International audienceObjective: to correlate the findings of high resolution computed tomography of the chest based on the Bhalla score with the clinical data and spirometry in children and adolescents with cystic fibrosis, and to study the concordance between two radiologists for the Bhalla score and its categories. Methods: we evaluated the medical records of 23 patients from the outpatient clinic. The items evaluated included age, weight, height, height/age Z-score, weight/ age Z-score, body mass index (BMI), O 2 saturation, spirometry and Bhalla score. Results: the patients had a mean age of 17.4 years ± 5.7 years, with fifteen females and eight males. There was good correlation between Bhalla score and spi-rometry (FVC-r =0.718, p<0.001; FEV1-r=0.830, p<0.001; FEF25-75%-r =0.786, p<0.001; FEV1/FVC-r=0.714, p<0.001). It was also noted that some patients with FEF25-75%> 70% already had changes in their final Bhalla score. In the analysis of the concordance between the examiners a Kappa coefficient of 0.81 (p <0.001) was found, and an intraclass correlation coefficient of 0.98. Conclusion: a good correlation between Bhalla scores with spirometry confirmed its usefulness in evaluating and monitoring patients with cystic fibrosis, given it can be used both in patients who are unable to perform spirometry as well as for a pooled analysis of the two examinations since the HRCT scans show early changes in patients with normal function tests
Placental adhesion disorder encompasses the various types of abnormal placentation that occur when the chorionic villi penetrate the uterine wall. Placenta accreta has become more common, mainly because of the increasing rates of cesarean section. Although ultrasound is the first-line imaging modality for evaluation of the placenta, it plays a limited role in cases of posterior placenta accreta and inconclusive findings. In such cases, magnetic resonance imaging (MRI) is indicated, mainly because it is a more accurate means of identifying placental invasion of extrauterine structures in high-risk pregnant women. In this review article, we present the ten major and minor MRI features of placental adhesion disorder, as described in the international literature. In addition, we propose a template for structured reports of MRI examinations of the placenta. We have also devised a guided questionnaire in order to identify risk factors in patients scheduled to undergo such examinations, with the objective of facilitating the multidisciplinary treatment planning needed in order to minimize maternal morbidity and mortality.
Knee pain is the most frequent symptom in osteoarthritis, a condition that is the leading cause of chronic disability in the elderly and one of the main sources of morbidity attributable to osteoarthritis in general. The causes of knee pain in individuals with osteoarthritis cannot be easily understood, and the knowledge of such causes is critical for determining future specific interventions. Bone attrition represents remodelling of the subchondral bone envelope in osteoarthritis, leading to a consequential change in bone shape and/or bone loss. However, bone attrition is not a feature that can be easily read, since it is hardly detected in the absence of clear defects of cortical bone integrity and because of overlap of bone structures at radiography. Bone attrition is associated not only with knee pain, but also with stiffness and disability. If attrition occurs prior to advanced osteoarthritis, this would suggest that changes in subchondral bone occur concurrently with cartilage loss and that treatments targeting cartilage loss alone are unlikely to be effective. Association with edemalike bone marrow lesions may be observed and constitute predictive factors for subchondral bone attrition. The present study was aimed at reviewing the literature, demonstrating the relevance of bone attrition and explaining how to diagnose this entity on imaging studies. Keywords: Magnetic resonance imaging; Osteoarthritis; Knee pain; Bone attrition; Subchondral bone; Diagnosis.A dor no joelho é o sintoma mais comum na osteoartrite, sendo a principal causa de incapacidade crônica em idosos e uma das principais fontes de morbidade atribuível à osteoartrite em geral. As causas de dor no joelho em pessoas com osteoartrite não são facilmente entendidas e o conhecimento sobre as causas da dor é fundamental para que futuramente sejam realizadas intervenções específicas. A fadiga óssea representa o remodelamento do osso subcondral na osteoartrite, levando a uma consequente alteração na forma do osso e/ou perda óssea. No entanto, a fadiga óssea não é algo facilmente interpretado, pois é de difícil detecção na ausência de defeitos claros da cortical e pela sobreposição de estruturas ósseas nas radiografias convencionais. A fadiga óssea está associada não apenas a dor no joelho, mas também a rigidez e incapacidade. Se a fadiga ocorre antes da osteoartrite avançada, isso sugere que alterações no osso subcondral podem ocorrer simultaneamente a alterações da cartilagem e que tratamentos visando sua preservação podem não ser eficazes. Lesões com padrão de edema ósseo estão associadas e são fatores preditivos para fadiga óssea. Este trabalho tem por objetivo rever a literatura mostrando a importância da fadiga óssea e de como diagnosticar esta alteração nos exames de imagem. Unitermos: Ressonância magnética; Osteoartrite; Dor nos joelhos; Fadiga óssea; Osso subcondral; Diagnóstico. AbstractResumo
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