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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
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Diferenciação entre esquistossomose hepatoesplênica e cirrose utilizando ressonância magnética / Differentiation between hepatosplenic schistosomiasis and cirrhosis using magnetic resonance imaging

Bezerra, Alexandre Sérgio de Araújo [UNIFESP] January 2007 (has links) (PDF)
Made available in DSpace on 2015-12-06T23:46:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2007 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivos: Identificar quais caracteristicas podem ser usadas para diferenciar doentes com esquistossomose hepatoesplenica e cirrose usando ressonancia magnetica e medir a reprodutibilidade deste metodo de imagem na avaliacao destes doentes. Metodos: Estudo transversal e observacional em 24 pacientes com esquistossomose hepatoesplenica cronica e 27 pacientes com cirrose alcoolica ou induzida por virus, submetidos a exame de ressonancia magnetica do abdome. Todas as imagens foram interpretadas independentemente por dois radiologistas, avaliando-se os seguintes aspectos em exames de ressonancia magnetica do figado e baco: alargamento de fissuras hepaticas, irregularidade de contornos hepaticos, fibrose periportal, heterogeneidade do parenquima hepatico e nodulos sideroticos esplenicos. Medidas dos lobos esquerdo, direito e caudado do figado e dos maiores diametros esplenicos tambem foram realizadas. A reprodutibilidade da ressonancia magnetica foi medida por meio do calculo da concordancia interobservador e intra-observador pelo testes kappa e correlacao intraclasses. Foram realizados os testes x2, exato de Fischer, teste t e analise de regressao com o objetivo de comparar os dois grupos de pacientes. Resultados: A concordancia interobservador e intra-observador foi substancial ou quase perfeita em quase todas as variaveis analisadas (k ou r = 0,81-1,00). Fibrose periportal, heterogeneidade do parenquima hepatico e nodulos sideroticos esplenicos foram mais frequentes no grupo de pacientes esquistossomoticos (p < 0,05). A fibrose periportal mostrou maior diferenca entre os dois grupos, sendo mais frequente nos esquistossomoticos. Houve tambem diferenca quanto a distribuicao, sendo a fibrose periportal periferica mais comum que a central em pacientes com esquistossomose. O diametro transverso do lobo hepatico direito foi maior nos pacientes cirroticos, e a relacao caudado/lobo direito, todos os diametros esplenicos e o indice esplenico foram maiores nos pacientes esquistossomoticos (p < 0,001). Na analise por regressao multipla, os nodulos sideroticos esplenicos e o indice esplenico foram altamente indicativos de esquistossomose e podem ser usados para diferenciacao entre os dois grupos. Em doentes previamente esplenectomizados, a relacao lobo caudado I lobo direito foi a variavel que diferenciou melhor os dois grupos (p = 0,009). Conclusao: A presenca de fibrose periportal periferica, heterogeneidade do parenquima hepatico e nodulos sideroticos esplenicos sao mais frequentes em pacientes esquistossomoticos. O indice esplenico e significativamente maior na esquistossomose. O exame de ressonancia magnetica apresentou elevada reprodutibilidade para a avaliacao das alteracoes morfologicas hepaticas e esplenicas em pacientes esquistossomoticos e em pacientes cirroticos / Purpose:. Identify imaging features that may be used to differentiate between hepatosplenic schistosomiasis and cirrhosis using magnetic resonance and to assess the reproducibility of this imaging method in the evaluation of these patients. Methods: A transversal observational study of 24 patients with chronic hepatosplenic schistosomiasis and 27 patients with alcohol or virus-induced cirrhosis submitted to MRI (1.5T) of the abdomen was made. Images were interpreted independently by two radiologists, evaluating the following MR features: hepatic fissure widening, irregularity of hepatic contours, periportal fibrosis, heterogeneity of the hepatic parenchyma and splenic siderotic nodules. Left, right, and caudate liver lobe and the largest spleen diameters were also measured. Reproducibility of magnetic resonance was assessed by measuring observer agreement using the kappa and intraclass correlation tests. Fisher exact test, x2 test and t test were used, and regression analysis was performed to compare the two patient groups. Results: Observer agreement was substantial or almost perfect for almost all variables analyzed (k or r = 0.81 – 1.00). Periportal fibrosis, heterogeneity of hepatic parenchyma and splenic siderotic nodules were more frequent in the schistosomotic group (p < 0.05). Periportal fibrosis showed the largest difference between both groups, being more frequent in the schistosomotic patients and also presented differences in its distribution (peripheric greater than central in schistosomiasis). The transverse diameter of the right hepatic lobe was larger in cirrhosis while caudate lobe/right lobe ratio, splenic diameters and the splenic index were larger in schistosomiasis (p < 0.001). At multiple regression analysis, splenic siderotic nodules and splenic index were predictive of schistosomiasis and could be used to differentiate between both groups. In patients previously splenectomized the caudate / right lobe ratio was the variable that best separated both groups (p = 0.009). Conclusion: The presence of peripheral periportal fibrosis, heterogeneity of hepatic parenchyma and splenic siderotic nodules were more frequent in the schistosomotic group. The splenic index was significantly larger in patients with schistosomiasis. Magnetic resonance imaging presented high reproducibility in the evaluation of the hepatic and splenic morphological changes in patients with schistosomiasis mansoni and in cirrhotic patients. / CAPES: 33009015037M5 / BV UNIFESP: Teses e dissertações

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