Made available in DSpace on 2014-07-29T15:21:57Z (GMT). No. of bitstreams: 1 Dissertacao Inara Rege.pdf: 692781 bytes, checksum: a7cf62e7e8ab3529ac5b269f1d1f915c (MD5) Previous issue date: 2011-03-18 / The use of cone beam computed tomography exam (CBCT) has increased greatly in recent years in dentistry, so there is much discussion about the role of the dentist in evaluating the anatomical structures near the maxillo-mandibular. Currently we do not know the occurrence of abnormalities in the maxillary sinuses in a large sample of CBCT examinations of dental patients with different indications. The aim of this study was 1-to investigate the occurrence of maxillary sinus abnormalities using cone beam computed tomography (CBCT) exams of asymptomatic patients, 2- identify the frequency, type and location of these findings, and 3- its association with the proximity of periapical lesions and inflammatory changes in the maxillary sinus.1113 CBCT exams were evaluated by two examiners to identify the presence or absence of abnormalities of the maxillary sinus. Cases with abnormalities were reevaluated for identification of the type of the abnormality and location within the sinus. The presence and proximity of periapical lesions in the upper posterior teeth to the lower sinus wall were recorded. Data were analyzed using descriptive statistics and chi-square test. Inter-rater agreement was calculated using Kappa statistics. Abnormalities were diagnosed in 760 (68.2%) cases (kappa coefficient 0.83). There was a significant difference between genders, showing greater occurrence in males (p<0.001). No difference in the occurrence of abnormalities was observed regarding age groups (p>0.05). Mucosal thickening was the most prevalent abnormality (66%), followed by retention cyst (10.1%) and opacification (7.8%). The most frequent location of sinusal abnormalities were in the inferior wall (46.2%), anterior (29%), medial(25.7%) and lateral wall (21.5%). No association between the proximity of periapical lesion and the presence and type of inflammatory abnormalities was observed (p=0.124). The occurrence of abnormalities in maxillary sinus of asymptomatic was considered high. These findings emphasize the importance of a comprehensive interpretation by the dentomaxillofacial radiologist of all volume of CBCT images, including the entire maxillary sinus as part of the imaging exam of routine patients. / A utilização do exame de tomografia computadorizada por feixe cônico (TCFC) tem aumentado muito nos últimos anos na Odontologia, com isso, muito se discute sobre o papel do cirurgião-dentista na avaliação de estruturas anatômicas próximas ao complexo maxilo-mandibular. Atualmente não se conhece a ocorrência de anormalidades nos seios maxilares em uma grande amostra de exames de TCFC de pacientes com diferentes indicações odontológicas. O objetivo deste estudo foi investigar: 1-ocorrência de anormalidades no seio maxilar por meio de exames de TCFC de pacientes assintomáticos, 2-identificar a frequência, tipo e localização destas anormalidades, e 3- sua associação com a proximidade de lesões periapicais e alterações inflamatórias detectadas no seio maxilar.1113 exames de TCFC foram avaliados por dois examinadores para identificar a presença ou ausência de anormalidades do seio maxilar. Os casos com anormalidades foram reavaliados para a identificação do tipo de anormalidade e localização no interior da cavidade sinusal. A presença e a proximidade das lesões periapicais em dentes superiores posteriores à parede inferior do seio foram registrados. Os dados foram analisados por estatística descritiva e teste do qui-quadrado. A concordância entre os examinadores foi calculada por meio da estatística Kappa. Anormalidades foram diagnosticadas em 760 pacientes (68,2%) (kappa 0,83 coeficiente). Houve diferença significante entre os sexos, com maior ocorrência no gênero masculino (p <0,001). Não houve diferença na ocorrência de anormalidades em relação às faixas etárias (p <0,05). Espessamento mucoso foi a alteração mais prevalente (66%), seguido de cisto de retenção (10,1%) e opacificação (7,8%). As localizações mais frequentes de anormalidades sinusais foram na parede inferior (46,2%), anterior (29%), média (25,7%) e parede lateral (21,5%). Não foi observada associação entre a proximidade da lesão periapical e presença e tipo de anormalidades inflamatórias (p = 0,124). A ocorrência de anormalidades no seio maxilar de assintomáticos foi considerada alta. Estes achados enfatizam a importância de uma interpretação abrangente pelo radiologista dentomaxillofacial de todo o volume de imagens de TCFC, incluindo todo o seio maxilar, como parte do exame de imagem dos pacientes de rotina

Background: Whole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relatively high radiation exposure that might result in an increased life time cancer risk. The aim of this study was to investigate the frequency and type of non trauma associated incidental medical findings in relation to patient age and potential clinical relevance. Methods: Between January 1st 2011 and December 15th 2012, a total of 704 trauma patients were referred to our hospital’s emergency room that triggered trauma room alarm according to our trauma mechanism criteria. Of these 534 (75.8%) received a whole-body CT according to our dedicated multiple trauma protocol. Incidental Findings (IF) were assigned in three groups according to their clinical relevance. Category 1: IF with high medical relevance (urgent life threatening conditions, unless treated) needing early investigations and intervention prior to or shortly after hospital discharge. Category 2: IF with intermediate or low medical relevance, warranting further investigations. Category 3: IF without clinical relevance. Results: Overall 231 IFs (43.3%) were identified, 36 (6.7%) patients had IFs with a high clinical relevance, 48 (9.0%) with a moderate or minor clinical relevance and 147 (27.5%) with no clinical relevance. The distribution of incidental findings with high or moderate relevance according to age showed an incidence of 2.6%, 6.6% and 8.8% for patients younger than 40 years, 40 to 60 years and older than 60 years, respectively. Conclusion: Whole-body CT scans of trauma patients demonstrate a high rate of incidental findings. Potentially life-threatening, medical findings were found in approximately every 15th patient, predominantly aged over 40 years and presenting with minor to moderate injuries and an Injury Severity Score (ISS) of 10 or less.

Bakgrund: Antalet datortomografiundersökningar (DT-undersökningar) har ökat kraftigt i Sverige och den kollektiva stråldosen till befolkningen blir allt högre. DT-undersökningar av buken är en av de undersökningarna som ger högst stråldos till patienten, därför är det viktigt att de endast görs när det krävs för att ställa diagnos. Därmed kan det vara relevant att undersöka huruvida antalet undersökningar också lett till ökat antal patologiska fynd hos patienter. Syfte: Undersöka hur många akuta DT-undersökningar med intravenös kontrast av buken som gjordes vid två sjukhus och hur stor andel av dessa som påvisade patologiska fynd. Metod: För att besvara syftet gjordes en kvantitativ retrospektiv studie där röntgenremisser och röntgensvar från mars 2013, mars 2018 och mars 2023 analyserades. Resultat: Antalet akuta DT-bukundersökningar med intravenös kontrast har ökat vid sjukhusen med i genomsnitt 49,5% mellan 2018–2023. Den mest markanta ökningen sågs i åldrarna 50–80 år. Vid Sjukhus 1 hade andelen fynd ökat från 57,5% i mars 2013 till 72,4% i mars 2023, samtidigt som andelen fynd vid Sjukhus 2 i stället minskat från 54% i mars 2018 till 46,3% i mars 2023. De vanligaste fynden vid de två sjukhusen var ileus/subileus, appendicit och kolecystit/gallsten/vidgade gallvägar. Könsfördelningen visade att något fler kvinnor än män genomgick akut DT buk med iv. kontrast, (Sjukhus 1: 54% kvinnor och Sjukhus 2: 55% kvinnor). Slutsatser: Det har vid båda sjukhusen skett en ökning av antalet undersökningar men utvecklingen av andelen fynd har gått i två olika riktningar. De vanligaste patologiska fynden som görs skulle kunna ställas med hjälp av andra modaliteter med låg eller ingen stråldos, såsom konventionell röntgen eller ultraljud. Ökningen av antalet akut DT-buk med iv. kontrast har medfört en ökad arbetsbelastning för röntgensjuksköterskor.

This thesis addresses the three principal questions concerning the development of CT urography for investigating haematuria and each question is the subject of a separate chapter. The questions are: What is the reasoning behind using CT urography? What is the optimum diagnostic strategy using CT urography? What are the problems with using CT urography and how may solutions be provided? Haematuria can signify serious disease such as urinary tract stones, renal cell cancer, upper tract urothelial cancer (UTUC) and bladder cancer (BCa). CT urography is defined as contrast enhanced CT examination of kidneys, ureters and bladder. The technique used here includes unenhanced, nephrographic and excretory-phases for optimized diagnosis of stones, renal masses and urothelial cancer respectively. The reasoning behind using excretory-phase CT urography for investigating haematuria is based on results showing its high diagnostic accuracy for UTUC and BCa. Patients with haematuria are classified as low risk or high risk for UTUC and BCa, by a risk score, determined by the presence/absence of risk factors: age > 50 years, visible or nonvisible haematuria, history of smoking and occupational exposure. The optimum diagnostic strategy for patients at high risk for urothelial cancer, uses CT urography as a replacement test for ultrasonography and intravenous urography and as a triage test for flexible and rigid cystoscopy, resulting in earlier diagnosis and potentially improving prognosis. For patients at low risk, ultrasonography, unenhanced and nephrographic-phase CT urography are proposed as initial imaging tests. Problems with using CT urography include false positive results for UTUC, which are eliminated by retrograde ureteropyelography-guided biopsy, an innovative technique, for histopathological confirmation of diagnosis. Recommendations for the NHS and possible future developments are discussed. CT urography, including excretory-phase imaging, is recommended as the initial diagnostic imaging test before cystoscopy for patients with haematuria at high risk for urothelial cancer.