Radiologia Brasileira最新文献

Objective: To determine whether the degree of microvascular flow on Doppler ultrasound correlates with the aggressiveness of prostate cancer, as defined by the Gleason score.

Materials and methods: This was a prospective cohort study including 88 patients evaluated between November 2023 and July 2024. We included men between 48 and 85 years of age with a prostate-specific antigen (PSA) level between 0.3 ng/mL and 21.0 ng/mL and an imaging finding with Prostate Imaging-Reporting and Data System (PI-RADS) category between 2 and 5. Patients with indeterminate biopsy results were excluded, as were those for whom PSA values were missing, those who did not undergo microvascular Doppler assessment, and those previously diagnosed with prostate cancer. In each case, we performed systematic 10-core transrectal biopsy, guided by 1.5-T magnetic resonance imaging-ultrasound fusion, as well as performing Doppler ultrasound with microvascular flow imaging. Vascularization was qualitatively assessed and categorized as absent/minimal, moderate, or marked. The Gleason score was classified as clinically significant (≥ 7) or not (≤ 6)..

Results: A significant association was found between the degree of microvascular flow and the Gleason score (p = 0.0384). Spearman's correlation was moderate (r = 0.377), and Kendall's tau was 0.300, indicating a positive relationship between higher microvascular flow and greater tumor aggressiveness.

Conclusion: Microvascular Doppler shows potential as a complementary tool in prostate biopsy, enabling more precise targeting of regions with increased vascularity, which might be associated with greater tumor aggressiveness.

Accurate preoperative assessment of axillary lymph node status is essential for guiding treatment in early-stage breast cancer. Because clinical examination alone is often inadequate, imaging modalities such as axillary ultrasonography (AUS), mammography, and magnetic resonance imaging (MRI) are integral to axillary staging. Obese women with breast cancer have poorer oncologic outcomes than do their non-obese counterparts, which raises concerns about potential limitations in diagnostic performance due to a high body mass index (BMI). The objective of this study was to evaluate the diagnostic performance of clinical examination, AUS, mammography, and MRI in detecting axillary metastases in overweight and obese women with early-stage breast cancer. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy guidelines. We included studies assessing the diagnostic accuracy of clinical and imaging modalities for detecting axillary metastasis in overweight and obese women. Methodological quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity and specificity data were extracted when available, and summary receiver operating characteristic curves were constructed. Nine studies met the inclusion criteria. The most frequently evaluated modality was AUS, which consistently demonstrated preserved diagnostic performance across weight groups; however, one retrospective cohort study reported that its negative predictive value decreases in parallel with increases in BMI. One study involving over 5,000 patients showed that the clinical examination is not significantly affected by the patient BMI. Mammography and MRI showed more variable results, with one study showing MRI performance potentially being impaired in overweight patients, although that study was rated as having a high risk of bias. Across studies, no substantial evidence supported the need for modifying diagnostic protocols based on BMI. Clinical examination and AUS continue to be reliable methods for axillary staging in overweight and obese women with early-stage breast cancer. Given one contradictory cohort study, negative AUS findings in obese patients should be interpreted with caution until standardized AUS criteria and prospective BMI-stratified studies are available. Further high-quality, prospective studies are needed in order to confirm these findings and to inform evidence-based refinements in staging protocols.

Objective: To evaluate the effect of saline hydration on contrast-induced acute kidney injury in a rat model of diabetes mellitus.

Materials and methods: This was a quantitative, preclinical experimental study. A total of 28 male Wistar rats were randomized into four groups: citrate (control); diabetes mellitus-only; diabetes mellitus + iodinated contrast (6 mL/kg iothalamate meglumine); and diabetes mellitus + iodinated contrast + saline (NaCl 0.9%, 12 mL/kg). Physiological parameters, renal hemodynamics, inulin clearance (as a proxy for renal function), urinary albumin, and oxidative injury were assessed. Statistical significance was set at p < 0.05. Results: In the diabetes mellitus-only group, there was sustained hyperglycemia, weight loss, polyphagia, polyuria, polydipsia, and renal hypertrophy, with significant differences in comparison with the control group. In the diabetes mellitus + iodinated contrast group (in comparison with the diabetes mellitus-only group), there was an additional reduction in the mean renal blood flow (2.1 ± 0.7 mL/min vs. 6.9 ± 0.8 mL/min), greater mean renal vascular resistance, lower mean inulin clearance (0.17 ± 0.02 mL/min vs. 0.85 ± 0.13 mL/min), and a higher mean level of urinary neutrophil gelatinase-associated lipocalin (318.1 ± 52.6 pg/mL vs. 42.2 ± 42.6 pg/mL), together with higher hydrogen peroxide concentrations, as well as elevated lipid peroxidation and thiol consumption in renal tissue. Pretreatment with saline hydration averted those changes (p < 0.05 for all).

Conclusion: Saline hydration attenuated the impairment of renal function and hemodynamics by reducing redox imbalance in contrast-induced acute kidney injury.

Objective: To evaluate the relationship between the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) and liver size in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), as well as to explore the role of determining the craniocaudal diameter of the right hepatic lobe (CCDHL), measured at the midclavicular line, and liver volumetry as complementary tools in the assessment of hepatic steatosis.

Materials and methods: This was a single-center, cross-sectional, prospective study including 289 patients with MASLD who underwent multiparametric MRI for the evaluation of hepatic steatosis, which was categorized by the MRI-PDFF value. Liver size measurements included the CCDHL, liver volume from automated segmentation, and its difference from the total expected liver volume (eLV), calculated with the Vauthey formula.

Results: A significant positive correlation was observed between the MRI-PDFF and liver size measurements, including the CCDHL (rs = 0.651; p < 0.001) and the eLV (rs = 0.568; p < 0.001). Patients with higher grades of steatosis showed a progressive increase in liver volume (p < 0.001). A receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for the CCDHL and for the eLV in identifying moderate-to-severe steatosis (area under the curve: 0.76 and 0.83, respectively).

Conclusion: The integrated assessment of the MRI-PDFF and liver size appears to be effective for the diagnosis, stratification, and monitoring of steatosis in patients with MASLD.

The objective of this systematic review and meta-analysis of observational studies was to estimate the prevalence of residual alterations in the lung parenchyma on computed tomography (CT) after coronavirus disease 2019 (COVID-19), correlating those alterations with the severity of the acute phase of the disease. We reviewed data related to adult patients evaluated at 3, 6, and 12 months after the diagnosis of moderate-to-critical COVID-19. We performed structured searches of 14 databases, encompassing works published between January 2020 and January 2024. Thus, 44 primary studies were selected. Data on mild cases of COVID-19 were excluded, as were those related to assessment of the acute phase of the disease. The results were analyzed descriptively, and meta-analyses were conducted to estimate prevalence. The estimated prevalence of altered CT scans at post-diagnosis months 3, 6, and 12 was 69.0% (95% CI: 60.0-77.6%; I ² = 86%; p < 0.001), 62.0% (95% CI: 52.0-71.5%; I ² = 77%; p < 0.001), and 54.0% (95% CI: 40.0-67.5%; I ² = 88%; p < 0.001), respectively. There was no correlation between severity of the acute phase and the persistence of alterations on CT in general. Among the CT scans acquired at post-diagnosis month 3, alterations indicative of fibrosis were observed in 22% (95% CI: 13-30%; I ² = 85%; p < 0.001), and no reduction in that prevalence was observed at the subsequent time points (rho-s = 0.952; p < 0.000). The severity of the acute phase showed a positive correlation with the presence of lesions indicative of pulmonary fibrosis on CT scans acquired at 3 months after the diagnosis of COVID-19.

Objective: To assess the prevalence and type of residual lung abnormalities on chest computed tomography (CT) and pulmonary function testing (PFT) variables in patients with respiratory symptoms related to post-COVID-19 condition at 12 months of follow-up, and to analyze associations between CT findings and PFT parameters.

Materials and methods: The CT findings were evaluated by two radiologists, who calculated semiquantitative CT scores. The PFTs included spirometry, plethysmography, and the diffusing capacity of the lung for carbon monoxide.

Results: Thirty-seven patients were included in the study. On CT scans of the chest acquired at 12 months of follow-up, 78.3% of the patients exhibited residual abnormalities, including reticular opacities, in 75.7%; traction bronchiectasis/bronchiolectasis, in 43.2%; and fibrosis-like findings, in 43.2%. The mean overall CT score was 9.30 ± 2.59. Patients with fibrosis-like findings had significantly lower total lung capacity (68.6% vs. 80.6% of the predicted value; p = 0.018). A moderate negative correlation was found between the overall CT score and total lung capacity (rs = -0.49; p = 0.003).

Conclusion: It seems that a significant proportion of patients with respiratory symptoms related to post-COVID-19 condition demonstrate residual lung abnormalities on chest CT at 12 months of follow-up, with a substantial prevalence of fibrosis-like findings. Such abnormalities are associated with restrictive lung disease.

Objective: To evaluate the relationship between the mean thyroid lobe diameter (MTLD) and the transverse tracheal diameter (TTD), as determined by ultrasound, in order to validate its efficacy as a quantitative marker of goiter.

Materials and methods: Thyroid ultrasound images were analyzed. Standardized measurements included the MTLD [(transverse + anteroposterior diameter) ∕ 2], TTD, and thyroid volume [transverse diameter × anteroposterior diameter × length × 0.470]. Statistical correlation and regression analyses were employed to assess the interactions among those variables and their diagnostic utility in goiter detection.

Results: A total of 300 thyroid ultrasound images (200 of adults and 100 of children/adolescents) were evaluated. We identified a significant correlation between the MTLD:TTD ratio and goiter. When the MTLD exceeded the normative TTD threshold (> 1.7 cm in adults; > 2.4 cm in children/adolescents), the mean thyroid volume was consistently elevated, in the adult patients-12.5 ± 2.1 mL (normal range, 7-10 mL)-and in the pediatric patients-18.3 ± 3.6 mL (normal range, 5.0-16.1 mL)-confirming goiter (p < 0.001). Regression analysis demonstrated a strong linear relationship between thyroid volume and the MTLD (R² = 0.82; β = 1.34; p < 0.001), with 89% sensitivity and 93% specificity for goiter prediction. An abnormal tracheal index (1.7-2.4 vs. the observed mean of 2.6 ± 0.3) was found to increase diagnostic accuracy (AUC = 0.94; 95% CI: 0.91-0.97).

Conclusion: The MTLD:TTD ratio is a reliable ultrasound biomarker for goiter detection, demonstrating strong diagnostic performance and volumetric correlation.

Tarsal tunnel syndrome results from compression or damage to the tibial nerve or its branches as they pass through the tarsal tunnel beneath the flexor retinaculum. Diagnosing tarsal tunnel syndrome is challenging because of nonspecific symptoms that overlap with those of other lower limb pathologies. Vascular disorders are common causes but are often overlooked. High-resolution ultrasonography has emerged as a valuable diagnostic tool, offering advantages over other imaging methods. This technique allows real-time assessment, identifying the factors that cause vascular compression and improving diagnostic accuracy. Increased awareness of the vascular contributions to tarsal tunnel syndrome can promote early diagnosis and improve treatment outcomes.