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1.
Br J Radiol ; 94(1117): 20200780, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33237824

RESUMO

Cardiovascular imaging has significantly evolved since the turn of the century. Progress in the last two decades has been marked by advances in every modality used to image the heart, including echocardiography, cardiac magnetic resonance, cardiac CT and nuclear cardiology. There has also been a dramatic increase in hybrid and fusion modalities that leverage the unique capabilities of two imaging techniques simultaneously, as well as the incorporation of artificial intelligence and machine learning into the clinical workflow. These advances in non-invasive cardiac imaging have guided patient management and improved clinical outcomes. The technological developments of the past 20 years have also given rise to new imaging subspecialities and increased the demand for dedicated cardiac imagers who are cross-trained in multiple modalities. This state-of-the-art review summarizes the evolution of multimodality cardiac imaging in the 21st century and highlights opportunities for future innovation.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Imagem Multimodal/métodos , Técnicas de Imagem Cardíaca/tendências , Humanos , Imagem Multimodal/tendências
2.
Radiol Med ; 125(11): 1124-1134, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33025305

RESUMO

Myocarditis is an inflammatory disease of the heart muscle, diagnosed by histological, immunological, and immunohistochemical criteria. Endomyocardial biopsy represents the diagnostic gold standard for its diagnosis but is infrequently used. Due to its noninvasive ability to detect the presence of myocardial edema, hyperemia and necrosis/fibrosis, Cardiac MR imaging is routinely used in the clinical practice for the diagnosis of acute myocarditis. Recently pixel-wise mapping of T1 and T2 relaxation time have been introduced into the clinical Cardiac MR protocol increasing its accuracy. Our paper will review the role of MR imaging in the diagnosis of acute myocarditis.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Endocárdio/patologia , Imagem por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Doença Aguda , Adulto , Doenças Assintomáticas , Betacoronavirus , Bioprospecção , Doença Crônica , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Miocardite/etiologia , Miocardite/patologia , Pandemias , Pericardite/diagnóstico por imagem , Pericardite/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Prognóstico
3.
Radiol Med ; 125(11): 1056-1071, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32946001

RESUMO

Cardiomyopathies are a heterogeneous entity. The progress in the field of genetics has allowed over the years to determine its origin more and more often. The classification of these pathologies has changed over the years; it has been updated with new knowledge. Imaging allows to define the phenotypic characteristics of the different forms of cardiomyopathy. Cardiac magnetic resonance (CMR) allows a morphological evaluation of the associated (and sometimes pathognomonic) cardiac findings of any form of cardiomyopathy. The tissue characterization sequences also make magnetic resonance imaging unique in its ability to detect changes in myocardial tissue. This review aims to define the features that can be highlighted by CMR in hypertrophic and dilated forms and the possible differential diagnoses. In hypertrophic forms, CMR provides: precise evaluation of wall thickness in all segments, ventricular function and size and evaluation of possible presence of areas of fibrosis as well as changes in myocardial tissue (measurement of T1 mapping and extracellular volume values). In dilated forms, cardiac resonance is the gold standard in the assessment of ventricular volumes. CMR highlights also the potential alterations of the myocardial tissue.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Cardiomiopatia Dilatada/genética , Cardiomiopatia Hipertrófica/genética , Meios de Contraste , Diagnóstico Diferencial , Feminino , Gadolínio , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/patologia , Humanos , Hipertrofia/diagnóstico por imagem , Hipertrofia/patologia , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade
4.
Radiol Med ; 125(11): 1167-1185, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32955650

RESUMO

Advances in the treatment have drastically increased the survival rate of congenital heart disease (CHD) patients. Therefore, the prevalence of these patients is growing. Imaging plays a crucial role in the diagnosis and management of this population as a key component of patient care at all stages, especially in those patients who survived into adulthood. Over the last decades, noninvasive imaging techniques, such as cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT), progressively increased their clinical relevance, reaching stronger levels of accuracy and indications in the clinical surveillance of CHD. The current review highlights the main technical aspects and clinical applications of CMR and CCT in the setting of congenital cardiovascular abnormalities, aiming to address a state-of-the-art guidance to every physician and cardiac imager not routinely involved in the field.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Humanos , Angiografia por Ressonância Magnética/métodos
5.
Radiol Med ; 125(11): 1087-1101, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32978708

RESUMO

Over the past few years, the approach to the 'arrhythmic patient' has profoundly changed. An early clinical presentation of arrhythmia is often accompanied by non-specific symptoms and followed by inconclusive electrocardiographic findings. In this scenario, cardiac magnetic resonance (CMR) has been established as a clinical tool of fundamental importance for a correct prognostic stratification of the arrhythmic patient. This technique provides a high-spatial-resolution tomographic evaluation of the heart, which allows studying accurately the ventricular volumes, identifying even segmental kinetic anomalies and properly detecting diffuse or focal tissue alterations through an excellent tissue characterization, while depicting different patterns of fibrosis distribution, myocardial edema or fatty substitution. Through these capabilities, CMR has a pivotal role for the adequate management of the arrhythmic patient, allowing the identification of those phenotypic manifestations characteristic of structural heart diseases. Therefore, CMR provides valuable information to reclassify the patient within the wide spectrum of potentially arrhythmogenic heart diseases, the definition of which remains the major determinants for both an adequate treatment and a poor prognosis. The purpose of this review study was to focus on the role of CMR in the evaluation of the main cardiac clinical entities associated with arrhythmogenic phenomena and to present a brief debate on the main pathophysiological mechanisms involved in the arrhythmogenesis process.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Técnicas de Imagem Cardíaca/métodos , Cardiomiopatias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Cardiomegalia Induzida por Exercícios , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia , Fibrose Endomiocárdica/complicações , Fibrose Endomiocárdica/diagnóstico por imagem , Humanos , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem
6.
Radiol Med ; 125(11): 1040-1055, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32939626

RESUMO

Cardiac magnetic resonance (CMR) imaging is an effective method for noninvasively imaging the heart which in the last two decades impressively enhanced spatial and temporal resolution and imaging speed, broadening its spectrum of applications in cardiovascular disease. CMR imaging techniques are designed to noninvasively assess cardiovascular morphology, ventricular function, myocardial perfusion, tissue characterization, flow quantification and coronary artery disease. These intrinsic features yield CMR suitable for diagnosis, follow-up and longitudinal monitoring after treatment of cardiovascular diseases. The aim of this paper is to review the technical basis of CMR, from cardiac imaging planes to cardiac imaging sequences.


Assuntos
Coração/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Técnicas de Imagem Cardíaca/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Frequência Cardíaca , Humanos , Imageamento Tridimensional , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Contração Miocárdica , Imagem de Perfusão do Miocárdio , Técnicas de Imagem de Sincronização Respiratória , Fatores de Tempo
7.
Cardiol Rev ; 28(6): 308-311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941261

RESUMO

Cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 infection in children is a relatively new entity. We present our initial experience managing children with coronavirus disease 2019-related acute myocardial injury. The 3 patients presented here represent a spectrum of the cardiac involvement noted in children with coronavirus disease 2019-related multisystem inflammatory syndrome, including myocarditis presenting as cardiogenic shock or heart failure with biventricular dysfunction, valvulitis, coronary artery changes, and pericardial effusion.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Insuficiência Cardíaca , Doenças das Valvas Cardíacas , Miocardite , Pandemias , Administração dos Cuidados ao Paciente/métodos , Derrame Pericárdico , Pneumonia Viral , Síndrome de Resposta Inflamatória Sistêmica , Adolescente , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Técnicas de Imagem Cardíaca/métodos , Criança , Pré-Escolar , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/virologia , Humanos , Miocardite/terapia , Miocardite/virologia , Derrame Pericárdico/terapia , Derrame Pericárdico/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Resultado do Tratamento
8.
Radiol Med ; 125(11): 1072-1086, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32970272

RESUMO

The restrictive cardiomyopathies constitute a heterogeneous group of myocardial diseases with a different pathogenesis and overlapping clinical presentations. Diagnosing them frequently poses a challenge. Echocardiography, electrocardiograms and laboratory tests may show non-specific changes. In this context, cardiac magnetic resonance (CMR) may play a crucial role in defining the diagnosis and guiding treatments, by offering a robust myocardial characterization based on the inherent magnetic properties of abnormal tissues, thus limiting the use of endomyocardial biopsy. In this review article, we explore the role of CMR in the assessment of a wide range of myocardial diseases causing restrictive patterns, from iron overload to cardiac amyloidosis, endomyocardial fibrosis or radiation-induced heart disease. Here, we emphasize the incremental value of novel relaxometric techniques such as T1 and T2 mapping, which may recognize different storage diseases based on the intrinsic magnetic properties of the accumulating metabolites, with or without the use of gadolinium-based contrast agents. We illustrate the importance of these CMR techniques and their great support when contrast media administration is contraindicated. Finally, we describe the useful role of cardiac computed tomography for diagnosis and management of restrictive cardiomyopathies when CMR is contraindicated.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiomiopatia Restritiva/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatia Restritiva/classificação , Fibrose Endomiocárdica/diagnóstico por imagem , Feminino , Humanos , Sobrecarga de Ferro/diagnóstico por imagem , Doenças por Armazenamento dos Lisossomos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/complicações , Lesões por Radiação/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem
9.
Radiol Med ; 125(11): 1114-1123, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32936388

RESUMO

Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Imagem por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Gadolínio , Humanos , Microvasos/diagnóstico por imagem , Microvasos/lesões , Isquemia Miocárdica/diagnóstico por imagem
12.
JACC Cardiovasc Imaging ; 13(7): 1615-1626, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32646721
13.
Am Heart J ; 227: 31-39, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32668323

RESUMO

BACKGROUND: Lung ultrasound (LUS) has emerged as a new tool for the evaluation of congestion in heart failure (HF); incorporation of LUS during follow-up may detect congestion earlier and prompt interventions to prevent hospitalizations. The aim of this study was to test the hypothesis that the incorporation of LUS during follow-up of patients with HF may reduce the rate of adverse events compared with usual care. METHODS: In this single-blinded, randomized controlled trial, patients were randomized into an LUS-guided arm or control arm. Patients were followed in 4 prespecified visits during a 6-month period. LUS was performed in every patient visit in both groups; however, LUS results were available for the treating physician only in the LUS group. The primary outcome was the composite of urgent HF visits, rehospitalization for worsening HF, and death from any cause. RESULTS: One hundred twenty-six patients were randomized to either LUS (n = 63) or control (n = 63) (age 62.5 ±â€¯10 years, median left ventricular ejection fraction 31%). The primary end point occurred in 30 (47.6%) patients in the control group and 20 (31.7%) patients in the LUS group (P = .041). LUS-guided treatment was associated with a 45% risk reduction in the primary end point (hazard ratio 0.55, 95% CI 0.31-0.98, P = .044), mainly driven by a reduction in urgent HF visits (hazard ratio 0.28, 95% CI 0.13-0.62, P = .001). No significant differences in rehospitalizations for HF or death were found. CONCLUSIONS: Incorporation of LUS into clinical follow-up of patients with HF significantly reduced the risk of urgent visits for worsening HF.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Ultrassonografia/métodos
14.
J Cardiovasc Med (Hagerstown) ; 21(7): 467-471, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32487868

RESUMO

: The recent outbreak of 2019 severe acute respiratory syndrome coronavirus-2 is having major repercussions on healthcare services provision in Italy and worldwide. Data suggest the virus has a strong impact on the cardiovascular system, and cardiac imaging will play an important role in patients affected by coronavirus disease-2019. Although paediatric patients are mildly affected, they represent a clear accelerator in spreading the virus, and healthcare workers are at higher risk of infection. The aim of this position paper is to provide clinical recommendation regarding the execution of imaging investigations for the cardiac diagnostic work-up of paediatric patients with suspected or confirmed infection.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiologia , Infecções por Coronavirus , Cardiopatias Congênitas , Exposição Ocupacional/prevenção & controle , Pandemias , Pediatria , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Cardiologia/métodos , Cardiologia/normas , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Pandemias/prevenção & controle , Pediatria/métodos , Pediatria/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Sociedades Médicas
15.
J Interv Cardiol ; 2020: 5894586, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508542

RESUMO

Coronary artery spasm (CAS) defined by a severe reversible diffuse or focal vasoconstriction is the most common diagnosis among INOCA (ischemia with no obstructive coronary artery disease) patients irrespective to racial, genetic, and geographic variations. However, the prevalence of CAS tends to decrease in correlation with the increasing use of medicines such as calcium channel blockers, angiotensin converting enzyme inhibitor, and statins, the controlling management of atherosclerotic risk factors, and the decreased habitude to perform a functional reactivity test in highly active cardiac catheterization centers. A wide spectrum of clinical manifestations from silent disease to sudden cardiac death was attributed to this complex entity with unclear pathophysiology. Multiple mechanisms such as the autonomic nervous system, endothelial dysfunction, chronic inflammation, oxidative stress, and smooth muscle hypercontractility are involved. Regardless of the limited benefits proffered by the newly emerged cardiac imaging modalities, the provocative test remains the cornerstone diagnostic tool for CAS. It allows to reproduce CAS and to evaluate reactivity to nitrates. Different invasive and noninvasive therapeutic approaches are approved for the management of CAS. Long-acting nondihydropyridine calcium channel blockers are recommended for first line therapy. Invasive strategies such as PCI (percutaneous coronary intervention) and CABG (coronary artery bypass graft) have shown benefits in CAS with significant atherosclerotic lesions. Combination therapies are proposed for refractory cases.


Assuntos
Bloqueadores dos Canais de Cálcio/farmacologia , Técnicas de Imagem Cardíaca/métodos , Vasoespasmo Coronário , Revascularização Miocárdica/métodos , Vasoespasmo Coronário/etiologia , Vasoespasmo Coronário/fisiopatologia , Vasoespasmo Coronário/terapia , Humanos , Fatores de Risco
16.
Arch Cardiol Mex ; 90(Supl): 41-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523146

RESUMO

COVID-19 is an acute respiratory syndrome caused by coronavirus-2 (SARS COV2). The different cardiac imaging methods have issued specific recommendations for the different imaging methods in this pandemic, so it is essential to emphasize the recommendations for carrying out these studies.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Infecções por Coronavirus/epidemiologia , Exposição Ocupacional/prevenção & controle , Pneumonia Viral/epidemiologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/transmissão
18.
Heart Fail Clin ; 16(3): 331-346, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32503756

RESUMO

Cardiovascular emergencies represent life-threatening conditions requiring a high index of clinical suspicion. In an emergency scenario, a simple stepwise biomarker/imaging diagnostic algorithm may help prompt diagnosis and timely treatment along with related improved outcomes. This article describes several clinical cases of cardiovascular emergencies, such as coronary stent thrombosis-restenosis, takotsubo syndrome, acute myocarditis, massive pulmonary embolism, type A acute aortic dissection, cardiac tamponade, and endocarditis.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Doenças Cardiovasculares , Emergências/classificação , Tratamento de Emergência/métodos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Humanos
19.
Int J Cardiovasc Imaging ; 36(10): 1801-1810, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32451877

RESUMO

The severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-2) pandemic currently constitutes a significant burden on worldwide health care systems, with important implications on many levels, including radiology departments. Given the established fundamental role of cardiovascular imaging in modern healthcare, and the specific value of cardiopulmonary radiology in COVID-19 patients, departmental organisation and imaging programs need to be restructured during the pandemic in order to provide access to modern cardiovascular services to both infected and non-infected patients while ensuring safety for healthcare professionals. The uninterrupted availability of cardiovascular radiology services remains, particularly during the current pandemic outbreak, crucial for the initial evaluation and further follow-up of patients with suspected or known cardiovascular diseases in order to avoid unnecessary complications. Suspected or established COVID-19 patients may also have concomitant cardiovascular symptoms and require further imaging investigations. This statement by the European Society of Cardiovascular Radiology (ESCR) provides information on measures for safety of healthcare professionals and recommendations for cardiovascular imaging during the pandemic in both non-infected and COVID-19 patients.


Assuntos
Betacoronavirus , Técnicas de Imagem Cardíaca/métodos , Doenças Cardiovasculares/diagnóstico por imagem , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Desinfecção , Europa (Continente) , Humanos , Segurança do Paciente , Equipamento de Proteção Individual , Sociedades Médicas
20.
Eur Heart J Cardiovasc Imaging ; 21(7): 709-714, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391912

RESUMO

Recent EACVI recommendations described the importance of limiting cardiovascular imaging during the COVID-19 pandemic in order to reduce virus transmission, protect healthcare professionals from contamination, and reduce consumption of personal protective equipment. However, an elevated troponin remains a frequent request for cardiac imaging in COVID-19 patients, partly because it signifies cardiac injury due to a variety of causes and partly because it is known to convey a worse prognosis. The present paper aims to provide guidance to clinicians regarding the appropriateness of cardiac imaging in the context of troponin elevation and myocardial injury, how best to decipher the mechanism of myocardial injury, and how to guide patient management.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Infecções por Coronavirus/epidemiologia , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Troponina I/sangue , Biomarcadores , Técnicas de Imagem Cardíaca/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/prevenção & controle , Gerenciamento Clínico , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler/estatística & dados numéricos , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Prognóstico , Medição de Risco , Papel (figurativo)
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