RESUMO

ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

RESUMO Introdução: Doenças pulmonares são comuns em pacientes com doença renal em estágio terminal (DRET), dificultando o diagnóstico diferencial com COVID-19. Este estudo descreve achados de tomografia computadorizada de tórax (TC) em pacientes com DRET em terapia renal substitutiva (TRS) hospitalizados com suspeita de COVID-19. Métodos: Indivíduos maiores de 18 anos com DRET, encaminhados ao pronto-socorro com suspeita de COVID-19 foram incluídos. Dados clínicos e epidemiológicos foram extraídos de registros eletrônicos de saúde. A TC foi classificada como típica, indeterminada, atípica, negativa. Comparamos achados tomográficos de pacientes com COVID-19 positivos e negativos. Resultados: Recrutamos 109 pacientes (62,3% COVID-19-positivos) entre março e dezembro de 2020, idade média de 60 ± 12,5 anos, 43% mulheres. A etiologia mais comum da DRET foi diabetes. Tempo médio em diálise foi 36 meses, intervalo interquartil = 12-84. A lesão pulmonar mais comum foi opacidades em vidro fosco. O padrão típico de TC foi mais comum em pacientes com COVID-19 (40 (61%) vs. 0 (0%) em pacientes sem COVID-19, p < 0,001). Sensibilidade 60,61% (40/66), especificidade 100% (40/40). Valores preditivos positivos e negativos foram 100% e 62,3%, respectivamente. Padrão atípico de TC foi mais frequente em pacientes COVID-19-negativos (9 (14%) vs. 24 (56%) em COVID-19-positivos, p < 0,001), enquanto padrão indeterminado foi semelhante em ambos os grupos (13 (20%) vs. 6 (14%), p = 0,606), e padrão negativo foi mais comum em pacientes COVID-19-negativos (4 (6%) vs. 12 (28%), p = 0,002). Conclusões: Em pacientes com DRET em TRS hospitalizados, um padrão atípico de TC de tórax não pode excluir adequadamente o diagnóstico de COVID-19.

RESUMO

O odontoma é o mais comum tumor odontogênico, definido como malformação benigna, geralmente descoberto na segunda década de vida, durante a investigação de erupção tardia de dentes adjacentes ou retenção prolongada de dentes decíduos. O odontoma é subdividido em composto e complexo. O Odontoma classificado como Composto é constituído por um conjunto de estruturas similares a dentes, de formas e tamanhos diversos, cercados por uma área delgada radiolúcida. Já o Odontoma Complexo se assemelha a uma massa calcificada que apresenta a mesma radiopacidade do tecido dentário, também cercado por uma área delgada radiolúcida. Ocasionalmente, esses dois aspectos podem ser vistos em uma mesma lesão. Frequentemente os odontomas podem provocar um aumento de volume ósseo local devido ao seu desenvolvimento. O diagnóstico é feito através de exames radiográficos de rotina e quando necessário pode-se também lançar mão de Radiografias Panorâmicas e Tomografia Computadorizada Cone Beam com o intuito de verificar sua extensão, as malformações e alterações de erupção causadas aos dentes adjacentes, assim como a classificação do tumor. Este relato de caso apresenta um Odontoma Composto-Complexo em um paciente de 13 anos, do sexo masculino, atendido em 2016 na Clínica de Diagnóstico Bucal II da Universidade Federal Fluminense, que apresentou elementos dentários 22 e 23 impactados, retenção prolongada do elemento 63 e aumento de volume na região anterior do lado esquerdo da maxila. Para obtenção do diagnóstico foram realizadas: Radiografias Periapicais, Radiografia Panorâmica e Tomografia Computadorizada Cone Beam. O objetivo deste trabalho foi elucidar as formas de diagnóstico por imagem que foram utilizadas neste caso clínico e quais as vantagens de cada exame.

Odontomas are the most common type of odontogenic tumors, defined as a benign malformation, usually diagnosed in the second decade of life, during the investigation of late adjacent teeth eruption or a delay in exfoliation of deciduous teeth. They are divided into two types: compound and complex. The odontoma classified as compound is composed of multiple small tooth-like structures, in several shapes and sizes, surrounded by a thin radiolucent rim. On the other hand, complex odontomas resemble a mass of calcified tissue that presents the same dental tissue radiopacity, also surrounded by a thin radiolucent rim. Occasionally, both aspects can be seen in the same lesion. Often, odontomas can cause a local increase in bone volume due to their development. The diagnosis is made through routine radiographic examination and, when it is necessary, it is possible to make use of panoramic radiographies and cone beam computed tomography with the purpose of verifying its extension, malformations and erupted alterations caused to the adjacent teeth, as well as the tumor classification. This case report presents a Compound-Complex Odontoma in a 13-year-old male patient, treated in 2016 at the Oral Diagnosis Clinic II of the Federal Fluminense University. He presented impacted teeth 22 and 23, delayed eruption of tooth 63 and volume increase in the left anterior maxilla site. Aiming the patient's diagnosis, the following exams were necessary: periapical radiographies, panoramic radiography, cone beam computed tomography. The aim of this paper is to explain the different image diagnostic tools which were used in this clinical study and what are the advantages of each exam.

Assuntos

RESUMO

SUMMARY: Since machine learning algorithms give more reliable results, they have been used in the field of health in recent years. The orbital variables give very successful results in classifying sex correctly. This research has focused on sex determination using certain variables obtained from the orbital images of the computerized tomography (CT) by using machine learning algorithms (ML). In this study 12 variables determined on 600 orbital images of 300 individuals (150 men and 150 women) were tested with different ML. Decision tree (DT), K-Nearest Neighbour (KNN), Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), and Naive Bayes (NB) algorithms of ML were used for unsupervised learning. Statistical analyses of the variables were conducted with Minitab® 21.2 (64-bit) program. ACC rate of NB, DT, KNN, and LR algorithms was found as % 83 while the ACC rate of LDA and RFC algorithms was determined as % 85. According to Shap analysis, the variable with the highest degree of effect was found as BOW. The study has determined the sex with high accuracy at the ratios of 0.83 and 0.85 through using the variables of the orbital CT images, and the related morphometric data of the population under question was acquired, emphasizing the racial variation.

Dado que los algoritmos de aprendizaje automático dan resultados más fiables, en los últimos años han sido utilizados en el campo de la salud. Las variables orbitales dan resultados muy exitosos a la hora de clasificar correctamente el sexo. Esta investigación se ha centrado en la determinación del sexo utilizando determinadas variables obtenidas a partir de las imágenes orbitales de la tomografía computarizada (TC) mediante el uso de algoritmos de aprendizaje automático (AA). En este estudio se probaron 12 variables determinadas en 600 imágenes orbitales de 300 individuos (150 hombres y 150 mujeres) con diferentes AA. Se utilizaron algoritmos de AA de árbol de decisión (DT), K-Nearest Neighbour, regresión logística (RL), Random Forest (RF), análisis discriminante lineal (ADL) y Naive Bayes (NB) para el aprendizaje no supervisado. Los análisis estadísticos de las variables se realizaron con el programa Minitab® 21.2 (64 bits). La tasa de ACC de los algoritmos NB, DT, KNN y RL se encontró en % 83, mientras que la tasa de ACC de los algoritmos ADL y RFC se determinó en % 85. Según el análisis de Sharp, la variable con el mayor grado de efecto se encontró como BOW. El estudio determinó el sexo con alta precisión en las proporciones de 0,83 y 0,85 mediante el uso de las variables de las imágenes de TC orbitales, y se adquirieron los datos morfométricos relacionados de la población en cuestión, enfatizando la variación racial.

Assuntos

RESUMO

SUMMARY: The Synsacrum is constructed of pelvic bones, sacral, lumbar vertebrae and some thoracic vertebrae, and it takes the form of a thin sheet of bone which is curled downwards at the sides. This study is designed to assess the morphometric specialization of the lumbosacral portion of the vertebral section in flying and non-flying winged creatures. Several parameters (ratio of cranial/caudal parts and diameter/length) of the lumbosacral vertebral column were calculated in computed tomography (CT). The ratio of diameter/length of the synsacrum was the narrowest in ostrich while the widest was in pigeon. While the cranial/caudal ratio was the smallest in ostrich and the largest in pigeon. The parameters of penguin were closed to that of pigeon. It is supposed that this ratio is related to the bird locomotion, flying, swimming or/and strolling.

El sinsacro está formado por huesos pélvicos, sacros, vértebras lumbares y algunas vértebras torácicas, y toma la forma de una fina lámina de hueso curvada a los lados hacia abajo. Este estudio está diseñado para evaluar la especialización morfométrica de la porción lumbosacra de la sección vertebral en criaturas aladas voladoras y no voladoras. Se calcularon varios parámetros (relación de partes craneal/caudal y diámetro/longitud) de la columna vertebral lumbosacra en tomografía computarizada (TC). La relación diámetro/longitud del sinsacro fue la más estrecha en avestruz mientras que la más ancha fue en paloma. Mientras que la relación craneal/caudal fue la más pequeña en avestruz y la más grande en la paloma. Los parámetros del pingüino estaban cerrados en relación a los de la paloma. Se supone que esta relación está relacionada con la locomoción de las aves, volando, nadando y/o caminando.

Assuntos

RESUMO

Los salmónidos, durante su desarrollo, pueden experimentar ocasionalmente deformaciones esqueléticas. Para su diagnóstico se emplean diversas metodologías, entre las que se incluyen radiografías, técnicas histológicas, diafanización con tinciones de alizarina y azul de alcián, así como el uso del microscopio electrónico de barrido (SEM), cada una con sus inherentes ventajas y desventajas. Este estudio tuvo como finalidad evaluar y comparar la eficacia de la tomografía microcomputarizada (Micro-CT) para el análisis anatómico, reconstruyendo tridimensionalmente las imágenes y contrastándolas con los resultados obtenidos mediante la técnica de diafanización. Se analizaron las aletas caudales de cinco ejemplares de salmón Oncorhynchus kisutch: dos sujetos a diafanización y tres procesados para análisis mediante Micro-CT utilizando el equipo BRUKER SkyScan 1272. La técnica de Micro-CT demostró superioridad en la resolución de las estructuras óseas, facilitando una exploración detallada de las variaciones morfológicas y la distribución de la densidad mineral. Este enfoque permitió identificar anomalías en la morfología y crecimiento de las últimas vértebras y lepidotriquias dorsales, así como una densidad incrementada en lepidotriquias dorsales malformadas. La mayor resolución proporcionada por la Micro-CT no solo potencia nuestra comprensión de la ontogenia piscícola y su adaptación a ambientes diversos, sino que además inaugura perspectivas innovadoras para el estudio de la evolución de las estrategias locomotoras y las respuestas adaptativas frente a cambios ambientales a través del tiempo.

SUMMARY: During their development, some species of salmonids may occasionally experience skeletal deformations. Several methodologies are currently being used for the diagnosis of such malformations, among which X-rays, histological techniques, diaphanization coupled either with Alizarin Red or Alcian Blue stains, as well as Scanning Electron Microscopy (SEM) can be mentioned. Each one of those methods presents inherent advantages and disadvantages. The purpose of this study was twofold: Firstly, to evaluate and compare the effectiveness of microcomputed tomography (Micro-CT) technology for anatomical analysis, three-dimensionally reconstructing the obtained images; and secondly, to contrast those images with the results obtained through the diaphanization technique. The caudal fins of five specimens of the Oncorhynchus kisutch salmon were analyzed: Two specimens were subjected to diaphanization and three were processed for Micro-CT analysis, using the BRUKER SkyScan 1272 equipment. The Micro-CT technology demonstrated superiority in the resolution of bone structures, facilitating a detailed exploration of morphological variations, as well as the distribution of mineral density. This experimental approach allowed us to identify anomalies in the morphology and growth of the last vertebrae and dorsal lepidotrichiae, as well as an increased mineral density in the malformed dorsal lepidotrichiae. The higher resolution provided by Micro-CT not only enhances our understanding of the fish ontogeny and its adaptation to diverse environments, but also opens innovative perspectives for the study of the evolution of locomotor strategies and adaptive responses to environmental changes.

Assuntos

RESUMO

El foramen mental, una abertura en la parte inferior de la mandíbula, es la salida de un ramo del nervio alveolar inferior, proporcionando sensibilidad a la mandíbula y la piel del mentón. Su variabilidad anatómica es importante en procedimientos dentales y quirúrgicos. Nuestro estudio en San Luis Potosí, México, examinó la posición y características morfológicas del foramen mental en una muestra de tomografías computarizadas de la mandíbula. En mujeres, la zona entre el primer y segundo premolar fue la más común, mientras que en hombres, fue la misma zona pero con mayor prevalencia en el lado izquierdo. Se observaron diferencias en la dirección del foramen mental entre sexos y lados de la mandíbula, con la dirección posterior predominante en ambos sexos. Estos hallazgos concuerdan con estudios previos en diferentes poblaciones, aunque se identifican variaciones significativas en la prevalencia y ubicación específica del foramen. La comparación con otros estudios resalta la importancia de considerar factores étnicos y geográficos en la interpretación de los resultados. Las diferencias anatómicas observadas tienen implicaciones clínicas importantes para procedimientos dentales y quirúrgicos, subrayando la necesidad de enfoques adaptados a la población específica para mejorar la precisión y seguridad de las intervenciones en el área del mentón.

SUMMARY: The mental foramen, an opening at the bottom of the jaw, is the exit of the inferior alveolar nerve branch, providing sensation to the jawbone and skin of the chin. Its anatomical variability is important in dental and surgical procedures. Our study was carried out in San Luis Potosí, Mexico and examined the position and morphological characteristics of the mental foramen in a sample of lower jaw CT scans. In women, the area between the first and second premolar was the most common, while in men, it was the same area but with a greater prevalence on the left side. Differences in the direction of the mental foramen were observed between sexes and sides of the mandible, with the posterior direction predominating in both sexes. These findings are consistent with previous studies in different populations, although significant variations in the prevalence and specific location of the foramen are identified. The comparison with other studies highlights the importance of considering ethnic and geographic factors in the interpretation of results. The anatomical differences observed have important clinical implications for dental and surgical procedures, underscoring the need for approaches tailored to the specific population to improve precision and safety of interventions in the mental foramen area.

Assuntos

RESUMO

SUMMARY: In this study, we aim to share the volumes of the carpal bone and the ratio of these volumes to the total volume of wrist bones from Computed Tomography (CT) images obtained from individuals of different ages and sex using 3D Slicer. Right wrist CT images of 0.625 mm slice thickness of 42 healthy individuals (21 female, 21 male) of both sexes were included in our study. Volume calculations were made by loading the images into 3D Slicer, an open-source software package. In this study, mean capitate volume was the largest in both sexes (male 3479.9±679.2; female 2207.1±272.1 mm3), while pisiform had the smallest mean volume (male 810.0±141.2; female 566.6±97.7 mm3). This order was ordered from largest to smallest as hamate, scaphoid, trapezium, lunate, triquetrum, trapezoid, and pisiform. According to this study, carpal bone volumes were larger in males than in females (p0.05). In this study, it was seen that carpal bone volume differed according to sex. However, it was observed that the bone volumes of both sexes took up the same amount in the total bone volume. This information will be very useful in sex determination, 3D anatomical material creation, implant applications and reconstructive surgery.

Nuestro objetivo fue determinar los volúmenes de los huesos del carpo y la relación entre estos volúmenes y el volumen total de estos huesos a partir de imágenes de TC obtenidas de individuos de diferentes edades y sexos utilizando 3D Slicer. En el estudio se incluyeron imágenes de TC del carpo de la mano derecha de los participantes en el estudio, con un grosor de corte de 0,625 mm, en 42 individuos sanos (21 mujeres, 21 hombres) de ambos sexos. Los cálculos de volumen se realizaron cargando las imágenes en 3D Slicer, un paquete de software de código abierto. El volumen medio del hueso capitado fue el mayor en ambos sexos (hombre 3479,9 ± 679,2; mujer 2207,1 ± 272,1 mm3), mientras que el hueso pisiforme tuvo el volumen medio más pequeño (hombre 810,0 ± 141,2; mujer 566,6 ± 97,7 mm3). De mayor a menor el volumen de los otros huesos fue: hamato, escafoides, trapecio, lunato, piramidal, trapezoide y pisiforme. Según este estudio, los volúmenes óseos del carpo eran mayores en hombres que en mujeres (p0,05). En este estudio se observó que el volumen de los huesos del carpo difería según el sexo. Sin embargo, se observó que los volúmenes óseos de ambos sexos ocuparon la misma cantidad del volumen óseo total. Esta información será de gran utilidad en la determinación del sexo, creación de material anatómico 3D, aplicaciones de implantes y cirugía reconstructiva.

Assuntos

RESUMO

Objetivo: El cóndilo mandibular bífido es una alteración morfológica de la articulación temporomandibular en la que el cóndilo presenta un surco en la superficie superior que genera dos cabezas condilares. Esta alteración puede ser unilateral o bilateral. La mayoría de los cóndilos mandibulares bífidos se detectan mediante radiografías panorámicas, sin embargo, la tomografía computarizada Cone Beam de articulación temporomandibular es considerado el examen de elección para el diagnóstico de esta alteración. El propósito de este trabajo es presentar un caso de cóndilo mandibular bífido bilateral detectado incidentalmente mediante una tomografía computarizada Cone Beam solicitada por un diagnóstico presuntivo de osteoartritis. Caso clínico: Una paciente de 22 años sin antecedentes de traumatismos cráneo faciales solicita una tomografía computarizada Cone Beam de articulaciones temporomandibulares por diagnóstico presuntivo de osteoartritis. En la exploración del volumen se encontraron cóndilos mandibulares bífidos con dos cabezas condilares, medial y lateral de forma bilateral, siendo más acentuado en el cóndilo derecho.(AU)

Aim: The bifid mandibular condyle is a morphological alteration of the temporomandibular joint in which the condyle has a groove on its upper surface that generates two condylar heads. This alteration can be unilateral or bilateral. Most bifid mandibular condyles are detected by panoramic radiographs, however, Cone Beam computed tomography of the temporomandibular joint is considered the test of choice for the diagnosis of this alteration. The purpose of this work is to present a case of bilateral bifid mandibular condyle, incidentally detected by Cone Beam computed tomography requested for a presumptive diagnosis of osteoarthritis. Clinical case: A 22-year old female patient with no history of craniofacial trauma requests a Cone Beam computed tomography of the temporomandibular joints due to a presumptive diagnosis of osteoarthritis. In the volume exploration, bifid mandibular condyles were found with two condylar heads, medial and lateral bilaterally, being more accentuated in the right condyle.(AU)

RESUMO

Positron emission tomography (PET) can provide information about tumor-associated macrophage (TAM) infiltration, as long as a suitable tracer is available. This study aimed to evaluate the radiolabeled peptide [18F]AlF-NODA-MP-C6-CTHRSSVVC as a potential PET tracer for imaging of the CD163 receptor, which is expressed on M2-type tumor-associated macrophages. The conjugated peptide NODA-MP-C6-CTHRSSVVC was labeled with aluminum [18F]fluoride. Tracer binding and its biodistribution were evaluated in an in vitro binding assay and in healthy BALB/c mice, respectively. In addition, different treatments with cyclophosphamide in tumor-bearing mice were used to assess whether the tracer could detect differences in CD163 expression caused by differential TAM infiltration. After 7 days of treatment, animals were injected with [18F]AlF-NODA-MP-C6-CTHRSSVVC, and a 60-min dynamic PET scan was performed, followed by an ex vivo biodistribution study. [18F]AlF-NODA-MP-C6-CTHRSSVVC was prepared in 23 ± 6 % radiochemical yield and showed approximately 50 % of specific receptor-mediated binding in an in vitro binding assay on human CD163-expressing tissue homogenates. No CD163-mediated binding of [18F]AlF-NODA-MP-C6-CTHRSSVVC was detected by PET under normal physiological conditions in healthy BALB/c mice. On the other hand, CD163-positive xenograft tumors were clearly visualized with PET and a positive correlation was found between CD163 levels and the [18F]AlF-NODA-MP-C6-CTHRSSVVC tumor-to-muscle ratio (TMR) obtained from the PET images (Pearson r = 0.76, p = 0.002). No significant differences in the CD163 protein level and in the tracer uptake between treatment groups were found in the tumors. Taken together, [18F]AlF-NODA-MP-C6-CTHRSSVVC appears a promising candidate PET tracer for M2-type TAM, as it binds specifically to CD163 in vitro and its tumor uptake correlates well with CD163 expression in vivo.

RESUMO

The article addresses the diagnostic value of the combined use of computed tomography (CT) perfusion and dual-energy CT (DECT) in patients with neuroendocrine tumors. It emphasizes the heterogeneity and complexity of these neoplasms, primarily affecting the gastrointestinal tract, bronchopulmonary system, and pancreas. While conventional CT is widely employed in their diagnosis, the combination of CT perfusion and dual-energy CT offers greater precision, particularly in detecting synchronous tumors and characterizing their vascularization. A clinical case of a patient with chronic abdominal symptoms, whose diagnosis was facilitated using both combined techniques, is presented. The discussion explores how CT perfusion assesses tumor vascularization and how dual-energy CT improves soft tissue differentiation, resulting in increased diagnostic accuracy. It is highlighted that this approach not only enhances detection rates but also positively impacts clinical management and healthcare costs. Therefore, the importance of considering these advanced tools in the diagnosis of neuroendocrine tumors to improve diagnostic precision and efficiency in patient care is underscored.