ABSTRACT
Abstract Objective: To evaluate the resistive indices (RIs) of the fetal umbilical and middle cerebral arteries, as well as to determine the cerebroplacental ratio (CPR), in fetuses of women with hypertension. Materials and Methods This was a comparative cross-sectional study involving 75 pregnant women with pregnancy-induced hypertension (PIH) and 75 apparently healthy pregnant women (control group), all of whom were submitted to Doppler ultrasound examination of the fetal middle cerebral and umbilical arteries between 20 and 40 weeks of gestation. The two groups were compared in terms of the RI of the middle cerebral and umbilical arteries, as well as the CPR. The level of statistical significance was set at p ≤ 0.05. Results: The mean age was 32.4 ± 4.6 years in the PIH group and 32.6 ± 4.6 years in the control group (p = 0.633). The mean umbilical artery RI was significantly higher in the PIH group than in the control group (0.67 ± 0.14 vs. 0.61 ± 0.08; p = 0.012), whereas the mean middle cerebral artery RI was significantly higher in the control group (0.80 ± 0.05 vs. 0.76 ± 0.08; p = 0.001). Among the women in the PIH group, the mean CPR was significantly lower for those with proteinuria than for those without (1.07 ± 0.26 vs. 1.27 ± 0.22; p = 0.001). Conclusion: Maternal hypertension during pregnancy appears to be associated with increased fetal umbilical artery RI and reduced fetal middle cerebral artery RI, as well as with a low CPR. In pregnant women, the combination of PIH and proteinuria is also apparently associated with an increased risk of a low CPR.
ABSTRACT
Abstract Active surveillance (AS) is an important strategy to avoid overtreatment of prostate cancer (PCa) and has become the standard of care for low-risk patients. The role of magnetic resonance imaging (MRI) in AS has expanded due to its ability to risk stratify patients with suspected or known PCa, and MRI has become an integral part of the AS protocols at various institutions. A negative pre-biopsy MRI result is associated with a very high negative predictive value for a Gleason score ≥ 3+4. A positive MRI result in men who are otherwise eligible for AS has been shown to be associated with the presence of high-grade PCa and therefore with ineligibility. In addition, MRI can be used to guide and determine the timing of per-protocol biopsy during AS. However, there are several MRI-related issues that remain unresolved, including the lack of a consensus and guidelines; concerns about gadolinium deposition in various tissues; and increased demand for higher efficiency and productivity. Similarly, the need for the combined use of targeted and systematic sampling is still a matter of debate when lesions are visible on MRI. Here, we review the current AS guidelines, as well as the accepted roles of MRI in patient selection and monitoring, the potential uses of MRI that are still in question, and the limitations of the method.
Resumo A vigilância ativa (VA) é uma estratégia importante para evitar o tratamento excessivo do câncer de próstata (CaP) e tornou-se o padrão de atendimento a pacientes de baixo risco. O papel da ressonância magnética (RM) na VA tem se expandido, devido à sua capacidade de estratificar o risco pacientes com CaP suspeito ou diagnosticado, tornando-se parte integrante dos protocolos de VA em várias instituições. Uma RM pré-biópsia negativa está associada a um valor preditivo negativo muito alto para o diagnóstico de Gleason ≥ 3+4. Um exame positivo em homens que são elegíveis para VA tem se mostrado associado à presença de CaP de alto grau e inelegibilidade para VA. A RM também pode ser usada para orientar e determinar o tempo ideal de uma biópsia, ou por protocolo, durante a VA. Há, no entanto, várias questões relacionadas à RM que permanecem não resolvidas. Estas incluem a falta de consenso ou diretrizes, preocupações com o depósito de gadolínio em vários tecidos e aumento da pressão por maior eficiência e produção. Da mesma forma, a necessidade de biópsia sistemática combinada à dirigida continua a ser uma questão controversa, quando as lesões são visíveis na RM. Revisaremos as atuais diretrizes de VA, os papéis consensualmente aceitos da RM na seleção e monitoramento dos pacientes, potenciais usos, ainda discutíveis, e as limitações do método.