Los estudios por imágenes en la evaluación del niño con estridor / Imaging studies in evaluating children with stridor

El estridor es un síntoma de obstrucción de la vía aérea superior y puede ser resultado de causas congénitas o adquiridas. El diagnóstico suele ser clínico. Si es necesaria una investigación adicional para el diagnóstico diferencial, la endoscopia es el método de elección en la mayoría de los casos. Los estudios por imágenes son complementarios a la endoscopia. Permiten evaluar la patología laríngea y traqueobronquial, las compresiones extrínsecas de la vía aérea por tumores o malformaciones vasculares y definir la localización, extensión y características de una lesión. Son útiles en casos de duda diagnóstica y cuando la endoscopia no está disponible. Es fundamental comprender la anatomía y fisiopatología del tracto respiratorio, y ser conscientes de las indicaciones y limitaciones de los exámenes complementarios para el diagnóstico adecuado. Se describen las diferentes modalidades de imágenes disponibles para evaluar el estridor en pediatría y se discuten sus ventajas.

Stridor is a symptom of upper airway obstruction and may result from congenital or acquired causes. The diagnosis is usually clinical. If further investigation is necessary for differential diagnosis, endoscopy is the method of choice in most cases. Imaging studies are complementary to endoscopy. They allow evaluation of laryngeal and tracheobronchial pathology and extrinsic airway compressions due to tumors or vascular malformations and define a lesion's location, extent, and characteristics. They are helpful in cases of diagnostic doubt and when endoscopy is unavailable. It is essential to understand the anatomy and pathophysiology of the respiratory tract and to be aware of the indications and limitations of complementary examinations for proper diagnosis. The different imaging modalities available to evaluate stridor in pediatrics are described, and their advantages are discussed.

Imaging diagnosis of compound - complex odontoma and impacted dental elements: a case report

O odontoma é o mais comum tumor odontogênico, definido como malformação benigna, geralmente descoberto na segunda década de vida, durante a investigação de erupção tardia de dentes adjacentes ou retenção prolongada de dentes decíduos. O odontoma é subdividido em composto e complexo. O Odontoma classificado como Composto é constituído por um conjunto de estruturas similares a dentes, de formas e tamanhos diversos, cercados por uma área delgada radiolúcida. Já o Odontoma Complexo se assemelha a uma massa calcificada que apresenta a mesma radiopacidade do tecido dentário, também cercado por uma área delgada radiolúcida. Ocasionalmente, esses dois aspectos podem ser vistos em uma mesma lesão. Frequentemente os odontomas podem provocar um aumento de volume ósseo local devido ao seu desenvolvimento. O diagnóstico é feito através de exames radiográficos de rotina e quando necessário pode-se também lançar mão de Radiografias Panorâmicas e Tomografia Computadorizada Cone Beam com o intuito de verificar sua extensão, as malformações e alterações de erupção causadas aos dentes adjacentes, assim como a classificação do tumor. Este relato de caso apresenta um Odontoma Composto-Complexo em um paciente de 13 anos, do sexo masculino, atendido em 2016 na Clínica de Diagnóstico Bucal II da Universidade Federal Fluminense, que apresentou elementos dentários 22 e 23 impactados, retenção prolongada do elemento 63 e aumento de volume na região anterior do lado esquerdo da maxila. Para obtenção do diagnóstico foram realizadas: Radiografias Periapicais, Radiografia Panorâmica e Tomografia Computadorizada Cone Beam. O objetivo deste trabalho foi elucidar as formas de diagnóstico por imagem que foram utilizadas neste caso clínico e quais as vantagens de cada exame.

Odontomas are the most common type of odontogenic tumors, defined as a benign malformation, usually diagnosed in the second decade of life, during the investigation of late adjacent teeth eruption or a delay in exfoliation of deciduous teeth. They are divided into two types: compound and complex. The odontoma classified as compound is composed of multiple small tooth-like structures, in several shapes and sizes, surrounded by a thin radiolucent rim. On the other hand, complex odontomas resemble a mass of calcified tissue that presents the same dental tissue radiopacity, also surrounded by a thin radiolucent rim. Occasionally, both aspects can be seen in the same lesion. Often, odontomas can cause a local increase in bone volume due to their development. The diagnosis is made through routine radiographic examination and, when it is necessary, it is possible to make use of panoramic radiographies and cone beam computed tomography with the purpose of verifying its extension, malformations and erupted alterations caused to the adjacent teeth, as well as the tumor classification. This case report presents a Compound-Complex Odontoma in a 13-year-old male patient, treated in 2016 at the Oral Diagnosis Clinic II of the Federal Fluminense University. He presented impacted teeth 22 and 23, delayed eruption of tooth 63 and volume increase in the left anterior maxilla site. Aiming the patient's diagnosis, the following exams were necessary: periapical radiographies, panoramic radiography, cone beam computed tomography. The aim of this paper is to explain the different image diagnostic tools which were used in this clinical study and what are the advantages of each exam.

Drenaje venoso anómalo. Vena cava superior izquierda persistente que drena en la aurícula derecha y vena cava superior derecha que drena en la aurícula izquierda: reporte de un caso / Anomalous Venous Drainage. Persistent Left Superior Vena Cava Draining into the Right Atrium and Right Superior Vena Cava Draining into the Left Atrium: Case Report

Introducción: Entre 0,3-0,5% de niños nacidos presentan una vena cava superior izquierda persistente, lo que lo hace una de las malformaciones congénitas más frecuentes del drenaje venoso. El drenaje de esta en la aurícula derecha, además del drenaje de la vena cava superior derecha en la aurícula izquierda, es extremadamente infrecuente. Caso Clínico: Se presenta el caso de un infante de 8 meses asintomático que es llevado a consulta por presentar desaturaciones. El examen físico es normal. El ecocardiograma de contraste con solución salina muestra una vena cava superior izquierda persistente que drena en la aurícula derecha y un retorno anómalo de la vena cava superior derecha. Se realiza una corrección quirúrgica y evoluciona de forma favorable. Conclusión: La presentación en simultáneo de una vena cava superior izquierda persistente que drena en la aurícula derecha y una vena cava derecha que drena en la aurícula izquierda es extremadamente rara. La mayoría de los casos registrados se diagnosticaron de manera incidental en personas adultas al no presentar síntomas.

Introduction: Between 0.3-0.5% of children born have a persistent left superior vena cava, which makes it one of the most frequent congenital malformations of venous drainage. Drainage of this vein into the right atrium, in addition to drainage of the right superior vena cava into the left atrium, is extremely rare. Clinical case: We present a case of an asymptomatic 8-month-old infant who was taken to the clinic for desaturations. Physical examination was normal. The contrast echocardiogram with saline solution showed a persistent left superior vena cava draining into the right atrium and an anomalous return of the right superior vena cava. Surgical correction was performed and the patient evolved favorably. Conclusion: The simultaneous presentation of a persistent left superior vena cava draining into the right atrium and a right superior vena cava draining into the left atrium is extremely rare. Most of the reported cases were diagnosed incidentally in adults in the absence of symptoms.

Sarcoma de Ewing extraesquelético: reporte de caso / Extraskeletal Ewing's Sarcoma: a Case Report

Introducción: El sarcoma de Ewing es un tumor maligno de alto grado con localización principalmente ósea; se han reportado aproximadamente 12% con presentación extra-esquelética. Actualmente, existen alrededor de 20 casos descritos en la literatura con origen mediastinal y 10 casos con origen pulmonar. Caso clínico: Se presenta el caso de una mujer de 25 años con un mes de disnea y dolor torácico, con el hallazgo de derrame pleural masivo y tumoración mediastinal en hemitórax derecho. Se le realiza toracotomía anterior bilateral con esternotomía transversa de Clamshell, con resección parcial que demuestra, por patología, sarcoma monomórfico de alto grado e inmunohistoquímica concluyente de sarcoma de Ewing. Conclusión: Este caso es una entidad rara y conlleva un reto diagnóstico para el clínico; sin embargo, debe sospecharse considerando la presentación clínica y radiológica del paciente, buscando incrementar la tasa de supervivencia mediante el diagnóstico y tratamiento oportuno.

Introduction: Ewing's sarcoma is a high-grade malignant tumor with mainly bony lo-calization; approximately 12% have been reported with extraskeletal presentation. Currently, there are about 20 cases described in the literature with mediastinal origin and 10 pulmonary cases. Case Report: We present the case of a 25-year-old woman with one month of dysp-nea and chest pain, with massive pleural effusion and mediastinal tumor in the right hemithorax who underwent bilateral anterior thoracotomy with Clamshell transverse sternotomy, with partial resection demonstrating, by pathology, high-grade monomorphic sarcoma and conclusive immunohistochemistry of Ewing's sarcoma. Conclusion: This case is a rare entity and involves a diagnostic challenge for the clinician; however, it should be suspected considering the clinical and radiological presentation of the patient, seeking to increase the survival rate through timely diagnosis and treatment.

Leiomioma intraligamentario degenerado como simulador de patología maligna de ovario. Reporte de un caso / Degenerated intraligamentary leiomioma as a simulator of malignant ovarian pathology. Report of a case

Los leiomiomas son tumores mesenquimatosos benignos que se presentan como la neoplasia uterina más común en mujeres en edad reproductiva. Según su crecimiento, se puede ver comprometido su aporte sanguíneo, ocurriendo cambios degenerativos por la carencia de oxígeno, lo cual le confiere un aspecto atípico que puede generar confusión con el diagnostico. Se describe caso de paciente de 47 años de edad, quien consulta por aumento progresivo de volumen de circunferencia abdominal de 7 meses de evolución, referida a la consulta de ginecología oncológica por gran masa tumoral retrouterina de probable origen ovárico con elevado riesgo de malignidad. Luego de realizar estudios preoperatorios es llevada a quirófano, obteniéndose como diagnóstico definitivo, leiomioma con degeneración hialina e hidrópica focal. Los leiomiomas con cambios degenerativos pueden simular tumores malignos de ovario, por lo cual deben ser considerados como un diagnóstico diferencial antes de intervenciones quirúrgicas por tumores abdominopélvicos de gran tamaño(AU)

Leiomyomas are benign mesenchymal tumors that occur as the most common uterine neoplasm in women of reproductive age. Depending on its growth, its blood supply may be compromised, causing degenerative changes due to lack of oxygen, which gives it an atypical appearance that may cause confusion with the diagnosis. The case of a 47-year-old patient is described, who consults for a progressive increase in the volume of abdominal circumference of 7 months of evolution, referred to the gynecology oncology consultation due to a large retrouterine tumor mass of probable ovarian origin with a high risk of malignancy. After performing preoperative studies, she was taken to the operating room, obtaining as a definitive diagnosis, leiomyoma with hyaline and focal hydropic degeneration. Leiomyomas with degenerative changes can simulate malignant ovarian tumors, which is why they should be considered as a differential diagnosis before surgical interventions for large abdominopelvic tumors(AU)

Pilot deployment of a cloud-based universal medical image repository in a large public health system: A protocol study.

This paper outlines the protocol for the deployment of a cloud-based universal medical image repository system. The proposal aims not only at the deployment but also at the automatic expansion of the platform, incorporating Artificial Intelligence (AI) for the analysis of medical image examinations. The methodology encompasses efficient data management through a universal database, along with the deployment of various AI models designed to assist in diagnostic decision-making. By presenting this protocol, the goal is to overcome technical challenges and issues that impact all phases of the workflow, from data management to the deployment of AI models in the healthcare sector. These challenges include ethical considerations, compliance with legal regulations, establishing user trust, and ensuring data security. The system has been deployed, with a tested and validated proof of concept, possessing the capability to receive thousands of images daily and to sustain the ongoing deployment of new AI models to expedite the analysis process in medical image exams.

A Data Ingestion Procedure towards a Medical Images Repository.

This article presents an ingestion procedure towards an interoperable repository called ALPACS (Anonymized Local Picture Archiving and Communication System). ALPACS provides services to clinical and hospital users, who can access the repository data through an Artificial Intelligence (AI) application called PROXIMITY. This article shows the automated procedure for data ingestion from the medical imaging provider to the ALPACS repository. The data ingestion procedure was successfully applied by the data provider (Hospital Clínico de la Universidad de Chile, HCUCH) using a pseudo-anonymization algorithm at the source, thereby ensuring that the privacy of patients' sensitive data is respected. Data transfer was carried out using international communication standards for health systems, which allows for replication of the procedure by other institutions that provide medical images. OBJECTIVES: This article aims to create a repository of 33,000 medical CT images and 33,000 diagnostic reports with international standards (HL7 HAPI FHIR, DICOM, SNOMED). This goal requires devising a data ingestion procedure that can be replicated by other provider institutions, guaranteeing data privacy by implementing a pseudo-anonymization algorithm at the source, and generating labels from annotations via NLP. METHODOLOGY: Our approach involves hybrid on-premise/cloud deployment of PACS and FHIR services, including transfer services for anonymized data to populate the repository through a structured ingestion procedure. We used NLP over the diagnostic reports to generate annotations, which were then used to train ML algorithms for content-based similar exam recovery. OUTCOMES: We successfully implemented ALPACS and PROXIMITY 2.0, ingesting almost 19,000 thorax CT exams to date along with their corresponding reports.

Factores etiopatogénicos de maloclusión: el factor dentario en la organización de la oclusión. Parte III / Etiopathogenic factors of malocclusion: the dental effect in occlusal organization. Part III

Esta publicación es la última de una serie de tres, dirigida a la organización de la oclusión, en el marco de un enfoque sistémico. En las anteriores fueron desarrollados los temas referidos al espacio en los arcos dentarios restando analizar, entonces, aspectos de la erupción dentaria. Al respecto, se sintetizarán conceptos de la evolución deseable desde el origen de los folículos dentarios hasta su inclusión en el arco y contacto con el antagonista y se presentarán ejemplos de alteraciones ordenadas según el avance biológico de la dentición (AU)

This publication is the last in a series of three, aimed at the organization of occlusion, within the framework of a systemic approach. In the previous ones, the topics related to the space in the dental arches were developed, leaving to analyze, then, aspects of the dental eruption. In this regard, concepts of the desirable evolution from the origin of the dental follicles to their inclusion in the arch and contact with the antagonist will be synthesized, and examples of alterations ordered according to the biological progress of the dentition will be presented (AU)

TEMPy: a toolkit for the modeling of weighted tissue equivalent material in diagnostic imaging.

Objective.Accurate simulation of human tissues is imperative for advancements in diagnostic imaging, particularly in the fields of dosimetry and image quality evaluation. Developing Tissue Equivalent Materials (TEMs) with radiological characteristics akin to those of human tissues is essential for ensuring the reliability and relevance of imaging studies. This study presents the development of a mathematical model and a new toolkit (TEMPy) for obtaining the best composition of materials that mimic the radiological characteristics of human tissues. The model and the toolkit are described, along with an example showcasing its application to obtain desired TEMs.Approach.The methodology consisted of fitting volume fractions of the components of TEM in order to determine its linear attenuation coefficient as close as possible to the linear attenuation coefficient of the reference material. The fitting procedure adopted a modified Least Square Method including a weight function. This function reflects the contribution of the x-ray spectra in the suitable energy range of interest. TEMPy can also be used to estimate the effective atomic number and electron density of the resulting TEM.Main results.TEMPy was used to obtain the chemical composition of materials equivalent to water and soft tissue, in the energy range used in x-ray imaging (10 -150 keV) and for breast tissue using the energy range (5-40 keV). The maximum relative difference between the linear attenuation coefficients of the developed and reference materials was ±5% in the considered energy ranges.Significance.TEMPy facilitates the formulation of TEMs with radiological properties closely mimicking those of real tissues, aiding in the preparation of physical anthropomorphic or geometric phantoms for various applications. The toolkit is freely available to interested readers.

Imaging studies in evaluating children with stridor. / Los estudios por imágenes en la evaluación del niño con estridor.

Stridor is a symptom of upper airway obstruction and may result from congenital or acquired causes. The diagnosis is usually clinical. If further investigation is necessary for differential diagnosis, endoscopy is the method of choice in most cases. Imaging studies are complementary to endoscopy. They allow evaluation of laryngeal and tracheobronchial pathology and extrinsic airway compressions due to tumors or vascular malformations and define a lesion's location, extent, and characteristics. They are helpful in cases of diagnostic doubt and when endoscopy is unavailable. It is essential to understand the anatomy and pathophysiology of the respiratory tract and to be aware of the indications and limitations of complementary examinations for proper diagnosis. The different imaging modalities available to evaluate stridor in pediatrics are described, and their advantages are discussed.

El estridor es un síntoma de obstrucción de la vía aérea superior y puede ser resultado de causas congénitas o adquiridas. El diagnóstico suele ser clínico. Si es necesaria una investigación adicional para el diagnóstico diferencial, la endoscopia es el método de elección en la mayoría de los casos. Los estudios por imágenes son complementarios a la endoscopia. Permiten evaluar la patología laríngea y traqueobronquial, las compresiones extrínsecas de la vía aérea por tumores o malformaciones vasculares y definir la localización, extensión y características de una lesión. Son útiles en casos de duda diagnóstica y cuando la endoscopia no está disponible. Es fundamental comprender la anatomía y fisiopatología del tracto respiratorio, y ser conscientes de las indicaciones y limitaciones de los exámenes complementarios para el diagnóstico adecuado. Se describen las diferentes modalidades de imágenes disponibles para evaluar el estridor en pediatría y se discuten sus ventajas.

Tuberculosis extrapulmonar en paciente embarazada. Reporte de caso / Extrapulmonary Tuberculosis in Pregnant Patient. Case Report

Introducción: La tuberculosis (TB) extrapulmonar es la afectación de cualquier órgano, sin compromiso pulmonar demostrado, como consecuencia de la diseminación hematógena/linfática del bacilo de Koch. Presentación de caso: Paciente en puerperio inmediato cursando cuadro clínico de gonalgia que se estudió con resonancia magnética que mostró lesión endomedular en región distal del fémur izquierdo. Se estudió con tomografía de tórax, abdomen y pelvis que evidenciaron otras lesiones a nivel esplénico, sin compromiso hepático ni pulmonar. Se realizó punción diagnóstica femoral con evidencia de granulomas con necrosis central. Se interpretó tuberculosis extrapulmonar y se inició tratamiento antifímico con mejora sintomática. Discusión: La TB extrapulmonar puede impactar a nivel de pleura, ganglios linfáticos, vías urinarias, sistema osteoarticular, sistema nervioso central y abdomen. En el embarazo, la prevalencia de TB extrapulmonar es baja. Conclusión: La TB femoral y esplénica concomitante en pacientes embarazadas es un hallazgo infrecuente por lo que su análisis resulta de gran importancia. Arribar al diagnóstico requiere un elevado índice de sospecha. El retraso diagnóstico conlleva a un aumento de la morbimortalidad

Introduction: Extrapulmonary tuberculosis (TB) is the involvement of any organ, without demonstrated pulmonary involvement, as a consequence of the hematogenous/lymphatic dissemination of the Koch bacillus. Case presentation: Patient in the immediate postpartum period with clinical symptoms of gonalgia that was studied with magnetic resonance imaging showing intramedullary lesion in the distal region of the left femur. A CT scan of the chest, abdomen and pelvis showed other lesions at the splenic level, without liver or lung involvement. A femoral diagnostic puncture was performed with evidence of granulomas with central necrosis. Extrapulmonary tuberculosis was interpreted and antifimic treatment was started with symptomatic improvement. Discussion: Extrapulmonary TB can impact the pleura, lymph nodes, urinary tract, osteoarticular system, central nervous system and abdomen. During pregnancy, the prevalence of extrapulmonary TB is low. Conclusion: Concomitant femoral and splenic TB in pregnant patients is a rare finding, which is why its analysis is of great importance. Arriving at a diagnosis requires a high index of suspicion. Delayed diagnosis leads to an increase in morbidity and mortalit

Comunicação na transferência de cuidados para realização de exames de imagem na ótica da enfermagem / Communication in the transfer of care for imaging exams from a nursing perspective / Comunicación en la transferencia de cuidados para exámenes por imágenes desde la perspectiva de enfermería

Objetivo:analisar a percepção de profissionais de enfermagem sobre a comunicação entre equipes na transferência de cuidados de pacientes para a realização de exames de imagem. Método:pesquisa exploratório-descritiva, qualitativa, realizada com 43 profissionais de enfermagem de um complexo hospitalar de Porto Alegre, entre junho e agosto de 2021. Os dados foram coletados por entrevista semiestruturada e utilizou-se Análise de Conteúdo de Minayo. Resultados:emergiram três temas: como ocorre o processo de comunicação para a transferência do paciente internado ao setor de exames; as potencialidades e fragilidades deste processo e ferramentas para qualificar a comunicação. O enfermeiro atua como articulador da comunicação, que ora ocorre utilizando ferramentase com etapas verbais/telefônicas. O sistema de notas de transferência, a dupla checagem e o readbackpossuem falhas, por não serem oficializados nem específicos. Conclusões:os profissionais consideram a comunicação verbal como a maior fragilidade e sugerem ferramentas formais para torná-la efetiva.

Objective:to analyze the perception of nursing professionals regarding communication between teams in the transfer of patient care for imaging examinations. Method:exploratory-descriptive research, qualitative, conducted with 43 nursing professionals from a hospital complex in Porto Alegre, between June and August 2021. Data were collected through semi-structured interviews and analyzed using Minayo's Content Analysis. Results: three themes emerged: how the communication process occurs for the transfer of the hospitalized patient to the examination department; the strengths and weaknesses of this process; and tools to enhance communication. The nurse acts as a communication facilitator, sometimes using tools and verbal/phone methods. The transfer note system, double-checking, and read-back have flaws because they are not formalized nor specific. Conclusions: professionals consider verbal communication the major weakness and suggest formal tools to make it more effective

Objetivo: analizar la percepción de profesionales de enfermería sobre la comunicación entre equipos al momento de transferir la atención al paciente para la realización de exámenes de imagen.Método: investigación realizada con 43 profesionales de enfermería de un complejo hospitalario de Porto Alegre, entre junio y agosto de 2021. Entrevistas semiestructuradas ocurrieron y se utilizó el análisis de contenido. Resultados: surgieron tres temas: cómo ocurre el proceso de comunicación para la transferencia delpaciente hospitalizado al departamento de exámenes; las potencialidades y debilidades de este proceso y las herramientas para cualificar la comunicación. El enfermero actúa como articulador de la comunicación, que en ocasiones ocurre mediante herramientasy pasos verbales/telefónicos. El sistema de notas de transferencia, la doble verificación y la relectura tienen fallas, pues no son oficiales ni específicos. Conclusiones: los profesionales consideran la comunicación verbal como la mayor debilidad y sugieren herramientas formales para hacerla efectiva.

Metodologias ativas no ensino de diagnóstico radiográfico da cárie proximal / Active methodologies in teaching radiographic diagnosis of proximal caries

O objetivo deste estudo foi avaliar o desempenho do estudante de Odontologia no diagnóstico radiográfico de cáries proximais. Sessenta e oito estudantes de Odontologia passaram pelas etapas de treinamento teórico e prático para o diagnóstico radiográfico de cárie. O material foi constituído de exames radiográficos convencionais e digitalizados de 40 dentes humanos, sendo 20 pré-molares e 20 molares com alterações clínicas não tratadas em uma das superfícies proximais. Para avaliar a semelhança entre as referências de escores de diagnóstico radiográfico da cárie e a avaliação histológica foi aplicado o Coeficiente de Correlação Intraclasse, que mediu a assertividade entre os escores dos estudantes e o verdadeiro diagnóstico, a qual foi classificada em níveis de reprodutibilidade. Na avaliação da reprodutibilidade utilizando o coeficiente de correlação intraclasse, os valores obtidos para as imagens digitalizadas dos dentes pré-molares foram considerados satisfatórios, onde os estudantes do sétimo semestre mais se aproximaram do diagnóstico correto. Conclui-se que os estudantes do sétimo semestre tiveram melhor desempenho no diagnóstico radiográfico de cáries proximais.

The objective of this study was to evaluate the performance of the dental student in the diagnosis of proximal caries. Sixty-eight students of Dentistry underwent the stages of theoretical and practical training for the radiographic diagnosis of caries. The sample consisted of conventional and digitized radiographic examinations of 40 human teeth, 20 premolars and 20 molars with untreated clinical alterations on one of the proximal surfaces. To evaluate the similarity between the references of the radiographic diagnosis scores of the caries and the histological evaluation, the Intraclass Correlation Coefficient was used, which measured the assertiveness between the students' scores and the true diagnosis, which was classified in levels of reproducibility. In the evaluation of reproducibility using the intraclass correlation coefficient, the values obtained for the digitized images of the premolar teeth were considered satisfactory, where the students of the seventh semester more approached the correct diagnosis. It was concluded that the seventh semester students had better performance in the radiographic diagnosis of proximal caries.

Cardiac disease discrimination from 3D-convolutional kinematic patterns on cine-MRI sequences / Discriminación de enfermedades cardiacas utilizando patrones cinemáticos codificados con convoluciones 3D en secuencias de cine-RM

Introduction. Cine-MRI (cine-magnetic resonance imaging) sequences are a key diagnostic tool to visualize anatomical information, allowing experts to localize and determine suspicious pathologies. Nonetheless, such analysis remains subjective and prone to diagnosis errors. Objective. To develop a binary and multi-class classification considering various cardiac conditions using a spatiotemporal model that highlights kinematic movements to characterize each disease. Materials and methods. This research focuses on a 3D convolutional representation to characterize cardiac kinematic patterns during the cardiac cycle, which may be associated with pathologies. The kinematic maps are obtained from the apparent velocity maps computed from a dense optical flow strategy. Then, a 3D convolutional scheme learns to differentiate pathologies from kinematic maps. Results. The proposed strategy was validated with respect to the capability to discriminate among myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy, abnormal right ventricle, and normal cardiac sequences. The proposed method achieves an average accuracy of 78.00% and a F1 score of 75.55%. Likewise, the approach achieved 92.31% accuracy for binary classification between pathologies and control cases. Conclusion. The proposed method can support the identification of kinematically abnormal patterns associated with a pathological condition. The resultant descriptor, learned from the 3D convolutional net, preserves detailed spatiotemporal correlations and could emerge as possible digital biomarkers of cardiac diseases.

Introducción. Las secuencias del cine-resonancia magnética (cine-MRI, cine magnetic resonance imaging) son una herramienta diagnóstica clave para visualizar la información anatómica que les permite a los expertos localizar y determinar aquellas anomalías que resulten sospechosas. No obstante, este análisis sigue siendo subjetivo y propenso a errores de diagnóstico. Objetivo. Desarrollar una clasificación binaria y multiclase, considerando diferentes condiciones cardiacas, mediante un modelo espaciotemporal que permita resaltar los movimientos cinéticos para caracterizar cada enfermedad. Materiales y métodos. Este estudio se centra en el uso de una representación de convolución 3D para caracterizar los patrones cinéticos durante el ciclo cardiaco que puedan estar asociados con enfermedades. Para ello, se obtienen mapas cinéticos a partir de mapas de velocidad aparente, calculados mediante una estrategia de flujo óptico denso. A continuación, un esquema de convolución 3D "aprende" a diferenciar patologías a partir de mapas cinemáticos. Resultados. La estrategia propuesta se validó según la capacidad de discriminar entre infarto de miocardio, miocardiopatía dilatada, miocardiopatía hipertrófica, ventrículo derecho anormal y un examen normal. El método propuesto alcanza una precisión media del 78,0 % y una puntuación F1 score del 75,55 %. Asimismo, el enfoque alcanzó el 92,31 % de precisión para la clasificación binaria entre enfermedades y casos de control. Conclusiones. El método propuesto es capaz de apoyar la identificación de patrones cinéticos anormales asociados con una condición patológica. El descriptor resultante, aprendido de la red de convolución 3D, conserva correlaciones espaciotemporales detalladas y podría surgir como posible biomarcador digital de enfermedades cardiacas.

Aspectos genéticos e imagenológicos de la enfermedad quística renal en pediatría: serie de casos / Genetic and radiological aspects of pediatric renal cystic disease: A case series

Las enfermedades quísticas renales son condiciones frecuentes cuya etiología puede ser muy heterogénea, por lo que se requiere un adecuado abordaje para su diagnóstico y manejo. El objetivo de este trabajo fue ilustrar parte del espectro de la enfermedad renal quística por medio de casos clínicos manejados en la Fundación Valle del Lili. Se describen 11 casos clínicos que incluyen enfermedades como displasia multiquística renal, enfermedad poliquística renal autosómica dominante y autosómica recesiva, entre otras. Las enfermedades quísticas renales varían en su presentación clínica, historia natural, hallazgos imagenológicos, bases genéticas y fisiopatológicas, por consiguiente, el enfoque diagnóstico y el manejo integral se debe realizar de forma individualizada y con un abordaje multidisciplinario.

Renal cystic diseases are common conditions whose etiology can be highly heterogeneous. They require a correct approach for adequate diagnosis and management. We aimed to illustrate part of the spectrum of renal cystic diseases through some clinical cases managed in our service. We describe 11 clinical cases including clinical entities such as renal multicystic dysplasia, and autosomal dominant and autosomal recessive polycystic renal disease, among other pathologies. Renal cystic diseases are heterogeneous in their clinical presentation, natural history, radiological findings, and genetic and pathophysiological basis. An integral clinical approach is needed to get a clear etiological diagnosis and offer adequate individualized care and follow-up for patients.

Which health conditions report the most spending on medical imaging? Evidence for Colombia.

Medical imaging is essential for the proper diagnosis and treatment of many diseases. The literature has found that medical imaging generally accounts for a significant percentage of total healthcare spending. We analyzed a national database between 2013 and 2021, with more than 19 million patients on average, to review which health conditions account for the highest spending on medical imaging in the Colombian health system. We segmented the analysis by type of medical imaging, life cycles, health condition and sex. Our findings indicate that cardiac and mental illnesses account for the highest per capita spending on medical imaging, especially for the elderly. As a proportion of total expenditure, hypertension and tuberculosis are added, with special emphasis on the infancy-childhood life cycle.

Precisão dos escaneamentos intraorais e modelos 3D, com diferentes escâneres e softwares: revisão sistemática / Accuracy of intraoral scanning and 3D models, with different scanners and software: systematic review

Objetivo: Esta revisão sistemática investigou se a precisão dos escaneamentos intraorais e modelos 3D com diferentes escâneres e softwares, é suficiente para os clínicos aceitarem e implementarem as novas tecnologias como critério de diagnóstico e planejamentos dos tratamentos. Material e métodos: Protocolo PROSPERO número CRD42020218151. Duas revisoras realizaram uma pesquisa avançada de banco de dados eletrônico, sem restrição de idioma ou data, no MEDLINE/PubMed; Embase; BVS/LILACS; Scopus; Cochrane Library; Google Scholar e Web of Science até janeiro de 2021. Os estudos foram escolhidos por título e resumo para triagem, de acordo com os seguintes critérios de inclusão: Estudos Clínicos in vivo e in vitro (pacientes, modelos de gesso de pacientes e manequins simulando bocas humanas) com os diferentes softwares e técnicas de escaneamento intraoral comparando a acurácia, fidelidade e/ou precisão como desfecho dos escaneamentos intraorais, dos modelos virtuais em 3D com modelos de gesso; com um mínimo de 5 pacientes escaneados sem limite de idade ou gênero; texto completo acessível; nos estudos de coorte, transversais e caso-controle. Após a leitura do texto completo os artigos foram excluídos de acordo com os seguintes critérios: 1) estudos com menos de 5 pacientes; 2) estudos em animais; 3) revisão sistemática, descrição de técnica, intervenções, protocolos; 4) escaneamentos por Ressonância Magnética ou Tomografia computadorizada; 5) estudos em que não foram utilizados scanners intraorais. Resultados. Dos 4410 estudos inicialmente identificados, 16 preencheram os critérios de inclusão. O guia PRISMA foi utilizado para redação da revisão e a ferramenta ROBINS-1 da Cochrane foi utilizada para análise de viés. Os estudos incluídos na sua maioria mostraram diferenças estatisticamente significativas entre os resultados das moldagens convencionais e digitais, porém também demonstraram que as diferenças não têm significância clínica. Conclusões: Esta revisão sistemática permitiu levantar dados que demonstraram que os escaneamentos intraorais não são superiores às moldagens convencionais, mas de acurácia equivalente com confiabilidade para o uso das imagens digitais conseguidas por escaneamento intraoral e dos modelos digitais provenientes destes escaneamentos.