Assuntos
Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/genética , Idoso , Biópsia/tendências , Testes Genéticos/tendências , Humanos , Imageamento por Ressonância Magnética/tendências , Masculino , Estadiamento de Neoplasias/tendências , Neoplasias da Próstata/sangue , Fatores de RiscoAssuntos
Radioisótopos do Iodo , Compostos Radiofarmacêuticos , Tecnécio , Doenças da Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/anormalidades , Glândula Tireoide/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/tendências , Cintilografia/métodos , Cintilografia/tendências , Doenças da Glândula Tireoide/congênito , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia Doppler/tendênciasRESUMO
Gadolinium-containing carbon nanomaterials are a new class of contrast agent for magnetic resonance imaging. They are characterized by a superior proton relaxivity to any current commercial gadolinium contrast agent and offer the possibility to design multifunctional contrasts. Intense efforts have been made to develop these nanomaterials because of their potential for better results than the available gadolinium contrast agents. The aim of the present work is to provide a review of the advances in research on gadolinium-containing carbon nanomaterials and their advantages over conventional gadolinium contrast agents. Due to their enhanced proton relaxivity, they can provide a reliable imaging contrast for cells, tissues or organs with much smaller doses than currently used in clinical practice, thus leading to reduced toxicity (as shown by cytotoxicity and biodistribution studies). Their active targeting capability allows for improved MRI of molecular or cellular targets, overcoming the limited labelling capability of available contrast agents (restricted to physiological irregularities during pathological conditions). Their potential of multifunctionality encompasses multimodal imaging and the combination of imaging and therapy.
Assuntos
Meios de Contraste/uso terapêutico , Gadolínio/uso terapêutico , Imageamento por Ressonância Magnética/tendências , Nanoestruturas/uso terapêutico , Carbono/química , Carbono/uso terapêutico , Meios de Contraste/química , Humanos , Imagem Multimodal/métodos , Nanoestruturas/química , Distribuição TecidualRESUMO
Los innegables progresos en la supervivencia de los pacientes con cardiopatía congénita en los últimos años fue acompañado de los avances en todas las áreas concurrentes a la cirugía cardiovascular, incluyendo la recuperación y los métodos diagnósticos que permiten una mejor comprensión de la patología cardíaca congénita o adquirida. La velocidad con que se desarrollan estas herramientas en el arsenal médico, exige una mejor comprensión a la hora de definir la estrategia diagnóstica para cada paciente en particular. Tradicionalmente, las imágenes diagnósticas de las cardiopatías congénitas eran dominio de la ecocardiografía y el cateterismo. En los últimos 10 años, la Resonancia y la Tomografía Computada fueron ganando terreno. La principal ventaja de la Resonancia es que no utiliza Rayos X para obtener las imágenes, diferencia de la angiografía por cateterismo y la tomografía axial computada. La resonancia magnética cardíaca se ha convertido en una herramienta importante para evaluar la enfermedad cardíaca congénita y también la adquirida en niños y adultos. La variedad y complejidad de la patología y sus posibilidades quirúrgicas hace indispensable la presencia del cardiólogo infantil durante la adquisición de las imágenes y su post procesamiento. En esta sección se presentarán algunas de las herramientas o secuencias que utiliza la Resonancia Magnética Cardíaca y su utilización práctica en el diagnóstico de las cardiopatías más frecuentes (AU)
The undeniable progress in survival of patients with congenital heart defects in recent years has been accompanied by advances in all areas related to cardiovascular surgery, including recovery and diagnostic methods that allow for a better understanding of congenital or acquired heart disease. The speed with which these tools are developed in the medical arsenal requires a better understanding when defining the diagnostic strategy for each individual patient. Traditionally, diagnostic images of choice for congenital heart disease were echocardiography and catheterization. Over the last 10 years, MRI. and CT scan have become more important. The main advantage of MRI is that it does not use X-rays to obtain the images, unlike catheterization and computed tomography angiogram. Cardiac MRI has become an important tool for assessing congenital and acquired heart disease in children and adults. The variety and complexity of the disease and its surgical possibilities warrant the presence of the child cardiologist during imaging acquisition and processing. This section will present some of the MRI tools and sequences and their practical use in the diagnosis of the most common heart diseases (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/tendências , Cardiopatias Congênitas/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Técnicas de Diagnóstico CardiovascularRESUMO
Treatment with a pipeline embolization device (PED) is widely accepted as an excellent option for patients harboring giant, wide neck, saccular intracranial aneurysms. It has been shown to be safe and very effective. We describe a previously unreported case of a large middle cerebral artery aneurysm, related to the carotid tip, that was treated with a PED and coils. The 6 month follow-up angiogram demonstrated complete occlusion of the aneurysm. However, the 9 month angiogram revealed recurrent filling of the aneurysm sac. To our knowledge, this is the first report to describe recanalization of an aneurysm totally occluded on the control angiography after treatment with a PED. Unanswered questions include the mechanism of recanalization and the need for additional control angiograms and MRI following a previous examination revealing total aneurysm occlusion.
Assuntos
Prótese Vascular , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Idoso , Prótese Vascular/tendências , Angiografia Cerebral/métodos , Embolização Terapêutica/tendências , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/tendências , Feminino , Humanos , Imageamento por Ressonância Magnética/tendências , Recidiva , Resultado do TratamentoRESUMO
OBJECTIVE: The Evans Index (EI) is used for recognition of individuals with normal pressure hydrocephalus. However, recent studies suggest that the EI is not a reliable marker of this condition. Rather, the EI may be inversely correlated with cognitive performance, but information on this correlation is lacking. We aimed to assess the relationship between the EI and cognitive performance in community-dwelling older adults. PATIENTS AND METHODS: The study included 314 non-disabled, stroke-free, individuals aged ≥60 years enrolled in the Atahualpa Project undergoing brain MRI and MoCA testing. Using generalized linear models, adjusted for demographics, cardiovascular risk factors edentulism, depression, global cortical atrophy and white matter hyperintensities of vascular origin, we assessed the relationship between the EI and cognitive performance. Predictive margins of the MoCA score according to percentiles of the EI were also evaluated, after adjusting for variables reaching significance in univariate models. RESULTS: The mean EI was 0.248⯱â¯0.022 and the mean MoCA score was 19.7⯱â¯4.8 points. A fully-adjusted generalized linear model showed a significant inverse relationship between the EI and the MoCA score. Predictive models showed a decrease in the MoCA score according to increased levels of the EI (ß: -3.28; 95% C.I.: -6.09 to -0.47; pâ¯=â¯0.022). CONCLUSION: The independent effect of the EI on the MoCA score provides evidence of the utility of the EI to evaluate cognitive performance.
Assuntos
Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/psicologia , Vida Independente/psicologia , Testes Neuropsicológicos , Vigilância da População , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Transtornos Cognitivos/epidemiologia , Pessoas com Deficiência , Equador/epidemiologia , Feminino , Humanos , Imageamento por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Diagnosing Alzheimer's disease (AD) in its earliest stages is important for therapeutic and support planning. Similarly, being able to predict who will convert from mild cognitive impairment (MCI) to AD would have clinical implications. OBJECTIVES: The goals of this study were to identify features from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database associated with the conversion from MCI to AD, and to characterize the temporal evolution of that conversion. METHODS: We screened the publically available ADNI longitudinal database for subjects with MCI who have developed AD (cases: n=305), and subjects with MCI who have remained stable (controls: n=250). Analyses included 1,827 features from laboratory assays (n=12), quantitative MRI scans (n=1,423), PET studies (n=136), medical histories (n=72), and neuropsychological tests (n=184). Statistical longitudinal models identified features with significant differences in longitudinal behavior between cases and matched controls. A multiple-comparison adjusted log-rank test identified the capacity of the significant predictive features to predict early conversion. RESULTS: 411 features (22.5%) were found to be statistically different between cases and controls at the time of AD diagnosis; 385 features were statistically different at least 6 months prior to diagnosis, and 28 features distinguished early from late conversion, 20 of which were obtained from neuropsychological tests. In addition, 69 features (3.7%) had statistically significant changes prior to AD diagnosis. CONCLUSION: Our results characterized features associated with disease progression from MCI to AD, and, in addition, the log-rank test identified features which are associated with the risk of early conversion.
Assuntos
Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/psicologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Progressão da Doença , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética/tendências , Masculino , Testes Neuropsicológicos , Fatores de TempoRESUMO
The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability. Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.
Assuntos
Imageamento por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico por imagem , Sobrevivência de Tecidos/fisiologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Meios de Contraste/normas , Humanos , Imageamento por Ressonância Magnética/normas , Imageamento por Ressonância Magnética/tendências , Infarto do Miocárdio/fisiopatologia , Revascularização Miocárdica , Miócitos Cardíacos/patologiaRESUMO
Abstract The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability.
Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.
Assuntos
Humanos , Sobrevivência de Tecidos/fisiologia , Imageamento por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico por imagem , Imageamento por Ressonância Magnética/normas , Imageamento por Ressonância Magnética/tendências , Meios de Contraste/normas , Miócitos Cardíacos/patologia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Revascularização MiocárdicaRESUMO
Clinical, neuroimaging, and laboratory features are not specific enough to establish the etiological diagnosis of the acute inflammatory myelitis (AIM). Longitudinally extensive transverse myelitis (LETM) seen on magnetic resonance imaging (MRI) has been associated with a poor functional prognosis. The aim of this study was to assess the functional outcomes of a first AIM event comparing patients with LETM vs. no LETM on MRI and to report the differential diagnosis. Clinical, radiological, biochemical aspects were collected, and Winner-Hughes Functional Disability Scale (WHFDS) was performed after 3 and 6 months. Centromedullary lesions were associated with LETM, lateral lesions with partial lesion (PL), and brain MRI lesions with multiple sclerosis and acute encephalomyelitis disseminated. LETM patients were associated with a worse functional outcome as the need of a wheelchair after 3 and 6 months (OR = 7.61 p = 0.01; OR 4.8 p = 0.04, respectively), a walker or cane (OR = 11.0 p = 0.002, OR = 4.3 p = 0.03, respectively). In addition, we found a correlation between LETM and acute complete transverse myelitis and PL with acute partial transverse myelitis (83.3 and 90.9%, respectively; p < 0.0001). In conclusion, AIM is a heterogeneous syndrome from an etiological point of view and LETM patients had worse functional prognosis compared with PL after 3 and 6 months.