O resultado da RM foi benigno (BI-RADS 1 ou 2) em 425 (71,2%) pacientes, provavelmente benigno (BI-RADS 3) em 143 (24,0%) e suspeito (BI-RADS 4 ou 5) em 29 (4,9%). Foram identificados 11 tumores malignos na RM, todos carcinomas invasivos, porcentagem de cânceres "mínimos" (< 1 cm) de 54,5% e porcentagem de axila negativa de 90,9%. A taxa de detecção de câncer na RM foi 18,4/1000 exames e o valor preditivo positivo para as lesões suspeitas submetidas a biópsia foi 37,9%. Conclusão: A principal indicação para RM de rastreamento na nossa população foi história pessoal de câncer de mama. Os resultados mostraram que a RM constitui um método com alta acurácia para detecção precoce de neoplasias da mama nessa população.
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BACKGROUND: The radiological manifestations of central nervous system (CNS) cryptococcosis are diverse and often subtle. There is heterogeneity on how different neuroimaging patterns impact prognosis. This study aims to assess the association between the neuroimaging and clinical outcomes of CNS cryptococcosis. METHODS: All patients with CNS cryptococcosis between July 2017 and April 2023 who underwent brain magnetic resonance imaging (MRI) were included. The primary outcome was mortality during hospitalisation. Secondary outcomes were readmission, ventricular shunting, duration of hospitalisation and time to the first negative cerebrospinal fluid culture. We compared the outcomes for each of the five main radiological findings on the brain MRI scan. RESULTS: We included 46 proven CNS cryptococcosis cases. The two main comorbidity groups were HIV infection (20, 43%) and solid organ transplantation (10, 22%), respectively. Thirty-nine patients exhibited at least one radiological abnormality (85%), with the most common being meningeal enhancement (34, 74%). The mortality rates occurred at 11% (5/46) during hospitalisation. We found no significant disparities in mortality related to distinct radiological patterns. The presence of pseudocysts was significantly associated with the need for readmission (p = .027). The ventricular shunting was significantly associated with the presence of pseudocysts (p = .005) and hydrocephalus (p = .044). CONCLUSION: In this study, there is no association between brain MRI findings and mortality. Larger studies are needed to evaluate this important issue.
Assuntos
Criptococose , Imageamento por Ressonância Magnética , Neuroimagem , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neuroimagem/métodos , Criptococose/diagnóstico por imagem , Criptococose/mortalidade , Criptococose/microbiologia , Adulto , Idoso , Estudos Retrospectivos , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico por imagem , Infecções Fúngicas do Sistema Nervoso Central/mortalidade , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Prognóstico , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/mortalidade , Hospitalização , Infecções por HIV/complicaçõesRESUMO
Osteolipoma is a rare benign variant of lipoma and constitutes less than 1% of all lipomas, presenting as a well-circumscribed painless mass. It is a tumor known to occur in several regions, usually intraosseous or adjacent to bone tissue, whose pathogenesis is still unclear. Imaging exams are useful in their evaluation and, mainly, in surgical planning, which consists of tumor excision. However, the definitive diagnosis of osteolipoma is made by histopathological examination. Although benign, osteolipomas can compress surrounding structures, leading to important symptomatology, as in this case reported in which it is in contact with the brachial plexus.
RESUMO
BACKGROUND: Clinical trials for upcoming disease-modifying therapies of spinocerebellar ataxias (SCA), a group of rare movement disorders, lack endpoints sensitive to early disease progression, when therapeutics will be most effective. In addition, regulatory agencies emphasize the importance of biological outcomes. OBJECTIVES: READISCA, a transatlantic clinical trial readiness consortium, investigated whether advanced multimodal magnetic resonance imaging (MRI) detects pathology progression over 6 months in preataxic and early ataxic carriers of SCA mutations. METHODS: A total of 44 participants (10 SCA1, 25 SCA3, and 9 controls) prospectively underwent 3-T MR scanning at baseline and a median [interquartile range] follow-up of 6.2 [5.9-6.7] months; 44% of SCA participants were preataxic. Blinded analyses of annual changes in structural, diffusion MRI, MR spectroscopy, and the Scale for Assessment and Rating of Ataxia (SARA) were compared between groups using nonparametric testing. Sample sizes were estimated for 6-month interventional trials with 50% to 100% treatment effect size, leveraging existing large cohort data (186 SCA1, 272 SCA3) for the SARA estimate. RESULTS: Rate of change in microstructural integrity (decrease in fractional anisotropy, increase in diffusivities) in the middle cerebellar peduncle, corona radiata, and superior longitudinal fasciculus significantly differed in SCAs from controls (P < 0.005), with high effect sizes (Cohen's d = 1-2) and moderate-to-high responsiveness (|standardized response mean| = 0.6-0.9) in SCAs. SARA scores did not change, and their rate of change did not differ between groups. CONCLUSIONS: Diffusion MRI is sensitive to disease progression at very early-stage SCA1 and SCA3 and may provide a >5-fold reduction in sample sizes relative to SARA as endpoint for 6-month-long trials. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Assuntos
Progressão da Doença , Imageamento por Ressonância Magnética , Ataxias Espinocerebelares , Humanos , Ataxias Espinocerebelares/diagnóstico por imagem , Ataxias Espinocerebelares/patologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodosRESUMO
BACKGROUND: The purpose of this study was to review and summarize the association between preoperative magnetic resonance imaging (MRI) and surgical outcomes in women with newly diagnosed invasive breast cancer from published randomized controlled trials (RCT). MATERIALS AND METHODS: Two independent researchers conducted a systematic review through a comprehensive search of electronic databases, including PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science. If there was disagreement between the two reviewers, a third reviewer assessed the manuscript to determine whether it should be included for data extraction. The quality of the papers was assessed using the risk of bias tool, and the evidence was analyzed using GRADE. Meta-analyses using a fixed-effects model were used to estimate the pooled risk ratio (RR) and 95% confidence interval (CI). RESULTS: Initially, 21 studies were identified, 15 of which were observational comparative studies. A total of five RCTs were included, and they suggested that preoperative MRI significantly reduced the rate of immediate breast-conserving surgery and increased the risk for mastectomy. CONCLUSIONS: From the RCT perspective, preoperative MRI for newly diagnosed invasive breast cancer did not improve surgical outcomes and may increase the risk of mastectomy.
Assuntos
Neoplasias da Mama , Imageamento por Ressonância Magnética , Cuidados Pré-Operatórios , Humanos , Neoplasias da Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Imageamento por Ressonância Magnética/métodos , Prognóstico , Mastectomia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tomada de Decisão Clínica , Mastectomia Segmentar/métodosRESUMO
The differential diagnosis of supratentorial brain tumours in children can be challenging, especially considering the recent changes to the WHO classification of CNS tumours published in 2021. Many new tumour types have been proposed which frequently present in children and young adults and their imaging features are currently being described by the neuroradiology community. The purpose of this article is to provide guidance to residents and fellows new to the field of paediatric neuroradiology on how to evaluate an MRI of a patient with a newly diagnosed supratentorial tumour. Six different approaches are discussed including: 1. Tumour types, briefly discussing the main changes to the recent WHO classification of CNS tumours, 2. Patient age and its influence on incidence rates of specific tumour types, 3. Growth patterns, 4. Tumour location and how defining the correct location helps in narrowing down the differential diagnoses and 5. Imaging features of the tumour on DWI, SWI, FLAIR and post contrast sequences.
Assuntos
Imageamento por Ressonância Magnética , Neoplasias Supratentoriais , Humanos , Neoplasias Supratentoriais/diagnóstico por imagem , Neoplasias Supratentoriais/patologia , Criança , Imageamento por Ressonância Magnética/métodos , Diagnóstico Diferencial , Fatores Etários , Meios de ContrasteRESUMO
Colorectal cancer is the third most common cancer and the second leading cause of cancer-related death. Rectal cancer accounts for approximately one-third of new colorectal cancer cases, with adenocarcinoma as the predominant subtype. Despite an overall decline in colorectal cancer incidence and mortality, due to advancements in screening, early diagnosis, and treatment options, there is a concerning increase in incidence rates among young patients. Recent significant advances in managing locally advanced rectal cancer, such as the establishment of different surgical approaches, neoadjuvant treatment using different protocols for high-risk cases, and the adoption of organ-preservation strategies, have increased the importance of the role played by radiologists in locoregional assessment on magnetic resonance imaging at baseline, at restaging, and during active surveillance of patients with rectal cancer. In this article, we review the role of restaging rectal magnetic resonance imaging after neoadjuvant therapy, providing radiologists with a practical, step-by-step guide for assessing treatment response.
O câncer colorretal é o terceiro câncer mais comum e a segunda principal causa de morte relacionada ao câncer. O câncer retal representa aproximadamente um terço dos novos casos de câncer colorretal, sendo o adenocarcinoma o subtipo predominante. Apesar de uma diminuição geral na incidência e mortalidade, impulsionada por avanços na prevenção do câncer, diagnóstico precoce e opções de tratamento aprimoradas, há uma preocupante elevação nas taxas entre os pacientes jovens. Avanços recentes significativos no manejo do câncer retal localmente avançado, como abordagens cirúrgicas, o uso de diferentes protocolos de tratamento neoadjuvante para casos de alto risco e a adoção de estratégias de preservação de órgãos, aumentaram o papel dos radiologistas na avaliação locorregional por meio da ressonância magnética na avaliação inicial, reestadiamento e vigilância ativa de pacientes com câncer retal. Este manuscrito tem como objetivo revisar o papel da ressonância magnética retal no reestadiamento após terapia neoadjuvante, fornecendo aos radiologistas um guia prático para revisar exames nesse contexto.