Association between the ultrasonographic and clinical findings in the hips of patients with juvenile idiopathic arthritis

OBJECTIVE: To describe the ultrasonographic (US) findings in the hips of patients with juvenile idiopathic arthritis (JIA) and the association between these findings and the signs, symptoms, and activity of the disease. MATERIALS AND METHODS: The present retrospective study included 92 patients with JIA. The disease subtypes, age at disease onset, length of disease progression, disease activity, and clinical manifestations of the hip pathology were assessed. US examinations were routinely performed, and the images were analysed by two ultrasonographers who were blinded to the patients' clinical conditions. RESULTS: Of the 92 patients included in the study, 69.6% were girls, and the average age was 12.4 ± 5.1 years. Thirty-three (35.9%) participants exhibited the persistent oligoarticular subtype, and 30 (32.6%) exhibited the rheumatoid factor (RF)-negative polyarticular subtype. Forty-four participants exhibited signs and/or symptoms of hip pathology. Twentynine (31.5%) participants exhibited abnormal US findings, and 34.4% exhibited subclinical synovitis. The US alterations exhibited an association with subclinical synovitis in 34.4% of the cases. The US alterations bore a correlation with the presence of hip-related signs and/ or symptoms (P = 0.021), particularly joint limitations (P = 0.006), but were not correlated with the disease activity (P = 0.948) or subtype (P = 0.108). Clinical synovitis was associated with polyarticular involvement (P = 0.002) and disease activity (P = 0.017). Subclinical synovitis was not correlated with the investigated variables. CONCLUSION: Clinical affection of the hip in JIA, particularly joint limitation, is associated with synovitis (revealed by US assessment) independently of the activity and subtype of the disease. Therefore, healthcare professionals should consider the possible occurrence of silent disease and subclinical synovitis, which might contribute to hip deterioration.OBJETIVO: Descrever os achados ultrassonográficos do quadril em pacientes com artrite idiopática juvenil (AIJ) e sua associação com sinais, sintomas e atividade da doença. MATERIAIS E MÉTODOS: Estudo retrospectivo com 92 pacientes com AIJ. Foram avaliados os subtipos da doença, a idade de início, o tempo de evolução, a atividade da doença e as manifestações clínicas do envolvimento do quadril. A avaliação ultrassonográfica foi realizada na rotina dos pacientes, e as imagens foram analisadas por dois ultrassonografistas cegos em relação às condições clínicas dos pacientes. RESULTADOS: Do total de 92 pacientes, 69,6% eram meninas, com média de idade de 12,4 ± 5,1 anos. Trinta e três (35,9%) apresentaram subtipo oligoarticular persistente e trinta (32,6%) poliarticular com fator reumatoide negativo. Quarenta e quatro (47,8%) apresentaram sinal e/ou sintoma relacionado ao quadril. Vinte e nove (31,5%) apresentaram alterações ultrassonográficas, com sinovite subclínica em 34,4%. As alterações ultrassonográficas se associaram com presença de sinais e/ou sintomas do quadril (P = 0,021), especialmente limitação articular (P = 0,006), mas não com atividade (P = 0,948) ou subtipo de doença (P = 0,108). Sinovite clínica se associou com comprometimento poliarticular (P = 0,002) e atividade de doença (P = 0,017). Não houve associação entre sinovite subclínica e as variáveis estudadas. CONCLUSÃO: O acometimento clínico do quadril na AIJ, especialmente a limitação articular, está associado à sinovite na avaliação por US, independente do subtipo e da atividade da doença. Os profissionais de saúde devem estar atentos à possibilidade de doença silenciosa com sinovite subclínica, que pode contribuir para a deterioração da articulação do quadril.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM, Depto. de Diagnóstico por ImagemSciEL

Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?

OBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >;12 hours of observation, or neuro-specialist evaluation. RESULTS: Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%. CONCLUSION: A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention; therefore, the use of computed tomography scans may be questioned in this group. The results support the trend of more careful indications for cranial computed tomography scans for children with minor head trauma

Comparação entre a ressonância de corpo total e os métodos convencionais de imagem no estadiamento do linfoma de hodgkin em crianças e adolescentes

Objective: to compare whole-body magnetic resonance imaging (WB-MRI) with conventional imaging methods compared to a standard clinical-radiological follow-up in the staging of Hodgkin lymphoma (HL) in children and adolescents. Methods: We included 22 patients aged 5 to 21 years. The staging was performed by conventional imaging methods and WB-MRI. We considered conventional imaging computed tomography of the neck, chest, abdomen and pelvis and the cervical and / or abdominal ultrasound. The sensitivity of the methods in the staging of LH and the sensitivity and specificity in detecting the involvement of nodal and extranodal sites were calculated. The kappa statistic (?) was used to test the correlation between WB-MRI and conventional imaging methods in the staging of HL in relation to clinical-radiological follow up. Results: The correlation between WB-MRI and clinical-radiological follow-up to stage LH was excellent (? = 0.928) and between conventional imaging methods and clinical-radiological follow-up was good (? = 0.797) as well as between WB-MRI and conventional imaging methods (? = 0.729). WB-MRI showed sensitivity higher than conventional image methods for HL staging, but with no significant difference (95.5% and 86.4%, respectively). The WB-MRI and conventional methods showed similar sensitivity and specificity in the detection of nodal (99.1 and 100% vs. 97.3 and 100%, respectively) and extranodal involvement sites (90.5 and 98.7% vs. 90.5 and 99.4%, respectively). Conclusion: WB-MRI has excellent sensitivity in the staging of HL in children and adolescents, higher than conventional methods when compared to clinical- radiological standard reference, proving to be a safer alternative for this purpose mainly because it does not use ionizing radiation.Objetivo: comparar a ressonância magnética de corpo inteiro (WB-MRI - whole body magnetic resonance imaging) com os métodos convencionais de imagem, em relação a um padrão de acompanhamento clinicorradiológico, no estadiamento do linfoma de Hodgkin (LH) em crianças e adolescentes. Métodos: foram incluídos 22 pacientes com idade variando de 5 a 21 anos. O estadiamento dos pacientes foi realizado pelos métodos convencionais de imagem e pela WB-MRI. Foram considerados como métodos convencionais de imagem a tomografia computadorizada de pescoço, tórax, abdome e pelve e a ultrassonografia cervical e/ ou abdominal. Foram calculadas a sensibilidade dos métodos no estadiamento do LH e a sensibilidade e especialidade na detecção do acometimento de sítios nodais e extranodais. A estatística kappa (?) foi utilizada para testar a concordância entre a WB-MRI e os métodos convencionais de imagem no estadiamento do linfoma, em relação ao padrão clinicorradiológico. Resultados: a concordância entre a WB-MRI e o acompanhamento clinicorradiológico para o estadiamento do LH foi excelente (?=0,928) e entre os métodos convencionais de imagem e o acompanhamento clinicorradiológico foi boa (?=0,797), assim como entre a WB-MRI e os métodos convencionais de imagem (?=0,729). A WB-MRI demonstrou sensibilidade superior à dos métodos convencionais de imagem para o estadiamento, mas sem diferença significativa (95,5% e 86,4%, respectivamente). A WB-MRI e os métodos convencionais mostraram sensibilidade e especificidade semelhantes na detecção de acometimento dos sítios nodais (99,1 e 100% vs. 97,3 e 100%; respectivamente) e extranodais (90,5 e 98,7% vs. 90,5 e 99,4%; respectivamente). Conclusão: A WB-MRI apresenta excelente sensibilidade no estadiamento do LH em crianças e adolescentes, superior aos métodos convencionais quando comparada ao padrão de referência clinicorradiológico, demonstrando ser uma alternativa mais segura para essa finalidade, sobretudo por não utilizar radiação ionizante.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Evaluation of non-radiologist physicians' knowledge on aspects related to ionizing radiation in imaging

Objective: To assess the non-radiologist physicians' knowledge on the use of ionizing radiation in imaging. Materials and Methods: Cross-sectional study utilizing an anonymous questionnaire responded by physicians in clinical and surgical specialties, divided into two parts as follows: one including questions about the physicians' characteristics, frequency of imaging studies requests and participation in professional updating events, and another part including multiple choice questions approaching general knowledge about radiation, optimization principles and radioprotection. Results: From a total of 309 questionnaires, 120 (38.8%) were responded, 50% by physicians in surgical specialties and 50% in clinical specialties; respectively 45% and 2.5% of physicians responded that magnetic resonance imaging and ultrasonography use ionizing radiation. Overall, the average grade was higher for surgical specialists with no significant difference, except for the question about exposure in pregnant women (p = 0.047). Physicians who are professionally updated, particularly those attending clinical meetings (p = 0.050) and participating in teaching activities (p = 0.047), showed statistically superior knowledge about ionizing radiation as compared with others. Conclusion: The non-radiologist physicians' knowledge is heterogeneous and in some points needs to be improved. Multidisciplinary clinical meetings and teaching activities are important ways to disseminate information on the subject.Objetivo: Avaliar o conhecimento dos médicos não radiologistas sobre a utilização da radiação ionizante em exames de imagem. Materiais e Métodos: Estudo transversal, utilizando questionário anônimo, aplicado a médicos de especialidades clínicas e cirúrgicas, dividido em duas partes: uma com questões sobre as características dos médicos, frequência de solicitação de exames e de participação em eventos de atualização profissional, e outra com questões de múltipla escolha, abordando conhecimentos gerais sobre radiação, princípios de otimização e radioproteção. Resultados: De 309 questionários distribuídos, 120 (38,8%) foram respondidos, 50% por médicos de especialidades cirúrgicas e 50% clínicas; 45% e 2,5% dos médicos responderam, respectivamente, que a ressonância magnética e a ultrassonografia utilizam radiação ionizante. No geral, a média das notas foi maior nas especialidades cirúrgicas, sem diferenças significativas, exceto na questão sobre exposição em grávidas (p = 0,047). Os médicos que se atualizam profissionalmente mostraram conhecimento sobre radiação ionizante estatisticamente superior aos demais, principalmente os que frequentam reuniões clínicas (p = 0,050) e participam de atividades de ensino (p = 0,047). Conclusão: O conhecimento dos médicos não radiologistas sobre radiação ionizante é heterogêneo e em alguns pontos precisa ser melhorado. Reuniões clínicas multidisciplinares e atividades de ensino são importantes formas de disseminar informações sobre o tema

Whole-body diffusion-weighted magnetic resonance imaging versus FDG-PET/CT for initial lymphoma staging: systematic review on diagnostic test accuracy studies

CONTEXT AND OBJECTIVE: Positron emission tomography with [18]F-fluoro-2-deoxyglucose (FDG-PET/CT) has been advocated as the method of choice for lymphoma staging, since it enables whole-body analysis with high sensitivity for detection of affected areas and because it combines capacities for anatomical and functional assessment. With technological advances, magnetic resonance imaging (MRI) has emerged as an alternative to FDG-PET/CT. This systematic review with meta-analysis aimed to compare whole-body diffusion-weighted MRI (WB-MRI) with FDG-PET/CT for lymphoma staging. DESIGN AND SETTING: Systematic review on diagnostic test accuracy studies conducted at a public university. METHODS: The Medline, Scopus, Embase and Lilacs databases were searched for studies published up to September 2013 that compared WB-MRI and FDG-PET/CT for lymphoma staging. The reference lists of included studies were checked for any relevant additional citations. RESULTS: Six studies that evaluated the initial lymphoma staging in 116 patients were included. WB-MRI and FDG-PET/CT agreed in 90.5% of the cases (κ = 0.871; P < 0.0001). In most of the studies, when there was disagreement between the methods, WB-MRI overstaged in relation to FDG-PET/CT. The sensitivity of WB-MRI and FDG-PET/CT, in comparison with the clinical-radiological standard, ranged from 59 to 100% and from 63 to 100% respectively. CONCLUSION: WB-MRI is a highly sensitive method for initial lymphoma staging. It has excellent agreement with FDG-PET/CT and is a great alternative for managing lymphoma patients, without using ionizing radiation or an intravenous contrast agent