RESUMEN
OBJECTIVE: To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. MATERIALS AND METHODS: This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. RESULTS: The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. CONCLUSION: Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
OBJETIVO: Avaliar, prospectivamente, a acurácia da angiografia por ressonância magnética (angio-RM) sem contraste, com a sequência steady-state free precession (SSFP) 1,5 T, para a identificação de artérias renais múltiplas, usando para isso a angiografia por tomografia computadorizada (angio-TC) como padrão de referência. MATERIAIS E MÉTODOS: Trinta e nove pacientes (26 do sexo masculino; idade média de 62,6 anos) foram submetidos a angio-TC e angio-RM para avaliação dos segmentos proximais e médios das artérias renais. A análise dividiu-se em duas partes: inicialmente, a qualidade das imagens de angio-RM foi classificada como diagnóstica ou não diagnóstica por dois avaliadores independentes; posteriormente, outros dois avaliadores analisaram as imagens consideradas diagnósticas quanto à presença de múltiplas artérias renais. Sensibilidade, especificidade e acurácia da angio-RM foram calculadas utilizando-se a angio-TC como referência. Estatística kappa foi utilizada para cálculo da concordância interobservador. RESULTADOS: A qualidade das imagens de angio-RM foi considerada diagnóstica em 70-90% dos segmentos arteriais extrarrenais. A angio-TC revelou 19 artérias renais múltiplas (8 direitas e 11 esquerdas). A acurácia da angio-RM para identificação de artérias renais múltiplas foi maior que 90%, com sensibilidade variando de 72,7% a 100% e especificidade variando de 96,3% a 100%. CONCLUSÃO: A angio-RM sem contraste proporciona imagens de alta qualidade dos segmentos extrarrenais das artérias renais. Este método pode ser alternativamente utilizado para avaliação renal, com acurácia comparável à da angio-TC.
RESUMEN
Abstract Objective: To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. Materials and Methods: This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. Results: The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. Conclusion: Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
Resumo Objetivo: Avaliar, prospectivamente, a acurácia da angiografia por ressonância magnética (angio-RM) sem contraste, com a sequência steady-state free precession (SSFP) 1,5 T, para a identificação de artérias renais múltiplas, usando para isso a angiografia por tomografia computadorizada (angio-TC) como padrão de referência. Materiais e Métodos: Trinta e nove pacientes (26 do sexo masculino; idade média de 62,6 anos) foram submetidos a angio-TC e angio-RM para avaliação dos segmentos proximais e médios das artérias renais. A análise dividiu-se em duas partes: inicialmente, a qualidade das imagens de angio-RM foi classificada como diagnóstica ou não diagnóstica por dois avaliadores independentes; posteriormente, outros dois avaliadores analisaram as imagens consideradas diagnósticas quanto à presença de múltiplas artérias renais. Sensibilidade, especificidade e acurácia da angio-RM foram calculadas utilizando-se a angio-TC como referência. Estatística kappa foi utilizada para cálculo da concordância interobservador. Resultados: A qualidade das imagens de angio-RM foi considerada diagnóstica em 70-90% dos segmentos arteriais extrarrenais. A angio-TC revelou 19 artérias renais múltiplas (8 direitas e 11 esquerdas). A acurácia da angio-RM para identificação de artérias renais múltiplas foi maior que 90%, com sensibilidade variando de 72,7% a 100% e especificidade variando de 96,3% a 100%. Conclusão: A angio-RM sem contraste proporciona imagens de alta qualidade dos segmentos extrarrenais das artérias renais. Este método pode ser alternativamente utilizado para avaliação renal, com acurácia comparável à da angio-TC.
RESUMEN
BACKGROUND: The prognosis of colorectal cancer (CRC) patients can be influenced by genetic mutations and nutritional status. The relationship between these variables is unclear. The objective of the study was to verify the variables involved in the nutritional status and genetic mutations, which correlate with survival of CRC patients. METHODS: Patients with surgical intervention for tumor resection were evaluated using body mass index, nutritional screening, patient self-produced global subjective assessment, phase angle, and computed tomography to calculate the areas of visceral adipose tissue (VAT) and subcutaneous adipose tissue, and muscle mass for the determination of sarcopenia. Ten gene mutations involved in CRC carcinogenesis were studied (PIK3CA, KRAS, BRAF, EGFR, NRAS, TP53, APC, PTEN, SMAD4, and FBXW7). DNA was extracted from fresh tumor or paraffin tissues. RESULTS: Of the 46 patients, 29 (64.4%) were at nutritional risk and 21 (45.7%) were moderately malnourished. However, there was a high percentage of VAT in 24 (61.5%) and sarcopenia in 19 (48.7%) patients. These variables were associated with a higher risk of mortality. Nutritional risk, moderate or severe malnutrition, phase angle < 5°, VAT < 163.8 cm2 in men and < 80.1 cm2 in women, and sarcopenia were associated with the relative risk of death, with respective hazard ratios/odds ratios and 95% confidence intervals of 8.77 (1.14-67.1), 3.95 (1.11-14.0), 3.79 (1.10-13.1), 3.43 (1.03-11.4), and 3.95 (1.06-14.6). Increased VAT was associated with a lower risk of death, even in patients older than 60 years or those harboring mutated KRAS. CONCLUSIONS: Patients with positive indicators for malnutrition or risk of malnutrition had an increased risk of death. No relationship was identified between the presence of mutations and survival.
