Correlação entre hipótese diagnóstica e laudo de tomografia axial computadorizada craniana

Abstract

RESUMO -Para avaliar a utilização da tomografia axial computadorizada craniana (TC) em nosso meio, analisamos as solicitações de 367 exames consecutivos no período compreendido entre 07/1995 e 07/1996. Houve ampla variação da faixa etária, com média de 31,7 ± 22,9 anos. As especialidades que mais solicitaram o exame foram: Neurologia (36,2%), Pronto Atendimento (17,4%), Neuropediatria (16,9%) e Clínica Médica (5,9%). As indicações mais frequentes para o exame foram: convulsão (30%), cefaléia (26,2%), déficit motor (20,2%) e redução do nível de consciência (16,9%). As hipóteses aventadas com maior frequência foram: afastar lesão estrutural (9,0%), acidente vascular não discriminado (8,2%) e neurocisticercose (8,2%). O laudo da TC foi normal em 50,4% dos exames. Os laudos anormais mais frequentes foram: hidrocefalia (5,4%), acidente vascular isquêmico (5,4%) e neoplasia (3,5%). As maiores taxas de achados normais foram encontradas nas hipóteses de cefaléia (94,4%), convulsão (71,4%) e afastar lesão estrutural (66,7%). Os maiores índices de acerto entre hipótese e laudo foram encontrados nas situações de afastar lesões estruturais (66,7%), hidrocefalia (50%), acidente vascular cerebral isquêmico (50%) e hematoma (50%). Concluimos que a utilização de um recurso auxiliar de diagnóstico como a TC cumpre melhor ainda a sua função se o requisitante do exame preencher com clareza e detalhamento o pedido do exame. PALAVRAS-CHAVE: tomografia computadorizada de crânio, cefaléia, lesões estruturais cerebrais. Correlation between diagnostic hypothesis and result of cranial computed axial tomographyABSTRACT -The use of computed axial tomography (CT) in the investigation of neurologic disorders is attractive for his disponibility in the health services. However, the indications of the exam and the correlation with the clinical features has not been frequently studied. We study correlation between the requests of CT and the findings reported by the radiologist, in 367 exams performed from 07/1995 to 07/ 1996. The mean age was 31.7 ± 22.9 years. The CT were requested in decrescent order of frequency by the Services of Neurology (36.2%), Emergency room (17.4%), Pediatric Neurology (16.9%) and Internal Medicine (5.9%). The CT was more indicated in cases of seizures (30%), headache (26.2%), motor impairment (20.2%) and reduction of conscience level (16.9%). The main hypothetic diagnosis were to discard anatomic lesions (9.0%), not specified stroke (8.2%) and neurocisticercosis (8.2%).The result of the CT was normal in 50.4% of the exams specially those requested in cases of headache (94.4%), seizures (71.4%) and to discard anatomic lesions(66.7%).The more frequently CT abnormalities were hydrocephalus (5.4%), ischemic stroke (5.4%) and neoplasm (3.5%) The greatest rates of correlation were among those to discard anatomic lesions (66,7%), hydrocephalus (50%), ischemic stroke (50%) and hematoma (50%).We concluded that CT is more helpfull if more clinical data is provided in the request form, so aiding the radiologist in the final repo...

Diagnostic methods for extra-temporal neocortical focal epilepsies: present and future

“…Although being very employed in emergency rooms due to short performance time and low cost when compared to other imaging methods, computerized tomography has not well defined criteria to help diagnose or influence prognosis of epilepsies, as well as it has a high cost/ benefit rate, derived from scarce financial incomes for health sector in our country 24 . Besides this fact, this exam has low sensibility for the diagnose of primary structural cerebral lesions present in epilepsies, and is considered as a secondary or supplementary diagnostic method to others more accurate 11,13,23 .…”

“…Magnetic resonance imaging (MRI) revolutionized neuroimaging, since the end of 70's and the beginning of 80's, and it is considered the best non invasive method to evaluate the brain structure 11,24 . It is the elective method for drug resistant epilepsies with surgical indication, because it presents high sensibility and specificity for lesions like tumors, neuronal migration disturbances (especially dysplasias), hypoxic ischemic injuries, infections, born inherited metabolic errors, trauma, neuro-cutaneous diseases, vascular malformations, gliosis, among others 3,11,13,23 .…”

Proton magnetic spectroscopy agreed better with magnetic resonance image to lateralization of epileptogenic zone than with surface electroencephalography

“…Lateralization concordance rates between EEG and 1H + MRS, associated with normal MRI, were equal to 33.3% for NAA/Cho and NAA/Cr ratios, 40% for NAA/Cho+Cr ratios, and 0 for Cho/Cr ratios ( Table 2). Percentages based on total of patients with abnormal differences of asymmetry coefficient; 2 Percentages based on a total of patients with concordant lateralization between EEG and MRI; 3 Percentages based on eight patients with abnormalities restricted to EEG; MRI: magnetic resonance image; MRS: magnetic resonance spectroscopy.…”

“…The MRI is recognized as the best noninvasive method to the structural evaluation of brain 2,3 , and also the method of election for epilepsies refractive to drug treatment with surgical indication, because MRI has high sensibility and specificity for lesions like tumors, neuronal migration errors (specially dysplasia), hypoxic ischemic injuries, infections, metabolic errors, trauma, neurocutaneous diseases, vascular malformations, gliosis, etc. [4][5][6] .…”

Hemorragia intraparenquimatosa encefálica espontânea: achados à tomografia computadorizada

“…A TC vem sendo um exame de diagnóstico por imagem dos mais utilizados e a TC de crânio constitui o exame tomográfico mais solicitado, muito embora na grande parte das solicitações o laudo seja normal 3,4 . 9 os hematomas putaminais e holobasais foram os mais freqüentemente observados.…”