Uso Atual de Ressonância Magnética Cardíaca Pediátrica no Brasil / Current Use of Pediatric Cardiac Magnetic Resonance Imaging in Brazil

Resumo Fundamento Dados sobre o uso de ressonância magnética cardíaca (RMC) em crianças no Brasil são escassos. Objetivos Buscamos oferecer informações sobre as práticas atuais de RMC pediátricas no Brasil. Métodos Um questionário foi enviado a médicos solicitantes de RMC de todo o país, cobrindo informações sobre si próprios, sobre seus serviços de RMC, contexto clínico dos pacientes e sobre os obstáculos para a realização de RMC em crianças. Para a análise estatística, um p < 0,05 bilateral foi considerado significativo. Resultados A pesquisa obteve 142 respostas. Foi relatado que a RMC está disponível para 79% dos respondentes, dos quais 52% raramente ou nunca a utilizam. As indicações mais comuns são cardiomiopatias (84%), pós-operatório de correção de tetralogia de Fallot (81%) e malformações do arco aórtico (53%). A complexidade do exame se correlacionou à relação RMC/cirurgia (Rho = 0,48, IC 95% = 0,32-0,62, p < 0,0001) e ao número de exames de RMC (Rho = 0,52, IC 95% = 0,38-0,64, p < 0,0001). A complexidade da RMC esteve associada à sua realização por cardiologistas pediátricos (RC 2,04, IC 95% 1,2-3,89, p < 0,01). Os principais obstáculos ao uso mais frequente de RMC foram o alto custo (65%), a necessidade de sedação (60%) e o número insuficiente de profissionais qualificados (55%). Conclusão A RMC pediátrica não é usada frequentemente no Brasil. A presença de um cardiologista pediátrico a frente dos exames esteve associado ao uso de RMC em pacientes mais complexos. O treinamento de especialistas em RMC pediátrica e a educação dos médicos solicitantes são passos importantes na direção de um uso mais abrangente de RMC no Brasil. (Arq Bras Cardiol. 2021; 116(2):305-312)

Abstract Background Data on the use of cardiac magnetic resonance imaging (CMR) on children in Brazil is lacking. Objectives This study sought to provide information on current pediatric CMR practices in Brazil. Methods A questionnaire was sent out to referring physicians around the country. It covered information on the respondents, their CMR practices, the clinical context of the patients, and barriers to CMR use among children. For statistical analysis, two-sided p < 0.05 was considered significant. Results The survey received 142 replies. CMR was reported to be available to 79% of the respondents, of whom, 52% rarely or never use CMR. The most common indications were found to be cardiomyopathies (84%), status of post-tetralogy of Fallot repair (81%), and aortic arch malformations (53%). Exam complexity correlated with CMR-to-surgery ratio (Rho = 0.48, 95% CI = 0.32-0.62, p < 0.0001) and with the number of CMR exams (Rho = 0.52, 95% CI = 0.38-0.64, p < 0.0001). Further, a high CMR complexity score was associated with pediatric cardiologists conducting the exams (OR 2.14, 95% CI 1.2-3.89, p < 0.01). The main barriers to a more frequent use of CMR were its high cost (65%), the need for sedation (60%), and an insufficient number of qualified professionals (55%). Conclusion Pediatric CMR is not used frequently in Brazil. The presence of a pediatric cardiologist who can perform CMR exams is associated with CMR use on more complex patients. Training pediatric CMR specialists and educating referring providers are important steps toward a broader use of CMR in Brazil. (Arq Bras Cardiol. 2021; 116(2):305-312)

Detection of glypican 3 in serum and its clinical significance on the diagnosis of hepatocellular carcinoma / 肿瘤

Objective: To evaluate the clinical significance of detection of serum glypican 3 (GPC3) on the diagnosis of hepatocellular carcinoma. Methods: Mouse anti-GPC3 (25-358 aa) monoclonal antibody and rabbit anti-GPC3 (379-393 as) antibody were used to establish the sandwich ELISA method for detecting serum GPC3 level in 364 HCC patients, 96 patients with chronic hepatitis, and 106 healthy subjects. Serum alpha-fetoprotein (AFP) level was detected by radioimmunoassay. Results: The mean concentration of serum GPC3 was 86.96 ± 42.2 ng/mL, 11.7 ± 12.23 ng/mL, and 6.04 ± 9.21 ng/mL in HCC patients, chronic hepatitis patients, and healthy subjects, respectively. The difference between HCC patients and chronic hepatitis patients and healthy subjects was highly significant (P 0.05). When the cutoff value was set at 30 ng/mL, the sensitivity and specificity of GPC3 in the diagnosis of hepatocellular carcinoma was 40% and 93%, respectively. Meanwhile, the positive rate of AFP was 49% and the positive rate of GPC3 was 40% in 151 HCC serum samples. The detection rate of HCC increased to 72% by combined detection of AFP with GPC3. Conclusion: Serum GPC3 can be used as a marker for the early diagnosis of HCC in clinic.