RESUMO
Resumen: Introducción: la mayoría de las fracturas por fragilidad ocurren en rango densitométrico de osteopenia, la escala ósea trabecular (TBS) permite valorar aspectos de la microarquitectura que influyen en la resistencia ósea. Objetivo: describir las características clínicas y los hallazgos de la microarquitectura ósea aplicando TBS combinado con densitometría ósea (DXA) en un grupo de pacientes. Material y métodos: estudio descriptivo, de recolección retrospectiva. Se incluyen los pacientes a los que se les realizó DXA con TBS en el INRU en julio y agosto de 2020. Resultados: se analizaron 194 pacientes, 173 (89%) de sexo femenino y 21 (11%) de sexo masculino. El 36,1% (70 pacientes) en rango de osteopenia, 36,1 (70 pacientes) en rango de osteoporosis. El 32,9% (23 pacientes) con osteopenia y el 47,1% (33 pacientes) con osteoporosis tenían microarquitectura degradada. 76,9% de los pacientes con artritis reumatoidea y 45,8% de los que tenían espondiloartritis presentaban microarquitectura alterada. Conclusiones: el TBS permitió reestratificar el riesgo de fractura en un número importante de pacientes, mostrándose como una herramienta muy útil en la valoración complementaria de la salud ósea.
Summary: Introduction: most fractures that result from bone fragility occur in the osteopenia range The trabecular bone score (TBS) enables the assessment of microarchitecture aspects that impact bone resistance. Objective: to describe the clinical characteristics and findings of bone microarchitecture, by applying TBS and bone densitometry in a group of patients. Method: descriptive study of retrospective collection. Patients who were included in the study underwent a Dual-energy X-ray Absorptiometry (DXA) with TBS at the National Rheumatology Service between July and August, 2020. Results: 94 patients were analysed, 173 (89%) were female and 21 (11%) were male. 36.1% (70 patients) lay in the osteopenia range, 36.1 (70 patients) in the osteoporotic range. 32.9% (23 patients) with osteopenia and 47.1% (33 patients) with osteoporosis evidenced a degraded bone microarchitecture. 76.9 % of patients with rheumatoid arthritis and 45.8 % of patients with spondyloarthritis respectively evidenced altered bone microarchitecture. Conclusions: TBS allowed stratification of fracture risk in a significant number of patients, which may suggest it is a useful tool for complementary assessment of bone health.
Resumo: Introdução: a maioria das fraturas por fragilidade ocorre na faixa densitométrica da osteopenia; o escore de osso trabecular (TBS) permite avaliar aspectos da microarquitetura que influenciam a resistência óssea. Objetivo: descrever as características clínicas e os achados da microarquitetura óssea aplicando TBS combinado com densitometria óssea (DMO) em um grupo de pacientes. Material e métodos: estudo descritivo, retrospectivo, incluindo pacientes que realizaram DXA (absorciometria de raios-X de dupla energia) com TBS no INRU em julho e agosto de 2020. Resultados: foram analisados 194 pacientes, 173 (89%) mulheres e 21 (11%) homens. 36,1% (70 pacientes) na faixa de osteopenia, 36,1 (70 pacientes) na faixa de osteoporose. 32,9% (23 pacientes) com osteopenia e 47,1% (33 pacientes) com osteoporose tinham microarquitetura degradada. Nos pacientes com artrite reumatoide 76,9% e nas espondiloartrite 45,8% apresentaram microarquitetura alterada, respectivamente. Conclusões: a TBS permitiu fazer uma nova estratificação do risco de fratura em um número significativo de pacientes, mostrando-se uma ferramenta muito útil na avaliação complementar da saúde óssea.
Assuntos
Densidade Óssea , Fraturas por Osteoporose/diagnóstico por imagem , Doenças Ósseas Metabólicas/diagnóstico por imagem , Absorciometria de FótonRESUMO
The association between bone mineral density (BMD) and hepatic glycogen storage diseases (GSDs) is still unclear. To evaluate the BMD of patients with GSD I, IIIa and IXα, a cross-sectional study was performed, including 23 patients (GSD Ia = 13, Ib = 5, IIIa = 2 and IXα = 3; median age = 11.9 years; IQ = 10.9-20.1) who underwent a dual-energy X-ray absorptiometry (DXA). Osteocalcin (OC, n = 18), procollagen type 1 N-terminal propeptide (P1NP, n = 19), collagen type 1 C-terminal telopeptide (CTX, n = 18) and 25-OH Vitamin D (n = 23) were also measured. The participants completed a 3-day food diary (n = 20). Low BMD was defined as a Z-score ≤ -2.0. All participants were receiving uncooked cornstarch (median dosage = 6.3 g/kg/day) at inclusion, and 11 (47.8%) presented good metabolic control. Three (13%) patients (GSD Ia = 1, with poor metabolic control; IIIa = 2, both with high CPK levels) had a BMD ≤ -2.0. CTX, OC and P1NP correlated negatively with body weight and age. 25-OH Vitamin D concentration was decreased in seven (30.4%) patients. Our data suggest that patients with hepatic GSDs may have low BMD, especially in the presence of muscular involvement and poor metabolic control. Systematic nutritional monitoring of these patients is essential.
Assuntos
Doenças Ósseas Metabólicas/epidemiologia , Doença de Depósito de Glicogênio/epidemiologia , Hepatopatias/epidemiologia , Absorciometria de Fóton , Adolescente , Adulto , Densidade Óssea , Doenças Ósseas Metabólicas/sangue , Brasil/epidemiologia , Criança , Pré-Escolar , Colágeno Tipo I/sangue , Comorbidade , Estudos Transversais , Feminino , Doença de Depósito de Glicogênio/sangue , Humanos , Hepatopatias/sangue , Masculino , Osteocalcina/sangue , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Vitamina D/sangue , Adulto JovemRESUMO
OBJECTIVES: To present the ballistic gelatin as a new material capable of simulating the soft tissues in cone-beam CT (CBCT) images. METHODS: CBCT images of three piglet heads were acquired with their soft tissues intact (standard group). Subsequently, the piglet heads were fixed in a container using metallic pins and moulded with acrylic resin; the soft tissues were then removed and replaced by ballistic gelatin, with the same thickness of the original soft tissues. The images were evaluated by two oral radiologists, to check the adaptation on bone surfaces, thickness and density, penetration into large bone cavities and cancellous bone, and the presence of air bubbles using a 5-score scale. Additionally, an objective analysis was carried out by one oral radiologist. For each CBCT scan, three axial reconstructions were selected to represent the mandibular, occlusal, and maxillary levels. The mean and standard deviation (SD) of the grey values were calculated in four regions of interest determined on soft tissue areas and compared by two-way ANOVA. RESULTS: The ballistic gelatin showed subjective scores ranging from good to excellent for all parameters evaluated. There was no significant difference in the mean and SD values of the grey values between ballistic gelatin and the gold standard groups for all levels (p > 0.05). Higher SD values were observed in the occlusal level for both groups (p < 0.05). CONCLUSIONS: Ballistic gelatin has visual and objective similarity with the gold standard. Thus, the ballistic gelatin is a promising material capable of simulating soft tissues in CBCT images.
Assuntos
Gelatina , Tomografia Computadorizada de Feixe Cônico Espiral , Animais , Tomografia Computadorizada de Feixe Cônico , Humanos , Mandíbula/diagnóstico por imagem , Radiografia Dentária , SuínosRESUMO
ABSTRACT BACKGROUND: During weight gain, most of the excess adipose tissue accumulates in the trunk. This alters the body shape and makes collection of anthropometric measurements, especially waist circumference (WC), difficult. OBJECTIVE: To evaluate the sensitivity and applicability of additional abdominal measurements in order to assess body composition of obese women. METHODS: A total of 30 women between 20 and 50 years of age and BMI above 30 kg/m² were assessed. Three WC measurements, were performed: at the umbilical scar designated as WC1 and at 8 and 16 cm above the umbilical scar, designated as WC2, and WC3 respectively. The correlation (r) between these anthropometric measurements and their sum was assessed against the parameters fat mass (FM), free fat mass (FFM), body fat percentage (%BF), and trunk fat percentage (%TF), obtained by total and trunk segmental bioelectric impedance analysis (BIA) as well as by the golden standard total and trunk dual energy X-ray absorptiometry (DXA). RESULTS: The measurements WC1, WC2, WC3, and their sum correlated strongly and moderately with the parameters FM, FFM, and %BF in total BIA and in both total DXA and trunk DXA. CONCLUSION: The results demonstrated a robust correlation between the sum of the three WC measurements and total and trunk DXA in obese women suggesting that such measurements may be a good indicator of body and trunk fat in women, actually superior to BIA results. The use of these three measurements may be an alternative for the assessment of body and trunk fat, in those cases in which the body shape due to adipose tissue trunk accumulation makes accurate classical measurement (WC1) difficult.
RESUMO CONTEXTO: O acúmulo de tecido adiposo excessivo no ganho de peso se dá em maior proporção no segmento do tronco, leva à alteração dos formatos corporais dificultando a tomada de medidas antropométricas, em especial a circunferência abdominal (CA). OBJETIVO: Avaliar a sensibilidade de medidas adicionais na região abdominal, considerando cada medida individualmente e sua somatória, e a aplicabilidade dessas medidas na avaliação da composição corporal de mulheres obesas. MÉTODOS: Foram avaliadas 30 mulheres com idade entre 20 e 50 anos e IMC acima de 30 kg/m² com a realização de três medidas de CA denominadas: CA1 padronizada na cicatriz umbilical, CA2 a 8 cm acima da cicatriz umbilical e CA3 a 16 cm acima da cicatriz umbilical. Foi avaliada a correlação (r) destas medidas antropométricas e de sua somatória com os parâmetros massa gorda (MG), massa livre de gordura (MLG), porcentagem de gordura corporal (%GC) e do tronco (%GT) obtidos por impedância bioelétrica (BIA) total e segmentar do tronco e por absorciometria de raios-X de dupla energia (DXA) total e do tronco, como padrão ouro. RESULTADOS: As medidas CA1, CA2, CA3 e a somatória das três tiveram correlação forte e moderada com os parâmetros MG, MLG e %GC tanto para BIA total como para DXA total e DXA do tronco. CONCLUSÃO: Os resultados deste estudo mostram forte correlação entre a soma das medidas de três pontos no abdome com DXA de tronco e total, em mulheres obesas, sugerindo serem estas medidas, um bom indicador de gordura corporal e de gordura da região do tronco, superior aos resultados obtidos por BIA. O uso dessas três medidas pode ser um indicador alternativo de avaliação da gordura corporal e de tronco, nos casos em que o formato corporal de acúmulo de gordura na região do tronco, dificultar a acurácia da medida clássica (CA1).
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Composição Corporal/fisiologia , Gordura Abdominal/metabolismo , Circunferência da Cintura/fisiologia , Obesidade/metabolismo , Peso Corporal , Índice de Massa Corporal , Impedância Elétrica , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The aim of this study is to evaluate the efficacy of metal artefact reduction (MAR) in different dental materials with Picasso Trio cone-beam computed tomography (CBCT) scanner. MATERIALS AND METHODS: Three imaging phantoms were custom-made of acrylic resin. Each phantom presented three cylinders of the same material: dental amalgam alloy, gutta-percha or aluminium-copper alloy. CBCT scans were performed on Picasso Trio unit with and without MAR, and artefact expression (standard deviation of grey values) was obtained and compared by Kruskal-Wallis and Student-Newman-Keuls (post hoc) (α = 0.05). RESULTS: Significant reduction of artefact expression (p < 0.05) was observed with MAR on areas around dental alloys. No significant difference (p > 0.05) was observed with or without MAR when gutta-percha was scanned. CONCLUSION: MAR was effective in reducing artefacts arising from dental alloys on CBCT images. CLINICAL RELEVANCE: Dental materials of high atomic number and density are widely used in dentistry and can produce artefact that compromise CBCT image. The present study demonstrated that metal artefact reduction algorithm is an effective tool to improve image quality.
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Artefatos , Tomografia Computadorizada de Feixe Cônico/métodos , Ligas Dentárias , Amálgama Dentário , Materiais Dentários , Guta-Percha , Alumínio , Cobre , Imagens de FantasmasRESUMO
BACKGROUND: Osteoporosis-related fractures represent a major health problem. Although spine and hip bone densitometry is the gold standard to assess bone density, this test is not always accesible. The purpose of this study was to describe two options to assess the risk of fracture due to osteoporosis in post-menopausal women assigned to a primary care unit where bone densitometry is not available. METHODS: A cross-sectional study was conducted in 332 post-menopausal women without diagnosis or treatment for osteoporosis, attending regularly to a primary care unit. A heel bone peripheral densitometry, physical exam and medical history were performed. The assessment of fracture risk was carried out using the FRAX™ method. RESULTS: Mean age was 60 ± 8.7 years and body mass index was 28.68 ± 4.24. According to the heel bone peripheral densitometry, 19 (5.7 %) women had osteoporosis (T-score less than or equal to -2.5), 171 (51.8 %) had osteopenia (T-score between -2.5 and less than or equal to -1) and 141 (42.5 %) had normal bone mineral density. According to the FRAX method, 13 (3.9 %) had an increased risk of osteoporotic fracture in a 10-year period and 40 (12 %) of hip fracture. CONCLUSIONS: There was low concordance in the 10-year risk for major osteoporotic fracture and hip fracture assessed with both the FRAX™ and the peripheral bone densitometry methods.
INTRODUCCIÓN: las fracturas relacionadas con la osteoporosis son un problema de salud. Aunque la densitometría ósea de columna y cadera es el estándar para evaluar la densidad ósea, no siempre es accesible. El objetivo de este estudio fue describir dos alternativas a la densitometría ósea para evaluar el riesgo de fractura por osteoporosis en mujeres posmenopáusicas. MÉTODOS: estudio transversal de 332 mujeres posmenopáusicas sin diagnóstico o tratamiento de osteoporosis, que asistían regularmente a una unidad de primer nivel. Se realizó densitometría periférica de talón, examen físico e historia médica. La evaluación del riesgo de fractura se llevó a cabo mediante FRAXTM. RESULTADOS: la edad media fue de 60 ± 8.7 años y el índice de masa corporal de 28.68 ± 4.24. Según la densitometría periférica de talón, mujeres 19 (5.7 %) tenían osteoporosis (T-score menor de 2.5), 171 (51.8 %) osteopenia (T-score entre 2.5 y menos de 1) y 141 (42.5 %) densidad mineral ósea normal. Según el método FRAX, 13 (3.9 %) tenían riesgo aumentado de fractura osteoporótica en un periodo de 10 años y 40 (12 %) de fractura de cadera. CONCLUSIONES: la prevalencia de riesgo para osteoporosis es diferente de acuerdo con el método que se utilice para medirlo. La concordancia entre los dos métodos fue baja.
Assuntos
Técnicas de Apoio para a Decisão , Indicadores Básicos de Saúde , Osteoporose Pós-Menopausa/diagnóstico , Fraturas por Osteoporose/prevenção & controle , Idoso , Densidade Óssea , Estudos Transversais , Densitometria , Feminino , Humanos , Anamnese , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Fraturas por Osteoporose/etiologia , Exame Físico , Medição de Risco , Fatores de RiscoRESUMO
OBJECTIVES: To assess the influence of milliamperage and kilovolt peak (kVp) on the variability of cone beam CT (CBCT) voxel values. METHODS: CBCT scans were obtained from radiographic phantoms in varying concentrations of dipotassium hydrogen phosphate solutions (200-1200 mg ml(-1)) under different protocols of milliamperage and kVp. In addition, scans were performed with and without a dental implant and exo-mass. The variability of CBCT voxel values was measured on each scan, and factorial analysis of variance and the post hoc Tukey test were performed (α = 0.05). Linear regression was performed to assess the relationship between voxel value variability and dipotassium hydrogen phosphate concentration. RESULTS: milliamperage and the presence of a dental implant did not produce significant interference (p = 0.28 and 0.87, respectively) in voxel value variability. Scans at the highest kVp value presented a significant reduction (p ≤ 0.0001) in voxel value variability when only exo-mass was not present. Voxel value variability was not influenced by exo-mass in scans at the highest levels of milliamperage and kVp. The presence of exo-mass produced a significant reduction (p ≤ 0.0001) in voxel value variability in most of the scans. Higher concentrations yielded greater variations in voxel values in all scans, except for those operating at the highest levels of mAs and kVp. CONCLUSIONS: mAs did not influence the variability of CBCT voxel values; higher kVp reduced such variability when only the object was smaller than the field of view.
Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Processamento de Imagem Assistida por Computador/métodos , Anatomia Transversal , Artefatos , Soluções Tampão , Tomografia Computadorizada de Feixe Cônico/estatística & dados numéricos , Implantes Dentários , Eletricidade , Humanos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Imagens de Fantasmas , Fosfatos/química , Compostos de Potássio/química , Doses de RadiaçãoRESUMO
OBJETIVO: Comparar a densidade mineral óssea (DMO) e a composição corporal (CC) de universitários com diferentes estilos de vida. MÉTODOS: Estudo transversal realizado em 85 estudantes dos cursos de Medicina (MED) e Educação Física (EF) da Universidade Regional de Blumenau. As variáveis antropométricas, sociodemográficas, clínicas e de estilo de vida foram obtidas por meio de anamnese densitométrica e as variáveis densitométricas por raio-x de dupla energia (DXA). Os testes estatísticos foram: t de Student, qui-quadrado e regressão logística. RESULTADOS: Os acadêmicos de EF apresentaram massa magra maior (79,5 ± 5,9 versus 75,1 ± 5,3; p = 0,03) e gordura corporal menor (16,7 ± 6,1 versus 21,6 ± 5,6; p = 0,02), e as acadêmicas de EF apresentaram massa magra maior (68,2 ± 5,5 versus 65,3 ± 5,5; p = 0,05). A DMO do colo do fêmur (CF), fêmur total (FT) e corpo total (CT) foi maior nos acadêmicos de EF em ambos os sexos. Os estudantes de EF praticavam mais exercícios físicos do que os de MED. A baixa massa óssea (BMO) foi mais frequente nos estudantes de MED (34,9% versus 4,7%; p = 0,001), sendo que o risco de um estudante de MED ter BMO foi 9 vezes maior para a CL, 5 vezes para o CF, 8 vezes para o FT e 7 vezes para o CT. CONCLUSÃO: A CC e a DMO foram diferentes entre os estudantes; os acadêmicos de MED apresentaram um risco maior de ter BMO e os acadêmicos de EF praticavam mais exercícios físicos.
OBJECTIVE: To compare bone mineral density (BMD) and body composition (BC) of college students with different lifestyles. METHODS: Transversal study with 85 students of Medicine (MED) and Physical Education (PE) at the Universidade Regional de Blumenau, SC, Brazil. The anthropometric, socio-demographic, clinical, and lifestyle variables were obtained through densitometric anamnesis and densitometric variables by dual-energy X-ray (DXA). The statistical tests used were: Student's t-test, Chi-square test, and logistic regression. RESULTS: PE male students showed a higher amount of lean body mass (79.5 ± 5.9 vs. 75.1 ± 5.3; p = 0.03) and a lower amount of body fat (16.7 ± 6.1 vs. 21.6 ± 5.6; p = 0.02) and PE female students showed a higher amount of lean body mass (68.2 ± 5.5 vs. 65.3 ± 5.5; p = 0.05). The BMD of the neck of femur (NOF), total femur (TF), and total body (TB) was higher in PE students of both genders. PE students practiced more physical activities than MED students. Low bone mass (LBM) was more frequent in MED students (34.9% vs. 4.7%; p = 0.001), provided that the risk of a MED student to show LBM was nine times higher for lumbar spine (LS), five times for NOF, eight times for TF, and seven times for TB. CONCLUSION: BC and BMD were different among the students; MED students have shown a higher risk of having LBM, and PE students practiced more physical activities.