Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2017-11-28T18:15:11Z No. of bitstreams: 1 Tese-MC.pdf: 2529108 bytes, checksum: d7557f03bd9245db7376252ca33303d0 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-12-04T12:45:28Z (GMT) No. of bitstreams: 1 Tese-MC.pdf: 2529108 bytes, checksum: d7557f03bd9245db7376252ca33303d0 (MD5) / Made available in DSpace on 2017-12-04T12:47:32Z (GMT). No. of bitstreams: 1 Tese-MC.pdf: 2529108 bytes, checksum: d7557f03bd9245db7376252ca33303d0 (MD5) Previous issue date: 2017-07-31 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction-objective: Cystic fibrosis is the most common genetic disease in the Caucasian population. The reduction in life expectancy is due to progressive lung disease, characterized by severe changes in the pulmonary structure, more precisely, bronchiectasis and air catabolization. Computed tomography of the chest is considered the most sensitive method to monitor lung disease in cystic fibrosis. The main disadvantage is the patient's exposure to radiation. Magnetic resonance imaging of the chest, a radiation-free technique, has been introduced as an alternative to computed tomography. Magnetic resonance has been compared to computed tomography in several studies using various sequences, but none have used the combined sensing, parallel imaging, and golden-angle radial sampling technique. The aim of this study was to evaluate the combined golden-angle radial technique of magnetic resonance imaging in patients with cystic fibrosis in relation to conventional magnetic resonance imaging and computed tomography of the chest. Cystic fibrosis has been compared to computed tomography in several studies using various sequences, but none have used the combined sensing, parallel imaging, and golden-angle radial sampling technique. The aim of this study was to evaluate the combined radial-angle golden-angle technique of magnetic resonance imaging in patients with cystic fibrosis in relation to conventional magnetic resonance imaging and computed tomography of the chest. Methods: Computed tomography and magnetic resonance of the chest were performed in 29 patients with cystic fibrosis who were followed at the pediatric pulmonology outpatient clinic of the S?o Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul. The Cartesian K-space sampling and, after the free-breathing magnetic resonance techniques, using the Golden_Angle Radial Sparse Parallel technique. Magnetic resonance imaging and computed tomography of the chest were evaluated by two independent observers using the Helbich-Bhalla score. Intraclass correlation coefficient and Bland-Altman analysis were used to assess agreement and reproducibility in the Helbich-Bhalla severity score. No patient was sedated or used contrast medium. Results: Intraclass correlation coefficients and the Bland-Altman graphical model between the Helbich-Bhalla scores and the evaluated methods, computed tomography, magnetic resonance and free breating magnetic resonance , showed very strong correlations in all comparisons of the total scores (ICCCT -RM = 97%, ICCCT-FB-RM = 96% and ICCCT-FB-RM = 99%). The association of the Helbich-Bhalla score of both computed tomography and magnetic resonance with pulmonary function tests were significant, mainly in relation to the severity of bronchiectasis and thickening of the bronchial walls. Conclusion: This study demonstrated that the new technique of free-breathing magnetic resonance and combination of compressed sensing, parallel imaging and radial golden-angle sampling, showed a good concordance with computed tomography in the assessment of pulmonary alterations in cystic fibrosis. The combined golden-angle radial technique can be used in clinical practice to monitor fibrocystic lung disease, and demonstrates particular value for patients who can not hold their breath during the examination. / Introdu??o-objetivo: Fibrose c?stica ? a doen?a gen?tica mais comum na popula??o caucasiana. A redu??o da expectativa de vida ? devido ? doen?a pulmonar progressiva, caracterizada por mudan?as severas na estrutura pulmonar, mais precisamente, bronquiectasias e alcaponamento de ar. A tomografia computadorizada de t?rax ? considerada o m?todo mais sens?vel para monitorar a doen?a pulmonar na fibrose c?stica. A principal desvantagem ? a exposi??o do paciente ? radia??o. A resson?ncia magn?tica de t?rax, t?cnica livre de radia??o, tem sido introduzida como uma alternativa ? tomografia computadorizada. A resson?ncia magn?tica tem sido comparada ? tomografia computadorizada em v?rios estudos usando v?rias sequ?ncias, mas, nenhuma utilizou a t?cnica de sensoriamento comprimido, imagem paralela e amostragem golden-angle radial combinada. O objetivo deste estudo foi avaliar a t?cnica de golden-angle radial combinada de resson?ncia magn?tica de t?rax em pacientes com fibrose c?stica em rela??o ? tomografia computadorizada e a resson?ncia magn?tica convencional de t?rax. M?todos: Foram realizados exames de tomografia computadorizada e resson?ncia magn?tica de t?rax em 29 pacientes com fibrose c?stica que eram acompanhados no ambulat?rio de pneumologia pedi?trica do Hospital S?o Lucas da Pontif?cia Universidade Cat?lica do Rio Grande do Sul. Os exames, foram realizados utilizando, primeiro, a amostragem de K-espa?o cartesiano e, ap?s, as t?cnicas de resson?ncia magn?tica com respira??o livre, utilizando a t?cnica Golden_Angle Radial Sparse Parallel. As imagens de resson?ncia magn?tica e tomografia computadorizada de t?rax foram avaliadas por dois observadores independentes utilizando o escore de Helbich-Bhalla. Coeficiente de correla??o intraclasse e an?lise de Bland-Altman foram usados para avaliar a concord?ncia e a reprodutibilidade no escore de severidade de Helbich-Bhalla. Nenhum paciente foi sedado ou usado meio de contraste. Resultados: Os coeficientes de correla??o intraclasse e o modelo gr?fico de Bland-Altman entre os escores de Helbich-Bhalla e os m?todos avaliados, tomografia computadorizada, resson?ncia magn?tica e resson?ncia magn?tica de respira??o livre, evidenciaram, em todas as compara??es dos escores totais, correla??es muito fortes (ICCCT-RM = 97%; ICCCT-FB-RM = 96% e ICCCT- FB-RM=99%). A associa??o do escore de Helbich-Bhalla, tanto da tomografia computadorizada como das imagens de resson?ncia magn?tica, com os testes de fun??o pulmonar foram significativas, principalmente, em rela??o ? severidade das bronquiectasias e espessamento das paredes br?nquicas. Conclus?o: Este estudo demonstrou que a nova t?cnica de resson?ncia magn?tica com respira??o livre e combina??o de sensoriamento comprimido, imagem paralela e amostragem golden-angle radial, mostrou uma boa concord?ncia com a tomografia computadorizada na avalia??o das altera??es pulmonares na fibrose c?stica. A t?cnica de golden-angle radial combinada pode ser utilizada na pr?tica cl?nica para acompanhamento de doen?a pulmonar fibroc?stica, e demonstra particular valor para os pacientes que n?o conseguem suspender a respira??o durante o exame.