RESUMEN
OBJECTIVE: To investigate the feasibility of developing a grading diagnostic model for schistosomiasis-induced liver fibrosis based on B-mode ultrasonographic images and clinical laboratory indicators. METHODS: Ultrasound images and clinical laboratory testing data were captured from schistosomiasis patients admitted to the Second People's Hospital of Duchang County, Jiangxi Province from 2018 to 2022. Patients with grade I schistosomiasis-induced liver fibrosis were enrolled in Group 1, and patients with grade II and III schistosomiasis-induced liver fibrosis were enrolled in Group 2. The machine learning binary classification tasks were created based on patients'radiomics and clinical laboratory data from 2018 to 2021 as the training set, and patients'radiomics and clinical laboratory data in 2022 as the validation set. The features of ultrasonographic images were labeled with the ITK-SNAP software, and the features of ultrasonographic images were extracted using the Python 3.7 package and PyRadiomics toolkit. The difference in the features of ultrasonographic images was compared between groups with t test or Mann-Whitney U test, and the key imaging features were selected with the least absolute shrinkage and selection operator (LASSO) regression algorithm. Four machine learning models were created using the Scikit-learn repository, including the support vector machine (SVM), random forest (RF), linear regression (LR) and extreme gradient boosting (XGBoost). The optimal machine learning model was screened with the receiver operating characteristic curve (ROC), and features with the greatest contributions to the differentiation features of ultrasound images in machine learning models with the SHapley Additive exPlanations (SHAP) method. RESULTS: The ultrasonographic imaging data and clinical laboratory testing data from 491 schistosomiasis patients from 2019 to 2022 were included in the study, and a total of 851 radiomics features and 54 clinical laboratory indicators were captured. Following statistical tests (t = -5.98 to 4.80, U = 6 550 to 20 994, all P values < 0.05) and screening of key features with LASSO regression, 44 features or indicators were included for the subsequent modeling. The areas under ROC curve (AUCs) were 0.763 and 0.611 for the training and validation sets of the SVM model based on clinical laboratory indicators, 0.951 and 0.892 for the training and validation sets of the SVM model based on radiomics, and 0.960 and 0.913 for the training and validation sets of the multimodal SVM model. The 10 greatest contributing features or indicators in machine learning models included 2 clinical laboratory indicators and 8 radiomics features. CONCLUSIONS: The multimodal machine learning models created based on ultrasound-based radiomics and clinical laboratory indicators are feasible for intelligent identification of schistosomiasis-induced liver fibrosis, and are effective to improve the classification effect of one-class data models.
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Cirrosis Hepática , Aprendizaje Automático , Esquistosomiasis , Ultrasonografía , Humanos , Esquistosomiasis/diagnóstico , Esquistosomiasis/diagnóstico por imagen , Cirrosis Hepática/parasitología , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/diagnóstico , Ultrasonografía/métodos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Máquina de Vectores de Soporte , Procesamiento de Imagen Asistido por Computador/métodos , RadiómicaRESUMEN
BACKGROUND: Abdominal ultrasound imaging is an important method for hepatic schistosomiasis diagnosis and staging. Several ultrasound staging systems have been proposed, each attempting to standardise schistosomal periportal fibrosis (PPF) diagnosis. This review aims to establish the role of ultrasound in the diagnosis and staging of schistosomal PPF, and to map the evolution of ultrasound staging systems over time, focusing on internal validation and external reproducibility. METHODS: A systematic search was undertaken on 21st December 2022 considering the following databases: PubMed/MEDLINE (1946-present), Embase (1974-present), Global Health (1973-present), Global Index Medicus (1901-present), and Web of Science Core Collection-Science Citation Index Expanded (1900-present) and the Cochrane Central Register of Controlled Trials (1996-present). Case reports, systematic reviews and meta-analyses, and studies exclusively using transient or shear-wave elastography were excluded. Variables extracted included study design, study population, schistosomal PPF characteristics, and diagnostic methods. The PRISMA-ScR (2018) guidelines were followed to inform the structure of the scoping analysis. RESULTS: The initial search yielded 573 unique articles, of which 168 were removed after screening titles and abstracts, 43 were not retrieved due to full texts not being available online or through inter-library loans, and 170 were excluded during full text review. There were 192 remaining studies eligible for extraction. Of the extracted studies, 61.8% (76/123) of studies that reported study year were conducted after the year 2000. Over half of all extracted studies (59.4%; 114/192) were conducted in Brazil (26.0%; 50/192), China (18.8%; 36/192) or Egypt (14.6%; 28/192). For the species of schistosome considered, 77.6% (149/192) of studies considered S. mansoni and 21.4% (41/192) of studies considered S. japonicum. The ultrasound staging systems used took on three forms: measurement-based, feature-based and image pattern-based. The Niamey protocol, a measurement and image pattern-based system, was the most used among the staging systems (32.8%; 63/192), despite being the most recently proposed in 1996. The second most used was the Cairo protocol (20.8%; 40/192). Of the studies using the Niamey protocol, 77.8% (49/63) only used the image patterns element. Where ultrasound technology was specified, studies after 2000 were more likely to use convex transducers (43.4%; 33/76) than studies conducted before 2000 (32.7%; 16/49). Reporting on ultrasound-based hepatic diagnoses and their association with clinical severity was poor. Just over half of studies (56.2%; 108/192) reported the personnel acquiring the ultrasound images. A small number (9.4%; 18/192) of studies detailed their methods of image quality assurance, and 13.0% (25/192) referenced, discussed or quantified the inter- or intra-observer variation of the staging system that was used. CONCLUSIONS: The exclusive use of the image patterns in many studies despite lack of specific acquisition guidance, the increasing number of studies over time that conduct ultrasound staging of schistosomal PPF, and the advances in ultrasound technology used since 2000 all indicate a need to consider an update to the Niamey protocol. The protocol update should simplify and prioritise what is to be assessed, advise on who is to conduct the ultrasound examination, and procedures for improved standardisation and external reproducibility.
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Cirrosis Hepática , Sistemas de Atención de Punto , Esquistosomiasis , Ultrasonografía , Humanos , Cirrosis Hepática/diagnóstico por imagen , Ultrasonografía/métodos , Esquistosomiasis/diagnóstico por imagen , Hígado/diagnóstico por imagen , Hígado/patología , Hígado/parasitología , Reproducibilidad de los ResultadosRESUMEN
Schistosomiasis is a parasitic disease that is widely considered a neglected tropical disease. It is ranked first after malaria among all parasitic diseases. The major forms of schistosomiasis are intestinal and urogenital; however, gallbladder involvement is rare and usually accompanied by imaging findings similar to those of acute cholecystitis, such as wall thickening or pericholecystic inflammation. We encountered a patient who did not show these typical imaging findings. A man in his late 40s presented to the emergency department with a 2-month history of abdominal distention. His initial laboratory examination showed iron deficiency anemia. Computed tomography revealed a mildly distended gallbladder with septations and a small calcified gallstone. Magnetic resonance imaging was performed for better characterization, and it showed gallbladder stones with multiseptated, cystic gallbladder mural lesions and no wall thickening or pericholecystic fluid. On his second visit, the patient complained of mild epigastric pain. A provisional diagnosis of cholecystitis was considered, and laparoscopic cholecystectomy was performed. Histopathological evaluation revealed a gallbladder wall with multiple foci of chronic granulomatous inflammation. Schistosoma-like ova were observed in the mucosa and submucosa and were consistent with schistosomiasis. Periodic acid-Schiff staining of the ova was positive. The patient's postoperative course was uneventful.
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Colecistitis , Enfermedades de la Vesícula Biliar , Cálculos Biliares , Esquistosomiasis , Masculino , Humanos , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/cirugía , Vesícula Biliar/patología , Colecistitis/diagnóstico por imagen , Colecistitis/cirugía , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Enfermedades de la Vesícula Biliar/cirugía , Esquistosomiasis/diagnóstico , Esquistosomiasis/diagnóstico por imagen , Inflamación/patología , Cálculos Biliares/patologíaRESUMEN
Schistosomiasis is prevalent in some developing countries; however, it does not commonly affect the breast. Mammary schistosomiasis may present as suspicious microcalcification or a mass on mammography. Image-guided biopsy is necessary to exclude malignancy and identify calcified Schistosoma ova on histology. We report a case of a patient born in the Philippines who was diagnosed with mammary schistosomiasis from incidental microcalcifications seen on mammography.
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Enfermedades de la Mama , Neoplasias de la Mama , Calcinosis , Esquistosomiasis , Humanos , Femenino , Mama/patología , Enfermedades de la Mama/diagnóstico por imagen , Enfermedades de la Mama/patología , Mamografía , Esquistosomiasis/complicaciones , Esquistosomiasis/diagnóstico por imagen , Neoplasias de la Mama/patologíaRESUMEN
Hepatosplenic schistosomiasis (HSS) is a major cause of chronic liver disease with portal hypertension (pHTN) in Africa, Asia, and America. Abdominal ultrasound is essential for diagnosis.
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Fascioliasis , Hipertensión Portal , Esquistosomiasis mansoni , Esquistosomiasis , Enfermedades del Bazo , Fascioliasis/complicaciones , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico por imagen , Esquistosomiasis/complicaciones , Esquistosomiasis/diagnóstico por imagen , Esquistosomiasis mansoni/complicaciones , Esquistosomiasis mansoni/diagnóstico por imagen , Enfermedades del Bazo/complicaciones , Enfermedades del Bazo/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVE: To construct an MR-radiomics nomogram to predict minimal hepatic encephalopathy (MHE) in patients with chronic hepatic schistosomiasis (CHS). METHODS: From July 2017 to July 2020, 236 CHS patients with non-HE (n = 140) and MHE (n = 96) were retrospective collected and randomly divided into training group and testing group. Radiomics features were extracted from substantia nigra-striatum system of a brain diffusion weighted images (DWI) and combined with clinical predictors to build a radiomics nomogram for predicting MHE in CHS patients. The ROC curve was used to evaluate the predicting performance in training group and testing group. The clinical decisive curve (CDC) was used to assess the clinical net benefit of using radiomics nomogram in predicting MHE. RESULTS: Low seralbumin (P < 0.05), low platelet count (P < 0.05) and high plasma ammonia (P < 0.05) was the significant clinical predictors for MHE in CHS patients. The AUC, specificity and sensitivity of the radiomics nomogram were 0.89, 0.90 and 0.86 in the training group, and were 0.83, 0.85 and 0.75 in the training group. The CDC analysis showed clinical net benefits for the radiomics nomogram in predicting MHE. CONCLUSIONS: The radiomics nomogram combining DWI radiomics features and clinical predictors could be useful tool to predict MHE in CHS patients.
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Encefalopatía Hepática/diagnóstico por imagen , Esquistosomiasis/complicaciones , Anciano , Amoníaco/sangre , Femenino , Encefalopatía Hepática/sangre , Encefalopatía Hepática/diagnóstico , Encefalopatía Hepática/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nomogramas , Recuento de Plaquetas , Curva ROC , Estudios Retrospectivos , Esquistosomiasis/sangre , Esquistosomiasis/diagnóstico por imagenAsunto(s)
Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/parasitología , Praziquantel/uso terapéutico , Esquistosomiasis/diagnóstico por imagen , Esquistosomiasis/patología , Antihelmínticos/uso terapéutico , Enfermedades del Colon/tratamiento farmacológico , Enfermedades del Colon/patología , Humanos , Masculino , Esquistosomiasis/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: Neuroschistosomiasis is a severe complication of schistosomiasis, triggered by the local immune reaction to egg deposition, with spinal cord involvement the most well recognised form. Early treatment with praziquantel and high dose steroids leads to a reduction of neurological sequelae. The rarity of this condition in returning travellers to high income countries can result in delayed diagnosis and treatment. We aimed to evaluate the diagnosis and management of neuroschistosomiasis in a UK national referral centre. MATERIALS/METHODS: A retrospective review of confirmed clinical cases of spinal schistosomiasis referred to the Hospital for Tropical Diseases, UK, between January 2016 and January 2020 was undertaken. Electronic referral records were interrogated and patient demographic, clinical, laboratory, and radiological data collected. RESULTS: Four cases of neuroschistosomiasis were identified. The median age at diagnosis was 28 (range 21 to 50) with three male patients. All patients had epidemiological risk factors for schistosomiasis based on travel history and freshwater exposure; two in Uganda (River Nile), one in Malawi and one in Nigeria. All patients presented with features of transverse myelitis including back pain, leg weakness, paraesthesia and urinary dysfunction. The mean time from presentation to health services to definitive treatment was 42.5 days (range 16-74 days). Diagnosis was confirmed with CSF serology for schistosomiasis in all cases. Radiological features on MRI spine included enhancement focused predominantly in the lower thoracic spinal cord in three cases and the conus in one patient. All patients received a minimum of three days of oral praziquantel and high dose steroids. At three-month follow-up, one patient had complete resolution of symptoms and three had residual deficit; one patient was left with urinary and faecal incontinence, another had urinary retention, and the final patient has persistent leg pains and constipation. CONCLUSION: We observed a marked delay in diagnosis of neuroschistosomiasis in a non-endemic country. We advocate undertaking a thorough travel history, early use of imaging and CSF schistosomal serology to ensure early diagnosis of neuroschistosomiasis in patients presenting with consistent symptoms. If schistosomal diagnostics are not immediately available, presumptive treatment under the guidance of a tropical medicine specialist should be considered to minimize the risk of residual disability. We advocate for consensus guidelines to be produced and reporting to be performed in a uniform way for patients with spinal schistosomiasis.
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Diagnóstico Tardío , Esquistosomiasis/diagnóstico por imagen , Médula Espinal/parasitología , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Malaui , Masculino , Persona de Mediana Edad , Mielitis Transversa , Neuroesquistosomiasis/diagnóstico , Nigeria , Praziquantel/uso terapéutico , Estudios Retrospectivos , Factores de Riesgo , Esquistosomiasis/tratamiento farmacológico , Esquistosomiasis/patología , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/parasitología , Centros de Atención Terciaria , Uganda , Reino Unido , Adulto JovenRESUMEN
Data on liver and spleen stiffness by 2-D shear wave elastography (2-D SWE) in hepatosplenic schistosomiasis (HES) remain scarce. We aimed to assess the correlation between single to multiple measurements of liver and spleen stiffness and to evaluate inter-hepatic lobe variability of liver stiffness measurement (LSM) using 2-D SWE in HES patients. Liver and spleen elastography were performed in HES patients in this cross-sectional study. A total of four stiffness measurements were performed in the right lobe (RL), left lobe (LL), and spleen. The correlation between the first measurement and the median of four measurements was assessed. Liver stiffness measurement of both hepatic lobes was compared. Twenty-six HES patients were included. Liver stiffness measurement was higher in the left than in the right hepatic lobe (17.9 kPa [11.3-92.0] versus 14.9 kPa [5.6-44.4]; P = 0.019). The first measurement was similar to the median of the four measurements for the RL (14.6 [5.6-60.8] versus 14.9 kPa [5.6-44.4]; P = 0.87), LL (17.4 [8.0-128.1] versus 17.9 kPa [11.3-92.0]; P = 0.54), and spleen (50.5 [10.0-157.0] versus 55.7 kPa [19.1-119.4]; P = 0.48). An excellent correlation between the first measurement and the median of four measurements for the RL (r = 0.93; P < 0.001), LL (r = 0.88; P < 0.001), and spleen (r = 0.89; P < 0.001) was observed. In HES, LSM of the LL seems to be higher than that of the right hepatic lobe. Considering the excellent correlation between the first measurement and the median of four measurements in both hepatic lobes and spleen, a single measurement would be sufficient to evaluate liver and splenic stiffness in patients with HES.
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Diagnóstico por Imagen de Elasticidad/métodos , Diagnóstico por Imagen de Elasticidad/normas , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/parasitología , Hígado/diagnóstico por imagen , Esquistosomiasis/diagnóstico por imagen , Bazo/diagnóstico por imagen , Estudios Transversales , Femenino , Humanos , Hígado/parasitología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Esquistosomiasis/complicaciones , Bazo/parasitologíaRESUMEN
OBJECTIVE: To assess the value of shear-wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal-gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis. METHODS: The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non-EGV and EGV groups, and the low- and high-risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB. RESULTS: The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non-EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high-risk EGV group (45.6%) and 49 cases in the low-risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non-EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut-off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high-risk EGVB groups than in the low-risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut-off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high-risk EGV, respectively. CONCLUSIONS: SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.
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Diagnóstico por Imagen de Elasticidad , Várices Esofágicas y Gástricas , Hemorragia , Esquistosomiasis , Anciano , Anciano de 80 o más Años , Diagnóstico por Imagen de Elasticidad/normas , Várices Esofágicas y Gástricas/diagnóstico por imagen , Várices Esofágicas y Gástricas/etiología , Femenino , Hemorragia/diagnóstico por imagen , Hemorragia/etiología , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esquistosomiasis/complicaciones , Esquistosomiasis/diagnóstico por imagen , Bazo/diagnóstico por imagenRESUMEN
A precise timeframe to differentiate acute schistosomiasis (AS) and chronic schistosomiasis (CS) is not well defined. Based on recent published literature, lung nodular lesions in AS and CS seem to have the same pathophysiology, that is, eggs laid in situ by adult worms, during an ectopic migration. Moreover, the occurrence of lung nodules due to clusters of eggs and the systemic immunoallergic reaction of AS (Katayama syndrome) may be two separate clinical entities, which may overlap during the early phase of infection. Consequently, the classical distinction between AS and CS loses much of its conceptual validity. If adult worms play a more important role in the early phase of the disease the clinical management of AS should probably be revised.
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Esquistosomiasis/diagnóstico , Esquistosomiasis/parasitología , Enfermedad Aguda , Animales , Enfermedad Crónica , Humanos , Schistosoma/fisiología , Esquistosomiasis/diagnóstico por imagenRESUMEN
Repeated praziquantel treatment for schistosomiasis is an effective method to reduce disease burden. Ultrasonographic methods were used to assess the severity of schistosoma mansoni-related liver disease and demonstrate improvement following treatment. We compared data from 733 children in 2010 and 972 children in 2018 to determine the effect of repeated praziquantel treatment on prevalence of liver disease. Three age groups were compared across three liver disease classifications (normal, mild, severe). From 2010 to 2018, there was a significant reduction in prevalence of severe liver disease in all age groups (P = 0.03 for 5-10 years, P < 0.001 for 11-15 years and 16-20 years). In both male and female students, the proportion having a normal liver significantly increased (P < 0.001) from 2010 to 2018, in the 11-15-year-olds and 16-20-year-olds, demonstrating that liver disease significantly reduced in these age groups. This study demonstrates a reduction in schistosomiasis-related morbidity with repeated praziquantel treatment.
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Antihelmínticos/administración & dosificación , Parasitosis Hepáticas/prevención & control , Praziquantel/administración & dosificación , Esquistosomiasis/prevención & control , Adolescente , Animales , Niño , Preescolar , Femenino , Humanos , Parasitosis Hepáticas/diagnóstico por imagen , Parasitosis Hepáticas/epidemiología , Parasitosis Hepáticas/patología , Masculino , Prevalencia , Población Rural , Schistosoma mansoni/efectos de los fármacos , Esquistosomiasis/diagnóstico por imagen , Esquistosomiasis/epidemiología , Esquistosomiasis/patología , Ultrasonografía , Adulto Joven , Zambia/epidemiologíaRESUMEN
A 23-year-old man presented to us with multiple episodes of visible haematuria associated with dysuria, but no other symptoms suggestive of infection. His physical examination was completely unremarkable. On detailed evaluation of history, it was noted that he was treated for urinary schistosomiasis as a child in Sudan. A diagnostic flexible cystoscopy, with both white light and narrow band imaging (NBI), was done among other tests as a further diagnostic tool to investigate possible causes. This revealed the characteristic features of bladder schistosomiasis. Urine microscopy for S chistosoma haematobium eggs was negative, and this could have caused the diagnosis to be missed. He was treated with praziquantel for chronic bladder schistosomiasis. This is the first time that the use of NBI as an adjunct to white light imaging in the diagnosis of bladder schistosomiasis has been reported.
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Imagen de Banda Estrecha , Esquistosomiasis/diagnóstico por imagen , Antihelmínticos/uso terapéutico , Hematuria , Humanos , Masculino , Praziquantel/uso terapéutico , Esquistosomiasis/tratamiento farmacológico , Adulto JovenRESUMEN
Schistosomiasis, a neglected tropical disease, is a major cause of chronic morbidity and disability, and premature death. The hepatosplenic form of schistosomiasis is characterized by hepatosplenomegaly, liver fibrosis, portal hypertension, and esophageal varices, whose rupture may cause bleeding and death. We review currently available abdominal imaging modalities and describe their basic principles, strengths, weaknesses, and usefulness in the assessment of hepatosplenic schistosomiasis (HSS). Advanced imaging methods are presented that could be of interest for hepatosplenic schistosomiasis evaluation by yielding morphological, functional, and molecular parameters of disease progression. We also provide a comprehensive view of preclinical imaging studies and current research objectives such as parasite visualization in hosts, follow-up of the host's immune response, and development of noninvasive quantitative methods for liver fibrosis assessment.
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Diagnóstico por Imagen/tendencias , Hepatopatías/diagnóstico por imagen , Hígado/diagnóstico por imagen , Esquistosomiasis/diagnóstico por imagen , Bazo/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Diagnóstico por Imagen/normas , Hígado/parasitología , Hepatopatías/parasitología , Esquistosomiasis/parasitología , Enfermedades del Bazo/parasitologíaRESUMEN
Abstract Background: Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis. Objective: To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS. Methods: cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student's t-test and the chi-square test (p < 0.05). Results: cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09). Conclusion: In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.
Resumo Fundamento: A síndrome hepatopulmonar (SHP), presente em pacientes cirróticos, é pouco estudada na esquistossomose hepatoesplênica (EHE) e inclui a ocorrência de dilatações vasculares intrapulmonares (DVP). O ecocardiograma transesofágico com contraste (ETEc) de microbolhas é mais sensível que o ecocardiograma transtorácico com contraste (ETTc) de microbolhas na identificação de DVP na cirrose. Objetivo: Avaliar o desempenho do ETEc comparado ao ETTc na identificação de DVP para diagnóstico de SHP em pacientes com EHE. Métodos: Incluímos 22 pacientes com EHE submetidos a ETEc e ETTc para pesquisa de DVP, além de exames laboratoriais. Os ETEc e ETTc foram realizados empregando-se solução salina agitada, injetada em veia periférica. A visualização tardia das microbolhas em câmaras esquerdas indicava presença de DVP. Os resultados foram comparados entre os dois métodos pelos testes t de Stu dent e qui-quadrado (significância p < 0,05). Resultados: Todos os 22 pacientes realizaram ETEc sem intercorrências. Foram excluídos três pela presença de forame oval patente (FOP), e a análise final foi realizada nos outros 19. A DVP esteve presente ao ETEc em 13 pacientes (68%) e em apenas seis ao ETTc (32%, p < 0,01). Não houve diferenças significativas nos dados clínicos e laboratoriais entre os grupos com e sem DVP, incluindo a diferença alveoloarterial de oxigênio. O diagnóstico de SHP (presença de DVP com alterações gasométricas) ocorreu em cinco pacientes pelo ETEc e em apenas um pelo ETTc (p = 0,09). Conclusão: Em pacientes com EHE, o ETEc foi seguro e superior ao ETTc na detecção de DVP não identificada ao ETTc, o que possibilitou adicionalmente excluir FOP.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Esquistosomiasis/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Ecocardiografía/métodos , Ecocardiografía Transesofágica/métodos , Dilatación Patológica/diagnóstico por imagen , Parasitosis Hepáticas/diagnóstico por imagen , Sensibilidad y Especificidad , Medios de Contraste , Síndrome Hepatopulmonar/diagnóstico , Síndrome Hepatopulmonar/diagnóstico por imagen , Microburbujas , Foramen Oval Permeable/diagnósticoRESUMEN
BACKGROUND: Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis. OBJECTIVE: To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS. METHODS: cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student's t-test and the chi-square test (p < 0.05). RESULTS: cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09). CONCLUSION: In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.