Análise comparativa de dois volumes diferentes de agente de contraste oral para enterografia por tomografia computadorizada em pacientes com doença de Crohn / Comparative analysis of two oral contrast agent volumes for computed tomography enterography in crohn's disease patients

ABSTRACT BACKGROUND: Crohn's disease (CD) is an inflammatory bowel disease characterized by a chronic and recurrent inflammation of the gastrointestinal tract caused by an interaction of genetic and environmental factors. OBJECTIVE: To compare the quality and acceptance of two different oral contrast volumes for computed tomography enterography in Crohn's disease patients. METHODS: A cross-sectional study was conducted in 58 consecutive Crohn's disease patients who randomly received an oral contrast agent composed of 78.75 g polyethylene glycol diluted in either 1,000 mL or 2,000 mL of water. An examination was performed to evaluate the presence of inflammation or complications in the small bowel. The variables included the quality of intestinal segment filling and luminal distension, and oral contrast agent acceptance and tolerance in the patients. Statistical analysis included descriptive statistics and association tests. RESULTS: A total of 58 patients were assessed, in which 58.6% were female, 34.5% exhibited clinically-active disease, and 63.8% were receiving biologic therapy. As for comparative analysis between the two different volumes of oral contrast, no statistically significant difference was found regarding bowel loop filling (P=0.58) and adequate luminal distension (P=0.45). Patients who received a larger volume (2,000 mL) exhibited side-effects more frequently (51.7% vs 31.0%; P=0.06) and had greater difficulty ingesting the agent (65.5% vs 37.9%; P=0.07) compared with a volume of 1,000 mL. CONCLUSION: The quality of computed tomography enterography was not influenced by the contrast volume. However, acceptance and tolerance were better in the 1,000 mL group.

RESUMO CONTEXTO: A doença de Crohn (DC) é uma doença inflamatória intestinal caracterizada por uma inflamação crônica e recorrente do trato gastrointestinal causada por uma interação de fatores genéticos e ambientais. OBJETIVO: Comparar a qualidade e aceitação de dois volumes diferentes de contraste oral para enterografia por tomografia computadorizada em pacientes com doença de Crohn. MÉTODOS: Um estudo transversal foi conduzido em 58 pacientes com doença de Crohn que receberam aleatoriamente um agente de contraste oral composto por 78,75 g de polietilenoglicol diluído em 1.000 mL ou 2.000 mL de água. Um exame foi realizado para avaliar a presença de inflamação ou complicações no intestino delgado. As variáveis incluíram a qualidade do preenchimento do segmento intestinal e distensão luminal e aceitação e tolerância do contraste oral nos pacientes. A análise estatística incluiu estatística descritiva e testes de associação. RESULTADOS: Foram avaliados 58 pacientes, dos quais 58,6% eram mulheres, 34,5% apresentavam doença clinicamente ativa e 63,8% estavam recebendo terapia biológica. Quanto à análise comparativa entre os dois diferentes volumes de contraste oral, não foi encontrada diferença estatisticamente significativa em relação ao enchimento da alça intestinal (P=0,58) e distensão luminal adequada (P=0,45). Pacientes que receberam um volume maior (2.000 mL) exibiram efeitos colaterais com mais frequência (51,7% vs 31,0%; P=0,06) e tiveram maior dificuldade para ingerir o agente (65,5% vs 37,9%; P=0,07) em comparação com um volume de 1.000 mL. CONCLUSÃO: A qualidade da entero-tomografia computadorizada não foi influenciada pelo volume de contraste. No entanto, aceitação e tolerância foram melhores no grupo de 1.000 mL.

Adult cerebellar medulloblastoma: CT and MRI findings in eight cases

Medulloblastoma is a brain tumor of neuroepithelial origin, which represents 15 to 30 percent of all pediatric brain tumors, and less than 1 percent of CNS adult neoplasms. We report the imaging findings of 8 adult patients with medulloblastoma. The mean age was 35 years, ranging from 20 to 65 years, and the male:female rate was 3:5. The tumors were predominantly lateral (63 percent), hyperdense on CT scans (83 percent), and on the MRI, hypointense on T1 (100 percent) and hyperintense on T2 (80 percent) weighted images. It was seen intratumoral necrosis and cysts in six cases and calcifications in three. Hydrocephalus was observed in 5 cases and brain stem invasion in four. The imaging findings of medulloblastomas in adults are different of those in child, and also nonspecific. Although these tumors are uncommon in adults, they must be considered in the differential diagnosis of cerebellar masses in the posterior fossa of this age group