ULTRA Tomografia Computadorizada Multidetectores com ultra baixa dose de radiação e impressão 3D como auxiliares para cirurgia guiada em implantodontia / Ultra-low dose Multidetector CT and 3D printing as aids to guided implant surgery

Objetivo: relatar um caso clínico de reabilitação com implante dentário imediato realizado utilizando Tomografia Computadorizada Multidetectores (TCMD) com ultra baixa dose de radiação, software de código aberto para manipulação das imagens e impressão 3D de baixo custo do guia cirúrgico. Relato de caso: paciente, sexo masculino, 50 anos de idade, foi avaliado clinicamente relatando dor na região do dente 45, com suspeita de fratura radicular. Como complemento ao exame clínico, o paciente realizou TCMD com ultra baixa dose de radiação para avaliar a condição dentária e do tecido ósseo adjacente. Tendo sido diagnosticada fratura radicular vertical, procedeu-se ao planejamento virtual do implante e à confecção do guia cirúrgico. As imagens em formato DICOM da TCMD foram convertidas para formato STL (Stereolithography) para manipulação e confecção do guia cirúrgico virtual. Esse guia foi impresso em PLA (poliácido láctico) utilizando impressora 3D pelo método FDM (Fusão e Deposição de Material). Após a exodontia atraumática, o guia cirúrgico foi posicionado nos dentes adjacentes e o implante foi inserido. Clinicamente, o paciente encontra-se assintomático, o implante sem sinais clínicos de inflamação e a prótese em função. Uma segunda tomografia do paciente permitiu comparar de forma tridimensional a posição final do implante e o planejamento virtual, que se mostraram equivalentes. Considerações finais: a impressão 3D em PLA mostrou-se uma solução com custo acessível para a produção de guias cirúrgicos, fornecendo previsibilidade e segurança ao implantodontista.(AU)

Objective: to report a clinical case of rehabilitation with dental implant performed using ultra- -low dose Multidetector Computed Tomography (MDCT), open source software for image manipulation, and low cost 3D printing of the surgical guide. Case report: a 50-year-old male patient was clinically evaluated complaining of pain in the tooth 45, and a root fracture was suspected. As a complement to the clinical examination, the patient performed an ultra-low dose MDCT to assess the dental condition and the adjacent bone tissue. A vertical root fracture was diagnosed, and then the virtual planning of the implant and preparation of the surgical guide were performed. The DICOM images from the MDCT were converted into STL (Stereolithography) format for manipulation and confection of the virtual surgical guide. The surgical guide was printed on PLA using a 3D printer by the FDM (Fused Deposition Modeling) method. After atraumatic extraction, the surgical guide was placed in the adjacent teeth and the implant was inserted. Clinically, the patient is asymptomatic, the implant has no clinical signs of inflammation, and the prosthesis is in function. A second ultra- -low dose MDCT of the patient allowed a three-dimensional comparison of the final position of the implant and the virtual planning, which were shown to be equivalent. Final considerations: 3D PLA printing has proved to be an affordable solution for the production of surgical guides, providing predictability and safety for the implantologist.(AU)

Aortitis: Hallazgos radiológicos en relación a sus diversas etiologías / Aortitis: Radiological Findings in Relation to its Various Etiologies

Resumen La inflamación de la aorta (aortitis) es una patología poco frecuente, con etiología infecciosa (pseudoaneurisma micótico, sífilis) y no infecciosa (arteritis, aortitis idiopática, espondilitis anquilosante, entre otras) de difícil diagnóstico clínico y variable pronóstico. Por esa razón, la utilización de diversos métodos por imágenes, tales como la tomografía computada multidetector (TCMD), la tomografía computada por emisión de positrones (PET-TC), la resonancia magnética (RM) y ultrasonido (US) facilitan la identificación, seguimiento y tratamiento de esa entidad. El siguiente trabajo tiene como objetivo realizar una revisión y actualización bibliográfica acerca de la aortitis y sus diversas etiologías, ejemplificando con casos de nuestra institución.

Abstract Aortic inflammation (aortitis) is a rare pathology, with infectious (fungal pseudoaneurysm, syphilis) and noninfectious etiology (arteritis, idiopathic aortitis, ankylosing spondylitis, among others), it has a difficult clinical diagnosis and a variable prognosis. The use of various imaging methods such as multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and ultrasound (US) facilitate the identification, monitoring and treatment of this entity. The following paper aims to perform a literature review and update about aortitis and its various etiologies, exemplifying cases of our institution.

In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

Abstract Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma? / Implementación de un nuevo protocolo de Tomografía Computarizada Corporal Total de un solo pase: ¿Es seguro, efectivo y eficiente en pacientes con trauma severo?

Abstract Purpose: The objective of this study was to evaluate the implementation of a new single-pass whole-body computed tomography Protocol in the management of patients with severe trauma. Methods: This was a descriptive evaluation of polytrauma patients who underwent whole-body computed tomography. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, whole-body computed tomography parameters and outcome variables were evaluated. Results: Were included 263 patients. Median injury severity score was 22 (IQR: 16-22). Time between arrival to the emergency department and completing the whole-body computed tomography was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50; p= 0.96)]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. real survival rate 85% (p= 0.69); Group 2: TRISS 69% vs. real survival rate 74% (p= 0.25); Group 3: TRISS 93% vs. real survival rate 87% (p= 0.07)]. Conclusion: This new single-pass whole-body computed tomography protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

Resumen Introducción: El objetivo de este estudio fue evaluar la implementación de un nuevo protocolo de tomografía computarizada corporal total para el manejo de pacientes con trauma severo. Métodos: Este estudio es una evaluación descriptiva de pacientes que recibieron tomografía computarizada corporal total. Los pacientes fueron divididos en 3 grupos: 1. Trauma cerrado hemodinámicamente estables, 2. Trauma cerrado hemodinámicamente inestables y 3. Trauma penetrante. Se evaluaron las características demográficas, parámetros relacionados con la técnica y los desenlaces de los pacientes. Resultados: Se incluyeron 263 pacientes. La mediana del puntaje de severidad de la lesión fue 22 (RIQ: 16-22). El tiempo entre el ingreso a urgencias y completar la tomografía corporal total fue menor a 30 minutos en la mayoría de pacientes [Grupo 1: 28 minutos (RIQ: 14-55), Grupo 2: 29 minutos (RIQ: 16-57), y Grupo 3: 31 minutos (RIQ: 13-50; p= 0.96). 172 pacientes (65.4%) recibieron manejo no operatorio. Las tasas de supervivencia calculadas y reales no difirieron entre ninguno de los grupos [Grupo 1: TRISS 86.4% vs. Tasa real de supervivencia 85% (p= 0.69); Grupo 2: TRISS 69% vs. Tasa real de supervivencia 74% (p= 0.25); Grupo 3: TRISS 93% vs. Tasa real de supervivencia 87% (p= 0.07)]. Conclusión: Este nuevo protocolo de tomografía corporal total de un solo pase fue seguro, efectivo y eficiente para definir si los pacientes con trauma severo requieren o no una intervención quirúrgica. Su uso podría reducir la tasa de intervenciones quirúrgicas innecesarias en estos pacientes incluyendo los que se presentan con trauma penetrante.

The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans / Avaliação anatômica do canal vidiano e estruturas adjacentes por tomografia computadorizada para a neurectomia do vidiano

Abstract Introduction: The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. Objective: The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. Methods: This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625 mm of 250 adults. Results: The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p < 0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p < 0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p < 0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05 ± 7.71°. Conclusions: Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

Resumo Introdução: O tipo de abordagem endoscópica para a neurectomia do vidiano pode ser definido pela avaliação do canal do vidiano e das estruturas adjacentes aos seios esfenoidais. Objetivo: Investigar as variações e a morfometria do canal vidiano com enfoque nas suas correlações funcionais, pois são parâmetros anatômicos cruciais para o planejamento pré-operatório. Método: Esse estudo foi realizado utilizando-se imagens de tomografia computadorizada multidetectores dos seios paranasais com espessura de corte de 0,625 mm obtidas de 250 indivíduos adultos. Resultados: A distribuição das 500 variantes do canal vidiano foi categorizada da seguinte forma: Tipo 1, dentro do corpo ósseo esfenoidal (55,6%); Tipo 2, protrusão parcial no interior do seio esfenoidal (34,8%); Tipo 3, no interior do seio esfenoidal (9,6%). A pneumatização do processo pterigoide foi observada principalmente no canal vidiano Tipo 2 (72,4%) e Tipo 3 (95,8%) (p < 0,001). As distâncias médias do canal vidiano até o forame redondo e o canal palatovaginal foram maiores no canal vidiano do Tipo 2 e 3, com a pneumatização do processo pterigoide (p < 0,001). A presença do septo intraesfenoidal entre o canal vidiano e a crista vomeriana e a extensão lateral, que termina na proeminência da carótida, foi muito maior no canal vidiano Tipo 3 do que nos outros tipos (p < 0,001). A angulação média entre a cauda da concha média e a margem lateral da abertura anterior do canal vidiano foi de 33,05° ± 7,71°. Conclusões: A análise radiológica pré-operatória do canal do vidiano e das estruturas circunjacentes permitem ao cirurgião escolher uma abordagem endoscópica apropriada e prever resultados pós-operatórios.

Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction? / Medidas obtidas por tomografia computadorizada em 3D das vias aéreas superiores em crianças com respiração bucal estão de acordo com o diagnóstico clínico-otorrinolaringológico de obstrução?

Abstract Introduction: Imaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing. Objective: The objective of this study was to compare 3D volumetric measurements of nasal cavity, nasopharynx and oropharynx of obstructed mouth-breathing children with measurements of non-obstructed mouth-breathing children. Methods: This retrospective study included 25 mouth-breathing children aged 5-9 years evaluated by otorhinolaryngological clinical examination, flexible nasoendoscopy and full-head multi-slice computed tomography. Tomographic volumetric measurements and dichotomic otorhinolaryngological diagnosis (obstructed vs. non-obstructed) in three anatomical regions (the nasal cavity, nasopharynx and oropharynx) were compared and correlated. An independent sample t-test was used to assess the association between the 3D measurements of the upper airways and the otorhinolaryngological diagnosis of obstruction in the three anatomical regions. Inter- and intra-observer intraclass correlation coefficients were used to evaluate the reliability of the 3D measurements. Results: The intra-class correlation coefficients ranged from 0.97 to 0.99. An association was found between turbinate hypertrophy and nasal cavity volume reduction (p < 0.05) and between adenoid hyperplasia and nasopharynx volume reduction (p < 0.001). No association was found between palatine tonsil hyperplasia and oropharynx volume reduction. Conclusions: (1) The nasal cavity volume was reduced when hypertrophic turbinates were diagnosed; (2) the nasopharynx was reduced when adenoid hyperplasia was diagnosed; and (3) the oropharynx volume of mouth-breathing children with tonsil hyperplasia was similar to that of non-obstructed mouth-breathing children. The adoption of the actual anatomy of the various compartments of the upper airway is an improvement to the evaluation method.

Resumo Introdução: O exame clínico otorrinolaringológico da via aérea superior tem sido historicamente feito com a ajuda de imagens radiográficas para diagnosticar causas obstrutivas da respiração bucal. Objetivo: O objetivo deste estudo foi comparar as medidas volumétricas em 3D da cavidade nasal, nasofaringe e orofaringe entre crianças com respiração bucal e obstrução respiratória e crianças respiradoras bucais sem obstrução respiratória. Método: Estudo retrospectivo que inclui 25 crianças respiradoras bucais de 5 a 9 anos. As crianças foram avaliadas por exame clínico otorrinolaringológico, nasofibroscopia flexível e tomografia computadorizada multi-slice. Medidas volumétricas obtidas tomograficamente de três regiões anatômicas (cavidade nasal, nasofaringe e orofaringe) foram correlacionadas e comparadas com diagnóstico dicotômico otorrinolaringológico (obstruído vs. não obstruído). Um teste t de amostra independente foi usado para avaliar a associação entre as medidas em 3D das vias aéreas superiores e o diagnóstico otorrinolaringológico de obstrução nas três regiões anatômicas. Os coeficientes de correlação intraclasse inter e intraobservador foram usados para avaliar a confiabilidade das medidas em 3D. Resultados: O coeficiente de correlação intraclasse variou de 0,97 a 0,99. Uma associação foi encontrada entre a hipertrofia de conchas e a redução do volume da cavidade nasal (p < 0,05) e entre a hiperplasia de tonsila faríngea e a redução do volume da nasofaringe (p < 0,001). Não foi encontrada associação entre a hiperplasia da tonsila palatina e a redução do volume da orofaringe. Conclusões: 1) O volume da cavidade nasal estava reduzido nas crianças com diagnóstico de hipertrofia de conchas; 2) O volume da nasofaringe estava reduzido nas crianças com diagnóstico de hiperplasia de tonsila faríngea; e 3) O volume da orofaringe de crianças com respiração bucal e hiperplasia de tonsila palatina foi semelhante ao de crianças respiradoras bucais sem aumento da tonsila palatina. A adoção da mensuração anatômica dos vários compartimentos da via aérea superior complementa o método de avaliação.

State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea / Alterações nas vias aéreas superiores avaliadas por TC multidetectores durante a vigília e o sono em indivíduos saudáveis e em pacientes com apneia do sono durante eventos obstrutivos

ABSTRACT Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

Resumo Objetivo: Determinar se o estreitamento das vias aéreas durante eventos obstrutivos ocorre predominantemente na região retropalatal e resulta de alterações dinâmicas nas paredes laterais da faringe e na posição da língua. Métodos: Avaliamos 11 pacientes com apneia obstrutiva do sono (AOS) grave (grupo AOS) e 7 indivíduos saudáveis sem AOS (grupo controle) durante a vigília e o sono natural (documentado por meio de polissonografia completa). Por meio de TC multidetectores rápida, obtivemos imagens das vias aéreas superiores no estado de vigília e de sono. Resultados: O estreitamento das vias aéreas superiores durante o sono foi significativamente maior na região retropalatal do que na região retrolingual no grupo AOS (p < 0,001) e no grupo controle (p < 0,05). O volume da via aérea retropalatal foi menor no grupo AOS do que no grupo controle durante a vigília (p < 0,05) e diminuiu significativamente da vigília ao sono apenas no grupo AOS. O estreitamento retropalatal da faringe foi atribuído à redução do diâmetro anteroposterior (p = 0,001) e lateral (p = 0,006), que se correlacionou com o aumento do volume das paredes laterais da faringe (p = 0,001) e o deslocamento posterior da língua (p = 0,001). Não ocorreu estreitamento retrolingual da faringe durante o sono no grupo AOS. Conclusões: Em pacientes com AOS, o estreitamento das vias aéreas superiores durante o sono ocorre predominantemente na região retropalatal e afeta as dimensões anteroposterior e lateral, além de estar relacionado com aumento das paredes laterais da faringe e deslocamento posterior da língua.

Tomografia computadorizada multidetectores de baixa dose de radiação para avaliação de canino incluso / Low-dose multidetector computed tomography for impacted canine evaluation

Objetivo: avaliar caninos inclusos em tomografias computadorizadas multidetectores (TCMD) realizadas no Hospital Universitário de Santa Maria. Materiais e mé¬todo: foi realizado um estudo observacional transversal com imagens de um banco de dados de TCMD de baixa dose de radiação, solicitadas por indicações clínicas odontológicas. Os exames em formato digital imaging and communications in medicine foram avaliados por um examinador treinado, no software Weasis Medical Viewer. A avaliação dos exames compreendeu a observação das seguintes características: impactação do canino (uni ou bilateral), localização do canino (maxila ou mandíbula), localização da coroa do canino (vesti¬bular ou lingual/palatal), eixo de erupção, espessura do folículo pericoronário, presença de lesões associadas, presença de reabsorção nos dentes adjacentes e presença de agenesias dentárias ou de supranumerários. Os resultados foram avaliados de maneira descritiva, por meio de prevalência dos achados. Resultados: foram encontrados 21 caninos inclusos em 837 tomografias avaliadas (1,9%). Foi observado um predomínio de indivíduos do sexo feminino (71,4%), e a retenção do canino foi mais frequente na maxila (71,4%) e com impactação unilateral (61,9%). Quatro caninos apre¬sentaram folículo pericoronário, com espessura maior que 2 mm; 19% dos exames apresentaram reabsorção radicular externa em algum incisivo lateral. Apenas um canino apresentava lesão associada, sugerindo esclero-se óssea. Além dos caninos inclusos, foi possível avaliar alterações relacionadas às demais regiões e estruturas dentomaxilofaciais. Conclusão: apesar da amostra limitada de imagens, o presente estudo demonstrou a aplicabilidade clínica da TCMD com protocolo de baixa dose de radiação, para a avaliação dos caninos inclusos e características relacionadas a esses dentes, bem como de dentes e regiões adjacentes. (AU)

Objective: to evaluate impacted canines by tomographic exams performed at the University Hospital of Santa Maria. Materials and method: a cross-sectional observational study was performed with selected images from a database of low dose computed tomography (CT) scans requested by several dental indications. The DICOM files were evaluated by a trained examiner, using Weasis Medical Viewer software. The evaluation of each exam included the following characteristics: canine impaction (uni or bilateral), location of the canine (maxilla or mandible), location of the canine crown (buccal or lingual / palatal), shaft of canine eruption, thickness of the pericoronal follicle, presence of associated lesions, presence of external root resorption in adjacent teeth and presence of dental agenesis or supernumerary tooth. The results were evaluated in a descriptive way, through prevalence of the findings. Results: a total of 21 impacted canines were found in 837 CT scans evaluated (1,9%). A predominance of female patients was observed (71,4%); canine impaction was more frequent in the maxilla (71,4%), and unilateral (61,9%). In 19% of the exams, external root resorption occurred in some lateral incisor. Four dental elements presented pericoronal follicles thicker than 2 mm. In the evaluated sample, only one canine presented an associated lesion, suggesting bone sclerosis. Beyond the canine-related, other dental and maxillofacial changes were also evaluated. Conclusion: in spite of the limited sample, the present study demonstrated the clinical applicability of low dose CT for the evaluation of impacted canines, and characteristics related to these teeth, as well as to the adjacent teeth and regions. (AU)

Recomendações para Avaliação por Imagens das Próteses Valvares Cardíacas / Recommendations for the Imaging Assessment of Prosthetic Heart Valves

Disfunção de prótese valvar cardíaca (PVC) é rara, porém é uma potencial ameaça à vida. Estabelecer o exato mecanismo da disfunção da PVC é desafiador, no entanto é essencial para determinar a estratégia terapêutica apropriada. Na prática clinica, uma abordagem abrangente que integra vários parâmetros de morfologia e função avaliados pelo eco transtorácico 2D/3D e transesofágico são fundamentais para detectar e quantificar a disfunção da PVC. A cinefluoroscopia, a tomografia computadorizada com multidectetores, a ressonância magnética cardíaca, e em menor escala, a imagem nuclear, são ferramentas complementares para o diagnóstico e abordagem das complicações das PVC. Este documento apresenta recomendações para o uso de imagem em multimodalidade para avaliação das PVCs

Anatomical variants of anterior cerebral arterial circle: a study by multidetector computerized 3D tomographic angiography / Variantes anatómicas de la región anterior del circulo arterial cerebral: estudio por angiotomografía computarizada 3D

One of the most common causes of stroke is rupture of aneurysms whose approach requires knowledge of anatomical variants. The aim of this study was to determine the prevalence of anatomical variants of the anterior cerebral artery (ACA) and the anterior communicating artery (AComA) by 3D computed tomography angiography (3D CTA) in Mexican individuals. A retrospective, observational, cross-sectional descriptive study of 283 patients, independent of sex or age, in which morphometric measurements of cerebral vessels were evaluated using contrasted 3D CTA from a period of two years was performed. We found at least one "atypical" variant in a third of the study population (33.93 %). The most common "atypical" variant was the absence of the AComA (14.1 %). A significant association between the hypoplastic variant of the right A1 segment and hypoplasia of the left A1 and the right A2 was found, while hypoplasia of the left A1 was associated with hypoplasia of the right A2. There is a difference in the prevalence of anatomical variants of the ACA-AComA complex in Mexican population in relation to other populations. The typical variant is the most prevalent form in the study population. However, the presence of atypical variants represents an important number that should be taken into account in clinical and surgical procedures.

Una de las causas más frecuentes de accidente cerebrovascular es la ruptura de aneurismas cuyo abordaje requiere el conocimiento de las variantes anatómicas. El presente estudio tuvo como objetivo determinar la prevalencia de variantes anatómicas de la Arteria Cerebral Anterior (ACA) y la Arteria Comunicante Anterior (AComA) mediante angiotomografías computarizadas 3D (angioTAC 3D) de individuos mexicanos. Se realizó un estudio retrospectivo, observacional, transversal y descriptivo en el que se evaluaron angioTAC contrastados con reconstrucción 3D de 283 pacientes, sin considerar género ni edad, obtenidas durante un periodo de dos años a los que se les realizaron mediciones morfométricas en los vasos de interés. Se encontró al menos una variante "atípica" en un tercio de la población estudiada (33,93 %). La variante "atípica" más común fue la ausencia de AComA (14,1 %). Se encontró asociación significativa entre la variante hipoplásica del segmento A1 derecha y la hipoplasia de A1 izquierda y A2 derecha; mientras que la hipoplasia de A1 izquierda se asoció a la variante hipoplasia de A2 derecha, encontrándose mayor tendencia de aparición de aneurismas en función del menor diámetro del segmento A2 derecho de la ACA. Existe diferencia en la prevalencia de variantes anatómicas del complejo ACA-AComA en población mexicana con respecto a otras poblaciones. La variante típica constituye la forma más prevalente en la población estudiada. Sin embargo, la presencia de variantes atípicas representa una cifra importante que deberá tomarse en cuenta en procedimientos clínicos y quirúrgicos.

Quiste pericardio - celómico / Spring water cyst

Paciente femenino, de 24 años que concurre por dolor torácico y disnea. Al examen por TC se observa masa homogénea, en seno cardiofrenico derecho, que no realza tras la administración EV de contraste iodado, y teniendo como característica, contenido líquido. Provoca desviación mediastinica hacia la izquierda. Luego de su exeresis, se concluye en el diagnóstico de quiste pericardio-celómico.

Female patient, 24 years that concurs with chest pain and dyspnea. To review by TC is observed homogeneous mass, in the cardiofrenico angle, which does not enhance after contrast administration EV iodide, and taking as a feature, liquid contents. Causes mediastinal deviation to the left. After excision, it is concluded in the diagnosis of pericardial cyst-coelomic.

Tomografia computada multidetector en la enfermedad diverticular del intestino delgado / Multislice computed tomography in small-bowel diverticulosis

La enfermedad diverticular del intestino delgado constituye una entidad de rara presentación, que suele confundirse con otras patologías más comunes cuando se complica. Los falsos divertículos son de origen primario o secundario, y asientan mayoritariamente en el duodeno. El divertículo verdadero más frecuente es el de Meckel. Las complicaciones aparecen en menos del 15% de los casos. Entre ellas, se destacan, por frecuencia, la perforación y/o inflamación, la obstrucción, el sangrado, y/o la diarrea crónica. El objetivo de este trabajo es mostrar el rol de la tomografía computada multidetector en el diagnóstico y manejo de la enfermedad diverticular del intestino delgado, exponiendo casos de la práctica diaria con correlato quirúrgico de pacientes evaluados en nuestra institución.

Small bowel diverticula is an uncommon and underdiagnosed pathology. False diverticula may be primary or secondary in origin and are frequently located in the duodenum. Meckel's diverticula is the most common true diverticula. Less than 15% of cases suffer complications, of which the following are, with decreasing frequency: inflammation and perforation, obstruction, bleeding, or chronic diarrhoea. In order to contribute to the best diagnosis and management of small-bowel diverticulosis, cases are presented that were initially evaluated with multislice computed tomography and confirmed surgically in our institution.

Un recorrido por la pared abdominal: evaluación de las hernias por tomografía computada multidetector / A tour of the abdominal wall: assessment of hernias by multidetector computed tomography

Si bien el diagnóstico de hernias de la pared abdominal es clínico y el estudio más indicado es la ecografía, en una gran cantidad de casos es difícil su evaluación o no se sospecha su presencia debido al biotipo del paciente, la ausencia de síntomas, la aparición de complicaciones o corresponde a algún tipo de hernia poco frecuente. Además, la debilidad de la pared abdominal generada por una cirugía predispone a la eventración de órganos, a veces poco habituales, como el hígado, la vejiga o el apéndice. La utilización de la tomografía computada multidetector (TCMD) brinda grandes ventajas cuando resulta dificultoso establecer el diagnóstico por otros métodos. También puede ser un hallazgo incidental a tener en cuenta por sus posibles complicaciones futuras. En el presente trabajo describimos los principales hallazgos por TCMD de las hernias y eventraciones de la pared abdominal (como la umbilical, epigástrica, hipogástrica, inguinal, de Spiegel, lumbar, obturatriz, intercostal e incisional) y su contenido.

Although the diagnosis of abdominal wall hernias is clinical, and the most appropriate study is ultrasound, in a lot of cases they are difficult to evaluate, or their presence is not suspected because of the biotype of the patient, the absence of symptoms, the presence of complications, or the appearance of rare hernias. Surgery weakness generated in the wall leads to organ hernia, sometimes unusual, as in the liver, bladder, or appendix. The use of multidetector computed tomography (MDCT) is a great advantage in these situations where the diagnosis can be difficult to determine with other methods. It also can be an incidental finding to consider eventual complications. In this paper, the main MDCT findings in abdominal wall hernias are described, including umbilical, epigastric, hypogastric, inguinal, Spiegel, lumbar, obturator, intercostal, and incisional, as well as their content.

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

Angiotomografia de Coronárias e Proteína C Reativa na Avaliação da Doença Arterial Coronariana / Coronary Computed Tomography Angiography and C-Reactive Protein in the Evaluation of Coronary Artery Disease

Fundamento: A doença arterial coronariana (DAC) constitui a principal causa de morte nos países desenvolvidos. No Brasil, gasta-se aproximadamente 1,74% do Produto Interno Bruto com doenças cardiovasculares. Testes de isquemia possuem baixa acurácia diagnóstica em indivíduos com risco intermediário de DAC e a angiotomografia computadorizada de múltiplos detectores (ATCMD) pode contribuir para esclarecer o diagnóstico desses pacientes, não obstante o custo deste procedimento que ainda é elevado para o nosso padrão. A proteína C reativa (PCR) eleva-se no caso de inflamação sistêmica e tem sido utilizada como marcador de DAC. Objetivo: Avaliar a correlação da PCR com a presença de placas ateroscleróticas identificadas pela angiotomografia. Métodos: Trata-se de um estudo de corte transversal, no qual foram incluídos 118 pacientes com risco intermediário para DAC, que realizaram ATCMD das artérias coronárias e dosagem de PCR de setembro de 2011 a janeiro de 2013 em um hospital de referência cardiológica. Resultados: Cerca de 55% da amostra foi representada pelo gênero masculino. A DAC, HAS e obesidade foram identificadas em 68,6%, 76,3% e 31,8% dos indivíduos, respectivamente. Observou-se que os pacientes com concentrações elevadas de PCR tiveram uma chance 2,9 maior de apresentarem DAC diagnosticada por ATCMD (p = 0,016). Conclusão: Indivíduos com PCR alterada têm maior chance de apresentarem DAC diagnosticada à ATCMD e possuem valores de PCR mais elevados que pacientes sem DAC. A PCR, junto a outros fatores de risco, pode representar um elemento preditivo relevante para o diagnóstico de DAC na ATCMD, ou em situações quando a realização da ATCMD não é possível

Background: Coronary artery disease (CAD) is the leading cause of death in developed countries. In Brazil, approximately 1.74% of the gross domestic product is spent on cardiovascular diseases. Ischemia tests have a low diagnostic accuracy for patients with intermediate CAD risk, and multidetector computed tomography angiography (MDCTA) may help establish the diagnosis of these patients, despite the cost of this procedure, which is still high for our standards. C-reactive protein (CRP) is increased in cases of systemic inflammation and has been used as a CAD marker. Objective: To evaluate the correlation of CRP with the presence of atherosclerotic plaques identified on CT angiography. Methods: Cross-sectional study including 118 patients with intermediate risk of CAD, who underwent coronary MDCTA and CRP measurement from September 2011 to January 2013 in a referral cardiology hospital. Results: Males comprised about 55% of the sample. CAD, hypertension, and obesity were identified in 68.6%, 76.3%, and 31.8% of the subjects, respectively. We observed that patients with increased CRP levels had a 2.9-fold higher chance of presenting CAD on MDCTA (p = 0.016). Conclusion: Individuals with altered CRP are more likely to present CAD diagnosed by MDCTA and have higher CRP values than patients without CAD. CRP, along with other risk factors, may represent a relevant predictive element in the diagnosis of CAD in MDCTA, or in situations in which MDCTA is not feasible

Evaluation of pulmonary sequestration with multidetector computed tomography angiography in a select cohort of patients: A retrospective study

OBJECTIVES: This study aimed to evaluate the role of multidetector computed tomography angiography in diagnosing patients with pulmonary sequestration. METHODS: We retrospectively analyzed the computed tomography studies and clinical materials of 43 patients who had undergone preoperative multidetector computed tomography angiography in our hospital and had pathologically proven pulmonary sequestration. Each examination of pulmonary sequestration was reviewed for type, location, parenchymal changes, arterial supply and venous drainage on two-dimensional and three-dimensional computed tomography images. RESULTS: Multidetector computed tomography successfully detected all pulmonary sequestrations in the 43 patients (100%). This included 40 patients (93.0%) with intralobar sequestration and 3 patients (7.0%) with extralobar sequestration. The locations of pulmonary sequestration were left lower lobe (28 cases, 70% of intralobar sequestrations), right lower lobe (12 cases, 30% of intralobar sequestrations) and costodiaphragmatic sulcus (3 cases). Cases of sequestered lung presented as mass lesions (37.2%), cystic lesions (32.6%), pneumonic lesions (16.3%), cavitary lesions (9.3%) and bronchiectasis (4.6%). The angioarchitecture of pulmonary sequestration, including feeding arteries from the thoracic aorta (86.1%), celiac truck (9.3%), abdominal aorta (2.3%) and left gastric artery (2.3%) and venous drainage into inferior pulmonary veins (86.0%) and the azygos vein system (14.0%), was visualized on multidetector computed tomography. Finally, the multidetector computed tomography angiography results of the sequestered lungs and angioarchitectures were surgically confirmed in all the patients. CONCLUSIONS: As a noninvasive modality, multidetector computed tomography angiography is helpful for making diagnostic decisions regarding pulmonary sequestration with high confidence and for visualizing the related parenchymal characteristics, arterial supply, and venous drainage features to help plan surgical strategies.

Tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography: association with N categories

OBJECTIVE: To determine whether the gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict the presence of regional lymph node metastasis and could determine N categories. MATERIALS AND METHODS: A total of 202 consecutive patients with gastric adenocarcinoma who had undergone gastrectomy 1 week after contrast-enhanced multidetector computed tomography were retrospectively identified. The gross tumor volume was evaluated on multidetector computed tomography images. Univariate and multivariate analyses were performed to determine whether the gross tumor volume could predict regional lymph node metastasis, and the Mann-Whitney U test was performed to compare the gross tumor volume among N categories. Additionally, a receiver operating characteristic analysis was performed to identify the accuracy of the gross tumor volume in differentiating N categories. RESULTS: The gross tumor volume could predict regional lymph node metastasis (p<0.0001) in the univariate analysis, and the multivariate analyses indicated that the gross tumor volume was an independent risk factor for regional lymph node metastasis (p=0.005, odds ratio=1.364). The Mann-Whitney U test showed that the gross tumor volume could distinguish N0 from the N1-N3 categories, N0-N1 from N2-N3, and N0-N2 from N3 (all p<0.0001). In the T1-T4a categories, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 12.3 cm3), N0-N1 from N2-N3 (cutoff, 16.6 cm3), and N0-N2 from N3 (cutoff, 24.6 cm3). In the T4a category, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 15.8 cm3), N0-N1 from N2-N3 (cutoff, 17.8 cm3), and N0-N2 from N3 (cutoff, 24 cm3). CONCLUSION: The gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict regional lymph node metastasis and N categories.