Avaliação do volume de fluxo portal em pacientes esquistossomóticos: estudo comparativo entre ressonância magnética e ultrassom Doppler

Leão, Alberto Ribeiro de Souza

doi:10.1590/s0100-39842009000100018

Cited by 5 publications

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“…This study presented by Leão et al (2) clearly demonstrates a high interobserver agreement for portal flow evaluation by DUS and by MRI. Therefore, both methods can be used successfully in the evaluation of portal flow in a serial fashion.…”

Section: Editorialsupporting

confidence: 62%

“…( 2) have written an interesting article testing interobserver reproducibility of DUS and MRI for the evaluation of portal blood flow in schistosomal patients (2) . An intriguing finding is the poor intermethod agreement between these two methods.…”

Section: Editorialmentioning

confidence: 99%

“…Clinical indications for hepatic venous pressure gradient measurements performed by angiography are: prediction of clinical events, sequential assessment of clinical evolution, assessment of pharmacologic therapy, and assessment of pre- operative risk in cirrhotic patients (1) . Because of the invasiveness of the procedure and that it is unlikely to achieve more widespread use, this direct measurement technique is likely to be confined to basic research studies and not develop substantially into clinical utilization.In this issue of Radiologia Brasileira Leão et al( 2) have written an interesting article testing interobserver reproducibility of DUS and MRI for the evaluation of portal blood flow in schistosomal patients (2) . An intriguing finding is the poor intermethod agreement between these two methods.…”

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confidence: 99%

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Imagem e avaliação do fluxo da veia porta: comparação entre ultrassom Doppler e RM

Semelka¹,

Elias

2010

Radiol Bras

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VIIRadiol Bras. 2010 Nov/Dez;43(6):VII-VIII EditorialThe diagnosis of diffuse liver disease, including characterization and quantification, has gained particular importance in recent years, reflecting in large measure advances in imaging techniques. During the same time period concern has escalated about the use of CT due to the harmful effects of radiation. The net result is that the non-invasive techniques of sonography and magnetic resonance imaging (MRI) have achieved considerable interest.Both methods are non-invasive, innocuous and safe, but with important and noticeable differences. While sonography is a well established and widely used method, reflecting its low cost and portability, it suffers with high operator dependence variations, low sensitivity and even lower specificity. On the other hand, MRI is a comprehensive method with multiple types of data acquisition, and unmatched ability to differentiate normal from diseased tissues. The drawbacks of MRI are less availability, no portability, and higher cost.Despite these limitations and others discussed below, both methods are progressively replacing more invasive diagnostic techniques. Portal system morphology and hemodynamics constitute suitable application areas for both Doppler sonography (DUS) and MR techniques. Clinical indications for hepatic venous pressure gradient measurements performed by angiography are: prediction of clinical events, sequential assessment of clinical evolution, assessment of pharmacologic therapy, and assessment of pre- operative risk in cirrhotic patients (1) . Because of the invasiveness of the procedure and that it is unlikely to achieve more widespread use, this direct measurement technique is likely to be confined to basic research studies and not develop substantially into clinical utilization.In this issue of Radiologia Brasileira Leão et al.( 2) have written an interesting article testing interobserver reproducibility of DUS and MRI for the evaluation of portal blood flow in schistosomal patients (2) . An intriguing finding is the poor intermethod agreement between these two methods. It is always refreshing when authors in the scientific literature provide sobering prudent observations, rather than the usual over enthusiastic description.The sonography evaluation of the portal system is probably adequate for the majority of patients. One major exception being the overly obese patients, as there is often the lack of appropriate sonographic window, and often, as a result, or due to coexistent fatty liver, which complicates visualization because of heterogeneous echotexture. With this caveat in mind, DUS can adequately diagnose hepatic schistosomiasis, characterize the portal vein flow, and display portal hypertension related findings, i.e., splenomegaly, ascites and varices. However, the challenge to identify patients at risk for upper gastrointestinal tract bleeding remains, and this has been the subject of other studies (3,4) . Compared to DUS, MRI is a much more comprehensive imaging method to evaluate the abdomen...

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Section: Editorialsupporting

confidence: 62%

Section: Editorialmentioning

confidence: 99%

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confidence: 99%

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Imagem e avaliação do fluxo da veia porta: comparação entre ultrassom Doppler e RM

Semelka¹,

Elias

2010

Radiol Bras

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“…Several studies have been undertaken by Brazilian authors approaching the importance of imaging methods in the evaluation of liver diseases (24)(25)(26)(27)(28) , with CT diagnosis of HS being traditionally made according the criteria applied to the non-contrast-enhanced phase (10,11,16) . However, in a scenario of increased preoccupation with the harmful effects of ionizing radiation, and considering the opportunity to obtain the diagnosis of HS by means of the portal contrast-enhanced phase and the fact that such phase is the most useful in most abdominal CT indications (9,14,15) , the possibility of confirming the value of contrast-enhanced CT in the screening for HS becomes particularly interesting.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography

et al. 2013

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Objective: To evaluate the diagnostic capacity of abdominal computed tomography in the assessment of hepatic steatosis using the portal phase with a simplified calculation method as compared with the non-contrast-enhanced phase. Materials and Methods: In the present study, 150 patients were retrospectively evaluated by means of non-contrast-enhanced and contrast-enhanced computed tomography. One hundred patients had hepatic steatosis and 50 were control subjects. For the diagnosis of hepatic steatosis in the portal phase, the authors considered a result of < 104 HU calculated by the formula [L -0.3 × (0.75 × P + 0.25 × A)] / 0.7, where L, P and A represent the attenuation of the liver, of the main portal vein and abdominal aorta, respectively. Sensitivity, specificity, positive and negative predictive values were calculated, using non-contrast-enhanced computed tomography as the reference standard. Results: The simplified calculation method with portal phase for the diagnosis of hepatic steatosis showed 100% sensitivity, 36% specificity, negative predictive value of 100% and positive predictive value of 75.8%. The rate of false positive results was 64%. False negative results were not observed. Conclusion: The portal phase presents an excellent sensitivity in the diagnosis of hepatic steatosis, as compared with the non-contrast-enhanced phase of abdominal computed tomography. However, the method has low specificity. Keywords: Fatty liver; Steatosis; Liver disease; Tomography; Multidetector computed tomography; Contrast media.Objetivo: Comparar a capacidade diagnóstica para esteatose hepática utilizando-se a fase portal com método simplificado de cálculo com a fase sem contraste na tomografia computadorizada de abdome. Materiais e Métodos: Foi realizado estudo retrospectivo em 150 pacientes submetidos a tomografia computadorizada de abdome sem e com contraste intravenoso, 100 deles com esteatose hepática e 50 controles. Para diagnóstico de esteatose hepática na fase portal considerou-se um resultado < 104 UH aplicando-se a fórmula [L -0,3 × (0,75 × P + 0,25 × A)] / 0,7, onde L, P e A representam a atenuação hepática, da veia porta e da aorta, respectivamente. Foram calculados sensibilidade, especificidade, valores preditivos positivos e negativos, utilizando-se a tomografia computadorizada sem contraste intravenoso como padrão de referência. Resultados: O método simplificado de cálculo para o diagnóstico de esteatose hepática na fase portal mostrou sensibilidade de 100%, especificidade de 36%, valor preditivo negativo de 100% e valor preditivo positivo de 75,8%. A taxa de falso-positivos foi 64%. Não foram encontrados falso-negativos. Conclusão: A utilização da fase portal apresenta elevada sensibilidade para o diagnóstico de esteatose hepática, quando comparada à fase sem contraste da tomografia computadorizada de abdome. Por outro lado, o método apresenta baixa especificidade. Unitermos: Fígado gorduroso; Esteatose hepática; Hepatopatias; Tomografia; Tomografia computadorizada multidetectores; Meios de contrast...

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“…One is very gratified and happy to see that very interesting studies on those imaging methods are being developed and published. Here are some of them: Abdominal gossypiboma (1) , four beautiful case reports (2)(3)(4)(5) , gallbladder wall thickening (6) , correlation between PSA and prostate cancer (7) , study of cerebral ventricles (8) , BI-RADS US (9) , abnormal uterine bleeding (10) , intima-media complex in atherosclerosis (11) , comparison between US and MRI in the portal flow assessment (12) , endoleaks in the endovascular management of aortic aneurysms (13) , abnormalities in the first trimester of pregnancy (14) , radiographic findings in the treatment of pulmonary paracoccidioidomycosis (15) , neurofibromatosis (16) , study of the spine after cervical traction (17) , and finally, three articles about medical physics (18)(19)(20) .…”

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confidence: 99%

Por que parte da especialidade está sendo relegada a segundo plano dentro do diagnóstico por imagem?

Carvalho

2012

Radiol Bras

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Radiologists graduated until the mid-eighties had almost only the opportunity of learning the old, centennial, and nowadays relegated to the backstage, conventional radiology, since most of our teaching hospitals with residency programs simply were not equipped with ultrasonography (US), another method that is about to be relegated to the limbo by newly graduates. Some of the "veterans" have taken the same path, managing to learn about US, which they used for many years in their daily activity. Others were attracted by computed tomography (CT) and magnetic resonance imaging (MRI), following their own personal preferences and willingness to be technologically updated. And some decided to remain technologically stagnant. Among trainees, residents, master and PhD fellows, one observes almost a certain "neglect" regarding conventional radiology and US. On the other hand, CT and MRI attract attention and interest from the younger generation. Curiously, the very basis of imaging diagnosis is the old, conventional radiology. It is from conventional radiology that one learns to interpret, think, vary and suggest other things. One tries to find out a reason for this, beyond the obvious financial reward, as the days when MRI professional made as much money as they wanted, are gone. I firmly believe that the roles are changing. With so many new professionals willing to learn MRI and CT, will those who know how to perform, interpret and report with quality "in the old imaging methods" soon enjoy appreciation in the "marketplace"? With a view on this trend, especially on the almost manifested disdain that some residents demonstrate for allegedly loosing time learning conventional radiology and US, we have carried out a survey in the Radiologia Brasileira (RB) journal, to check into what is still being published about such almost abandoned "subspecialties". Such survey covered the past ten years-a good reference to begin with. With the Brazilian word "ultra-sonografia" (ultrasonography), still written in the former orthography with a hyphen, we have found 77 articles. With the word "ultrassonografia", the current spelling without the hyphen, 63 articles have been published by RB since 2009. In order to compare, let us take an international look. Who knows, maybe "below the Equator" we are obsolete, and in

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Avaliação do volume de fluxo portal em pacientes esquistossomóticos: estudo comparativo entre ressonância magnética e ultrassom Doppler

Cited by 5 publications

References 0 publications

Imagem e avaliação do fluxo da veia porta: comparação entre ultrassom Doppler e RM

Imagem e avaliação do fluxo da veia porta: comparação entre ultrassom Doppler e RM

Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography

Por que parte da especialidade está sendo relegada a segundo plano dentro do diagnóstico por imagem?

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