Diagnosis of transition zone prostate cancer by multiparametric MRI: added value of MR spectroscopic imaging with sLASER volume selection.

BACKGROUND: Current multiparametric MRI (mp-MRI) in routine clinical practice has poor-to-moderate diagnostic performance for transition zone prostate cancer. The aim of this study was to evaluate the potential diagnostic performance of novel 1H magnetic resonance spectroscopic imaging (MRSI) using a semi-localized adiabatic selective refocusing (sLASER) sequence with gradient offset independent adiabaticity (GOIA) pulses in addition to the routine mp-MRI, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and quantitative dynamic contrast enhancement (DCE) for transition zone prostate cancer detection, localization and grading. METHODS: Forty-one transition zone prostate cancer patients underwent mp-MRI with an external phased-array coil. Normal and cancer regions were delineated by two radiologists and divided into low-risk, intermediate-risk, and high-risk categories based on TRUS guided biopsy results. Support vector machine models were built using different clinically applicable combinations of T2WI, DWI, DCE, and MRSI. The diagnostic performance of each model in cancer detection was evaluated using the area under curve (AUC) of the receiver operating characteristic diagram. Then accuracy, sensitivity and specificity of each model were calculated. Furthermore, the correlation of mp-MRI parameters with low-risk, intermediate-risk and high-risk cancers were calculated using the Spearman correlation coefficient. RESULTS: The addition of MRSI to T2WI + DWI and T2WI + DWI + DCE improved the accuracy, sensitivity and specificity for cancer detection. The best performance was achieved with T2WI + DWI + MRSI where the addition of MRSI improved the AUC, accuracy, sensitivity and specificity from 0.86 to 0.99, 0.83 to 0.96, 0.80 to 0.95, and 0.85 to 0.97 respectively. The (choline + spermine + creatine)/citrate ratio of MRSI showed the highest correlation with cancer risk groups (r = 0.64, p < 0.01). CONCLUSION: The inclusion of GOIA-sLASER MRSI into conventional mp-MRI significantly improves the diagnostic accuracy of the detection and aggressiveness assessment of transition zone prostate cancer.

Fístula coronário-cavitária da artéria coronária circunflexa para o átrio esquerdo como provável etiologia de insuficiência cardíaca: relato de caso / Coronary­cavitary fistula of the circumflex coronary artery to the left atrium as a probable etiology of heart failure: a case report

Fístulas de artérias coronárias têm incidência baixa, sendo diagnosticadas mais frequentemente pelo ecocardiograma ou angiotomografia coronariana, embora a cineangiocoronariografia seja o método padrão-ouro. Têm origem mais comumente na artéria coronária direita, sendo a drenagem para câmaras de baixa pressão o mais habitual. O tratamento pode ser expectante, cirúrgico ou percutâneo. Este relato descreve o caso de uma rara apresentação de insuficiência cardíaca, dada por fístula da coronária circunflexa com drenagem para o átrio esquerdo. (AU)

Coronary artery fistulas have a low incidence and are often diagnosed by echocardiography or coronary computed tomography angiography, although coronary angiography is the gold standard. They commonly originate in the right coronary artery, with drainage to low-pressure chambers being the most frequent finding. Treatment can be expectant, surgical, or percutaneous. This report describes a case of a rare presentation of heart failure due to a fistula of the circumflex coronary artery with drainage into the left atrium. (AU)

New device permitting non-invasive reversal of fetal endoscopic tracheal occlusion: ex-vivo and in-vivo study.

OBJECTIVE: One of the drawbacks of fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia is the need for a second invasive intervention to re-establish airway patency. The 'Smart-TO' device is a new balloon for FETO that deflates spontaneously when placed in a strong magnetic field, therefore overcoming the need for a second procedure. The safety and efficacy of this device have not yet been demonstrated. The aim of this study was to investigate the reversibility, local side effects and occlusiveness of the Smart-TO balloon, both in a simulated in-utero environment and in the fetal lamb model. METHODS: First, the reversibility of tracheal occlusion by the Smart-TO balloon was tested in a high-fidelity simulator. Following videoscopic tracheoscopic balloon insertion, the fetal mannequin was placed within a 1-L water-filled balloon to mimic the amniotic cavity. This was held by an operator in front of their abdomen, and different fetal and maternal positions were simulated to mimic the most common clinical scenarios. Following exposure to the magnetic field generated by a 1.5-T magnetic resonance (MR) machine, deflation of the Smart-TO balloon was assessed by tracheoscopy. In cases of failed deflation, the mannequin was reinserted into a water-filled balloon for additional MR exposure, up to a maximum of three times. Secondly, reversibility, occlusiveness and local effects of the Smart-TO balloon were tested in vivo in fetal lambs. Tracheal occlusion was performed in fetal lambs on gestational day 95 (term, 145 days), either using the balloon currently used in clinical practice (Goldbal2) (n = 5) or the Smart-TO balloon (n = 5). On gestational day 116, the presence of the balloon was assessed by tracheoscopy. Deflation was performed by puncture (Goldbal2) or MR exposure (Smart-TO). Six unoccluded fetal lambs served as controls. Following euthanasia, the lung-to-body-weight ratio (LBWR), lung morphometry and tracheal circumference were assessed. Local tracheal changes were measured using a hierarchical histologic scoring system. RESULTS: Ex vivo, Smart-TO balloon deflation occurred after a single MR exposure in 100% of cases in a maternal standing position with the mannequin at a height of 95 cm (n = 32), 55 cm (n = 8) or 125 cm (n = 8), as well as when the maternal position was 'lying on a stretcher' (n = 8). Three out of eight (37.5%) balloons failed to deflate at first exposure when the maternal position was 'sitting in a wheelchair'. Of these, two balloons deflated after a second MR exposure, but one balloon remained inflated after a third exposure. In vivo, all Smart-TO balloons deflated successfully. The LBWR in fetal lambs with tracheal occlusion by a Smart-TO balloon was significantly higher than that in unoccluded controls, and was comparable with that in the Goldbal2 group. There were no differences in lung morphometry and tracheal circumference between the two balloon types. Tracheal histology showed minimal changes for both balloons. CONCLUSIONS: In a simulated in-utero environment, the Smart-TO balloon was effectively deflated by exposure of the fetus in different positions to the magnetic field of a 1.5-T MR system. There was only one failure, which occurred when the mother was sitting in a wheelchair. In healthy fetal lambs, the Smart-TO balloon is as occlusive as the clinical standard Goldbal2 system and has only limited local side effects. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Resonancia magnética cardíaca en la miocardiopatía chagásica crónica. Una herramienta para optimizar el diagnóstico, la estratificación de riesgo y el pronóstico / Cardiac magnetic resonance imaging in chronic chagasic cardiomyopathy. A tool to optimize diagnosis, risk stratification and prognosis

Resumen La enfermedad de Chagas es un problema de salud pública en Latinoamérica, donde afecta a aproximadamente a 6 millones de personas. En Costa Rica se ha descrito la enfermedad desde 1941, con varios reportes de casos confirmados agudos y crónicos. La miocardiopatía chagásica afecta al 30% de los individuos con infección crónica y es la manifestación más grave de la enfermedad, con una morbimortalidad mayor que otras miocardiopatías. La resonancia magnética cardíaca, debido a su capacidad de caracterización tisular permite identificar con alta correlación histopatológica la presencia de fibrosis, edema e inflamación en la miocardiopatía chagásica. Esto ha permitido una mejor comprensión de la compleja fisiopatología de la enfermedad y además permite el diagnóstico diferencial con otras patologías simuladoras como lo es la cardiopatía isquémica. En la MCh la presencia de fibrosis miocárdica predice de manera independiente eventos adversos mayores tales como taquicardia ventricular sostenida y muerte cardiovascular. Debido a lo anterior la resonancia magnética cardíaca es una robusta herramienta capaz de mejorar el diagnóstico, la estratificación de riesgo y el pronóstico de estos pacientes, con miras a mejores y oportunas intervenciones terapéuticas.

Abstract Chagas disease is a public health problem in Latin America, where it affects approximately 6 million people. In Costa Rica the disease has been described since 1941, with several reports of acute and chronic confirmed cases. Chagas cardiomyopathy affects 30% of individuals with chronic infection and is the most serious manifestation of the disease, with a higher morbidity and mortality than other cardiomyopathies. Cardiac magnetic resonance, due to its capacity for tissue characterization, identifies the presence of fibrosis, aedema and inflammation in Chagas cardiomyopathy with high histopathological correlation. This has allowed a better understanding of the complex pathophysiology of the disease and also allows differential diagnosis with other pathologies that can simulate, such as ischemic heart disease. In Chagas cardiomyopathy, the presence of myocardial fibrosis independently predicts major adverse events such as sustained ventricular tachycardia and cardiovascular death. Due to the above, cardiac magnetic resonance is a robust tool capable of improving the diagnosis, risk stratification and prognosis of these patients, with a view to better and timely therapeutic interventions.

Resonancia magnética en el atrapamiento del nervio supraescapular por quiste supraglenoideo / Magnetic resonance in nerve entrapment suprascapular supraglenoid cyst

El síndrome de atrapamiento del nervio supraescapular es una causa infrecuente de dolor en el hombro y de difícil diagnóstico clínico. Puede ser consecuencia de traumatismo, infección, compresión extrínseca o estiramiento secundario a movimientos repetitivos. Los quistes supraglenoideos deben considerarse en el diagnóstico diferencial pues son una causa frecuente de compresión del nervio supraescapular que ocurre casi exclusivamente en hombres. Se evaluaron con resonancia magnética (RM) y en forma retrospectiva siete pacientes con diagnóstico de atrapamiento del nervio supraescapular por quiste supraglenoideo. La RM mostró la causa y localización de la compresión nerviosa así como la distribución del edema muscular en todos los casos. Puede evaluar el grado de severidad de la enfermedad y realizar el diagnóstico diferencial con otras causas que provocarían atrapamiento del nervio supraescapular. (AU)

Suprascapular nerve entrapment has been regarded as a relatively uncommon condition that is easily overlooked in the differential diagnosis of shoulder discomfort. The common feature is nerve damage, caused either by trauma, extrinsic compression or by stretching secondary to repeated movements. Ganglion cysts account for the majority of the masses causing entrapment and seem to occur exclusively in men. Seven cases of suprascapular nerve entrapment caused by supraglenoid cyst compression were reviewed with MRI. MRI showed the cause and location of nerve compression as well as the distribution of muscular edema in all cases. MR imaging also allows an evaluation of the severity of the disease. It is also very efficient in excluding several differential diagnoses. (AU)

Mielopatía aguda compresiva por absceso pulmonar. Presentación de un caso / Compressive acute myelopathy by pulmonary abscess. A case report

Las mielopatías constituyen un conjunto heterogéneo de procesos patológicos que directa o indirectamente afectan a la médula espinal. Son poco frecuentes y pueden ser producidos por variadas causas y vías de afectación, que conllevan a grandes secuelas y elevada discapacidad. Se describe un caso de mielopatía aguda compresiva desencadenada por un absceso pulmonar como causa y mecanismo de producción inusual. Hombre de 48 años, con antecedentes de salud y cuadro clínico de inicio brusco de paraparesia fláccida e hiporreflexia osteotendinosa de miembros inferiores asimétrica, con predominio derecho, nivel sensitivo dorsal a nivel de D4 y dolor a la percusión en procesos espinosos dorsales en D3-D6. Los estudios sanguíneos, inmunológicos y de líquido cefalorraquídeo resultaron irrelevantes, excepto muestra de signos indirectos de infección. La radiografía de tórax mostró la presencia del absceso pulmonar primario derecho y la afectación medular se corroboró a través de la realización de la resonancia magnética medular dorsal. Presentó pobre respuesta ante los esteroides parenteral, hasta que se inició la terapia antibiótica, de forma paulatina y con apoyo rehabilitador. Transcurridos tres meses se investigaron y fueron descartadas otras etiologías no compresivas. Las mielopatías agudas representan un grupo heterogéneo de trastornos con distintas etiologías y mecanismos de producción, a través de su estudio se evidenció como causa un absceso pulmonar con afectación medular, por lo que debe ser considerado en la extensa lista de diagnósticos diferenciales (AU).

Myelopathies are a heterogeneous group of pathological processes that directly or indirectly affect the spinal cord. They are rare and can be produced by different causes and affectation pathways leading to major consequences and high disability. A case of acute compressive myelopathy triggered by a lung abscess as unusual cause and production mechanism is described. It is the case of a man, aged 48 years, with a clinical history and symptoms of acute onset of flaccid paraparesis and asymmetric osteotendinous hyporeflexia of lower limbs, with right predominance, dorsal sensitive level at D4, and pain at percussion in D3-D6 dorsal spinal processes. Blood, immune and cerebrospinal fluid (CSF) studies were irrelevant, but showing indirect signs of infection. Chest radiography showed the presence of the right primary lung abscess and spinal cord involvement was confirmed by performing dorsal medullar magnetic resonance (MRI). The patient had poor response to parenteral steroids until antibiotic therapy began, gradually and with rehabilitation support. After three months, other non-comprehensive etiologies were studied and ruled out. Acute myelopathies represent a heterogeneous group of disorders with different etiologies and production mechanisms. The study evidenced a lung abscess with spinal cord involvement as a cause, so it should be considered in the extensive list of differential diagnoses (AU).

Orbitectomía en monobloque en un paciente con sarcoma neurogénico de la órbita / Single block orbitectomy in a patient with neurogenic orbital sarcoma

El sarcoma neurogénico es un tumor maligno que se origina en las células de Schwann de la vaina del revestimiento de los nervios periféricos y son poco frecuentes en la órbita. Se presenta un paciente de 23 años de edad, masculino, blanco, con antecedentes de neurofibromatosis tipo I, con desplazamiento anteroinferior del globo ocular izquierdo, dolor intenso y pérdida de la visión de 4 meses de evolución. Al examen oftalmológico se constató proptosis severa con descenso del globo ocular izquierdo, oftalmoplejia total, quemosis severa, hiperemia, opacidad corneal y aumento de volumen del párpado superior. En los estudios imagenológicos se evidenció lesión tumoral que ocupaba la totalidad del compartimiento orbitario sin infiltración de sus paredes óseas y con desplazamiento del globo ocular por fuera del reborde orbitario. Se realizó un abordaje quirúrgico combinado, y se logró una orbitectomía en monobloque con resección total del tumor y reconstrucción con colgajo rotado de músculo temporal ipsilateral. El estudio histopatológico informó la presencia de un sarcoma neurogénico de la órbita y se complementó con tratamiento adyuvante con radioterapia. El paciente se mantuvo controlado durante un año y a partir de esta fecha comenzó la aparición secuencial de varias lesiones a distancia(AU)

Neurogenic sarcoma is a malignant tumor that starts in Schwann cells of the peripheral nerves sheath and is rarely found in the orbit. Here is a 23 year old, male, Caucasian patient, with a history of Type-I Neurofibromatosis, and a left eye fore and lower side displacement of the left eyeball, intense pain and loss of vision for 4 months. A severe proptosis and the lowering of the left eyeball was detected during the ophthalmologic examination, as well as total ophthalmoplegia, severe chemosis, hyperemia, corneal opacity and increased upper eyelid volume. Imaging studies revealed a tumor lesion occupying the whole orbital compartment, with no bone wall infiltration, but causing the displacement of the eyeball out of the orbit border. A combined surgical approach was performed consisting in a single block orbitectomy with total tumor resection, as well as the reconstruction with the ipsilateral temporal muscle rotated flap. The histopathology study showed the presence of an neurogenic orbital sarcoma, so an adjuvant radiotherapy treatment was indicated. The patient was followed up for a year, after which the sequential occurrence of several lesions began(AU)

Modeling of Optimal Targeted Therapies Using Drug-Loaded Magnetic Nanoparticles for Liver Cancer.

To enhance locoregional therapies for liver cancer treatment, we propose in this study a mathematical model to optimize the transcatheter arterial delivery of therapeutical agents. To maximize the effect of the treatment and minimize adverse effects on the patient, different mathematical models of the tumor growth are considered in this study to find the optimal number of the therapeutic drug-loaded magnetic nanoparticles to be administered. Three types of therapy models are considered, e.g., angiogenesis inhibition therapy, chemotherapy and radiotherapy. We use state-dependent Riccati equations (SDRE) as an optimal control methodology framework to the Hahnfeldt's tumor growth formulation. Based on this, design optimal rules are derived for each therapy to reduce the growth of a tumor through the administration of appropriate dose of antiangiogenic, radio- and chemo-therapeutic agents. Simulation results demonstrate the validity of the proposed optimal delivery approach, leading to reduced intervention time, low drug administration rates and optimal targeted delivery.

Thermal magnetic resonance: physics considerations and electromagnetic field simulations up to 23.5 Tesla (1GHz).

BACKGROUND: Glioblastoma multiforme is the most common and most aggressive malign brain tumor. The 5-year survival rate after tumor resection and adjuvant chemoradiation is only 10 %, with almost all recurrences occurring in the initially treated site. Attempts to improve local control using a higher radiation dose were not successful so that alternative additive treatments are urgently needed. Given the strong rationale for hyperthermia as part of a multimodal treatment for patients with glioblastoma, non-invasive radio frequency (RF) hyperthermia might significantly improve treatment results. METHODS: A non-invasive applicator was constructed utilizing the magnetic resonance (MR) spin excitation frequency for controlled RF hyperthermia and MR imaging in an integrated system, which we refer to as thermal MR. Applicator designs at RF frequencies 300 MHz, 500 MHz and 1GHz were investigated and examined for absolute applicable thermal dose and temperature hotspot size. Electromagnetic field (EMF) and temperature simulations were performed in human voxel models. RF heating experiments were conducted at 300 MHz and 500 MHz to characterize the applicator performance and validate the simulations. RESULTS: The feasibility of thermal MR was demonstrated at 7.0 T. The temperature could be increased by ~11 °C in 3 min in the center of a head sized phantom. Modification of the RF phases allowed steering of a temperature hotspot to a deliberately selected location. RF heating was monitored using the integrated system for MR thermometry and high spatial resolution MRI. EMF and thermal simulations demonstrated that local RF hyperthermia using the integrated system is feasible to reach a maximum temperature in the center of the human brain of 46.8 °C after 3 min of RF heating while surface temperatures stayed below 41 °C. Using higher RF frequencies reduces the size of the temperature hotspot significantly. CONCLUSION: The opportunities and capabilities of thermal magnetic resonance for RF hyperthermia interventions of intracranial lesions are intriguing. Employing such systems as an alternative additive treatment for glioblastoma multiforme might be able to improve local control by "fighting fire with fire". Interventions are not limited to the human brain and might include temperature driven targeted drug and MR contrast agent delivery and help to understand temperature dependent bio- and physiological processes in-vivo.

Tumores cardíacos - Papel da tomografia computadorizada e da ressonância magnética / Cardiac tumors - The role of computed tomography and magnetic resonance

As melhorias na aquisição e no processamento de imagens na última década permitiram uma crescente evolução do papel da ressonância cardíaca e da tomografia computadorizada na avaliação das doenças do coração. Uma série de patologias cardíacas puderam ser melhor avaliadas, dentre elas as neoplasias cardíacas. Os tumores cardíacos são encontrados em 0,002%-0,3% das autópsias e, embora sejam raros, apresentam morbidade e mortalidade elevadas, especialmente quando malignos. A grande maioria dos tumores cardíacos são secundários, metastáticos, com acometimento preferencial das câmaras direita e comprometimento do pericárdio. Dentre os tumores cardíacos primários, os mais comuns são os de origem benigna e, dentre estes, os mais frequentes são os mixomas, os lipomas e os fibroelastomas, necessariamente nesta ordem. A melhor resolução espacial e o maior campo de visão destes novos métodos também os colocam em vantagem em relação à limitações de janela acústica da ecocardiografia transtorácica. A caracterização tecidual realizada, sobretudo pela ressonância pode auxiliar na distinção entre o grau de malignidade de um tumor, ao mesmo tempo que permite a avaliação da função ventricular e do comprometimento hemodinâmico. O diagnóstico diferencial com cistos, trombos ou achados da anatomia normal pode ser realizado permitindo, em alguns casos, prescindir de biópsia miocárdica. A ressonância magnética e a tomografia computadorizada tornaram-se ferramentas importantes na decisão terapêutica e no acompanhamento desses pacientes.

The improvements in the acquisitions and processing of images in the last decade has allowed a growing evolution of the role of cardiac magnetic resonance imaging and computed tomograpgy in the evaluation of heart disease. A number of cardiac pathologies could be better evaluated, cardiac neoplasms, cardiac tumors are found in 0,002% to 0,3% of the autopsies, and although rare, have high morbidity and mortality especially when malignant. The vasty majority of cardiac tumors are secondary, metastatic, with preferential involvement of the right chambers and pericardial dissemination. Among primary cardiac tumors, the most common are benign, in order of frequency: myxomas, limpomas and fibroelastomas. The best spatial resolution and wider filder of view of these new methods also put them at an advantage over the limitations of the transthoracic echocardiographic acoustic window. Tissue characteriztion performed mainly by cardiac magnetic resonance may help distinguish between the degree of malignancy of a tumor while allowing the evaluation of ventricular function and hemodynamic compromise. The differential diagnosis of cysts, thrombi or findings of normal anatomy can be accomplished in some cases without myocardial biopsy. Magnetic resonance imaging and computed tomography are becoming important tools in deciding the treatment and monitoring of these patients.

Ressonância e tomografia computadorizada nas cardiopatias congênitas / Resonance and computed tomography in congenitalo heart disease

A diversidade de apresentações anatômica das cardiopatias congênita torna imperativa a avaliação morfológica precisa, que é um dado fundamental para definir a melhor opção de manejo, bem como a melhor tática de abordagem para cada caso individualmete. A Doppler-ecocardiografia muitas vezes atende todas as necessidades diagnósticas, mas, por vezes, é imperativo que se obtenha informações a partir de método de imagem seccional, ou seja, pela tomografia e ressonância magnética. Ambas as técnica possibilitam a análise pormenorizada, a reconstrução em diferentes planos e a reconstrução tridimensional e podem ser utilizadas para o estudo destas entidades. A ressonância tem a vantagem de dispensar o uso de radiação ionizante e permitir a avaliação funcional precisa. Já a tomografia permiti fazer exames com maior rapidez e apresenta resolução espacial superior. Estas duas tecnologias têm grande utilidade no estudo das alterações congênitas da aorta e nas cardiopatias complexas, particularmente se há envolvimento de vasos pulmonares, situação na qual a tomografia apresenta resultados superiorres. Estes exames também apresentam grande utilidade no acompanhamento pós-operatório após a correção de diferentes entidades, com destaque para o seguimento tardio da cirurgia de Jatene e no seguimento pós-intervenção percutânea. Finalmente, deve ser lembrado que no caso de avaliações pós-implante de stent, o uso da tomografia é o que se impõe, uma vez que a ressonância sofre de muitos artefatos devido à presença das estruturas metálicas.

There is great diversity in the anatomical features of patients with congenital heart disease and the precise morphological evaluation is fundamental for the proper patient management. Doppler-echocardiography often furnishes optimal data, but in many instances there is need to perfect the imaging evaluation, a goal achieved by magnetic resonance imaging and computed tomography. Both allow optimal multiplane and tridimendional reconstruction. Cardiac magnetic resonance does not use any type of ionizing radiation and warrants optimal functional evaluation. Computed tomography, on the other hand, requirer patient exposition to X rays and also the use of iodine contrast media, but has excelent spatial resolution and is acquire in very short times. Among different clinical conditions that benefit from this approach we underscore aortic abnormalities. Complex congenital heart disease, particularly envolving pulmonary vascular abnormalities also represent conditions that are optimally evaluated by magnetic resonance and computed tomography. Likewise these are excellent techniques for the follow-up after surgical and interventional procedures, such as Jatene procedure and stent implantation, a condition which is properly analyzed by computed tomography.

[Impact of magnetic resonance therapy on sickness absence of patients with nerve root irritation following a lumbar disc problem]. / Effekte der Kernspinresonanztherapie auf Krankenstand bei Patienten mit Nervenwurzelirritation infolge eines lumbalen Bandscheibenvorfalls.

BACKGROUND: The prevalence of spinal symptoms in Western industrialised countries ranges up to 80 %. Back pain ranks second among the most common reasons to seek medical advice. The resulting financial burden on the health-care system is proportional to the subjectively experienced pain. The aim of the present study was to determine whether the use of magnetic resonance therapy alters the duration of sickness absence in patients with discogenic radiculopathy. PATIENTS AND METHOD: In a double-blind prospective randomised study, the use of magnetic resonance therapy for back pain in patients with discogenic radiculopathy was evaluated in the context of health economics. Patients aged 20 to 55 years with lumboischialgia and no indication for surgery were included in the study. The primary variable was the number of days of sickness absence in a study group before and after magnetic field therapy, and in a control group. The number of days of sickness absence was determined on the basis of a pain diary and by telephone inquiry. RESULTS: Patients who were treated with an activated magnetic resonance therapy device had significantly fewer days of sickness absence (p = 0.009) when evaluated by personal telephone calls. The duration of sickness absence before therapy was 14.7 days and that after therapy 5.8 days. In contrast, the days of sickness absence in the control group were 7.6 days before therapy and 13.8 days after therapy. The duration of symptoms was negatively correlated with the days of sickness absence. Patients who reported a burden at work had more days of sickness absence (8.3 days) than those with no burden at work (3.2 days). This correlation does not apply to familial burden. The cost-effectiveness analysis showed different degrees of compensation of the cost of magnetic resonance therapy, depending on the occupational group. Direct and indirect costs of magnetic resonance therapy were compensated by 16.9 fewer days of sickness absence among workers, 11.4 fewer days of sickness absence among employees, and 9.1 fewer days of sickness absence among civil servants. CONCLUSION: Based on the number of days of sickness absence, the study confirmed that a relatively economical alternative technique is able to provide pain relief as well as benefit the health economy. Unemployed patients or patients who have submitted an application for a pension may be problematic because they may not wish to be pronounced healthy by their doctors.

A importância do diagnóstico precoce e tratamento da taquicardiomiopatia / Importance of early diagnosis and treatment of tachycardiomyopathy

A taquicardiomiopatia é uma rara doença caracterizada por disfunção ventricular sistólica e insuficiência cardíaca congestiva causadas por taquiarritmias persistentes ourepetitivas com frequência cardíaca elevada, cujas manifestações clínicas são reversíveis com a normalização do ritmo cardíaco em pacientes sem uma doença estrutural cardíaca estabelecida. Relata-se o caso de paciente não cardiopata que apresentou acidente vascular encefálico como evento inicial, sendo definido na investigação taquicardiomiopatia desencadeada por taquiarritmia persistente.

Tachycardiomyopathy is a rare disease characterized by ventricular systolic dysfunction and heart failure causedby persistent or repetitive tachyarrhythmias with rapidheartbeats, whose clinical manifestations may be reversed by bringing the cardiac rhythm back to normal in patients with no established structural cardiac disease. This casestudy reports on a patient with no heart disease presenting a stroke as the initial event, defined in the research as tachycardiomyopathy triggered by persistent tachyarrhythmia.

Avaliação de dissincronia ventricular por métodos de imagem: visão da eletrofisiologia, ecocardiografia e ressonância magnética / Imaging cardiac resynchronization therapy: the vision of eletrophisiology, echocardiogram and MRI

A terapia de ressincronização cardíaca (TRC) estabeleceu-se na última década, como uma nova estratégia de tratamento de pacientes com insuficiência cardíaca refratária ao tratamento clínico. Entretanto, cerca de 20 a 30% dos pacientes não são responsivos à TRC, o que enfatiza a necessidade de se empenhar melhores critérios para a seleção de pacientes. Diversos estudos clínicos demonstraram resultados mais favoráveis à TRC, quando os pacientes apresentavam dissincronia mecânica do VE à ecocardiografia. No entanto, o resultado do principal estudo multicêntrico prospect demonstrou somente uma modesta acurácia dos parâmetros ecocardiográficos de dissincronia do VE, na predição à TRC. Esse resultado reforça a noção de que dissincronia mecânica é somente um dos substratos da TRC, e que outros fatores, tais como a viabilidade miocárdica e a presença de cicatriz transmural, na região em que usualmente realiza-se a estimulação do VE, são fatores relevantes no sucesso desse tratamento. Nesta revisão, realizou-se, uma avaliação geral sobre a TRC e discutiu-se os principais métodos de avaliação de dissincronia ao ecocardiograma e ressonância magnética, sua aplicação na prática clínica atual e as perspectivas futuras.

Describen la utilidad de la resonancia magnética en el diagnóstico del cáncer de cerviz: [revisión] / Advances in imaging diagnosis, scheduling and radiotherapy for cervical cancer: [review]

La resonancia magnética (RM) es una herramienta de gran ayuda para la evaluación del cáncer de cérvix. Cuando se integra junto a los hallazgos clínicos, permite optimizar el plan de tratamiento. En el cáncer de cérvix la RM es superior a otras modalidades de diagnóstico por imágenes, tanto para la estadificación local como para la identificación de recurrencias locales. Esta preferencia se debe al desarrollo de nuevas secuencias y antenas, la introducción de nuevos agentes de contraste y la evidencia acumulada durante los últimos años de la gran eficacia de la RM en la evaluación y manejo del cáncer de cérvix. Las principales limitaciones de la estadificación clínica son la evaluación del parametrio, la invasión de la pared pélvica, la extensión proximal del tumor y la evaluación de las metástasis línfáticas. La RM es la técnica más precisa para el estudio de estas estructuras, ya que tiene un importante papel para determinar el volumen tumoral, la localización, el estadio y la extensión proximal con vistas a una posible cirugía con preservación de la fertilidad. En un futuro cercano, el desarrollo de nuevas técnicas incrementará su potencial en el diagnóstico y seguimiento de estas pacientes. La secuencia ponderada en difusión es una técnica recientemente introducida basada en difusión molecular, muy útil para discriminar entre lesiones benignas y malignas y para el estudio de diseminación peritoneal.

Edema de la médula ósea de la rodilla / Bone marrow edema of knee

Bone marrow edema (BME) or transient bone marrow edema syndrome (TMES) affects the joints, particularly thehip and less frequently the knee and ankle. Knee problemsare usually related to traumatic causes, nevertheless, this can also be caused by micro traumatisms brought on bydaily life or overload. Diagnosis is confirmed by usingnuclear magnetic resonance (NMR), since both x-rays andcomputer assisted tomographies (CAT) are unsupportive,and scintigraph, though sensitive, is none specific. It isdescribed as the cause of pain in osteoarthritis and canalso be observed in transitory osteoporosis, in migratoryregional osteoporosis, and in the first stage of avascularbone necrosis (ABN), which is its main differential diagnosis. We present three cases of patients with knee pain, with no history of contusion. Two cases presented minor signs of osteoarthritis, two presented a decrease in bone density, and one presented hyperlaxity. NMRs were required, since normal procedures led to no results, and showed the existence of BME. Treatment was conservative, specially oriented towards unloading the joints, with a favorable evolution prior to six months.