Look-Locker T1 relaxometry and high-resolution T2 in the evaluation of lung lesions: a single-center prospective study.

Objective: To explore the feasibility of two magnetic resonance imaging (MRI) sequences-high-resolution T2-weighted (HR T2) and Look-Locker T1 (LL T1) relaxometry-for the investigation focal lung lesions (FLLs). As a secondary objective, we analyzed the diagnostic accuracy of these sequences. Materials and Methods: This was a prospective observational study involving 39 subjects with FLLs scanned in a 1.5-T MRI system with LL T1 relaxometry and HR T2 sequences focused on the FLL region, in addition to a conventional protocol. All images were evaluated by two radiologists, working independently, who were blinded to other findings. Results: Most of the examinations (31 of the LL T1 relaxometry sequences and 36 of the HR T2 sequences) were of adequate diagnostic quality. Nondiagnostic examinations were considered so mainly because of limited coverage of the sequences. Of the FLLs studied, 19 were malignant, 17 were benign, and three were excluded from the accuracy analysis because there was no definitive diagnosis. Although LL T1 relaxometry could not distinguish between benign and malignant lesions, the signal intensity at its first inversion time (160 ms) differed between the two groups. The HR T2 sequence was considered the best sequence for assessing specific morphological characteristics, especially pseudocavities and pleural tags. We found that MRI showed better accuracy than did computed tomography (86% vs. 74%). Conclusion: Both MRI sequences are feasible for the evaluation of FLLs. Images at 160 ms of the LL T1 relaxometry sequence helped distinguish between benign and malignant lesions, and the HR T2 sequence was considered the best sequence for evaluating specific morphological characteristics.

Objetivo: Explorar a viabilidade de imagens de alta resolução T2 (T2 AR) e relaxometria T1 Look-Locker (T1 LL) para lesões pulmonares focais (LPFs). Como objetivo secundário, analisamos a precisão diagnóstica dessas sequências. Materiais e Métodos: Este é um estudo observacional prospectivo com 39 sujeitos com LPFs examinados em um sistema de ressonância magnética 1.5T com imagens T1 LL e T2 AR focadas na região das LPFs, além de um protocolo convencional. As imagens foram avaliadas por dois radiologistas independentes e cegos para o estudo. Imagens de tomografia computadorizada estavam disponíveis, mas foram avaliadas sem conhecimento dos outros resultados. Resultados: A maioria dos exames apresentou qualidade diagnóstica adequada em ambas as sequências (T1 LL em 31 exames e T2 AR em 36). Exames considerados não diagnósticos estavam principalmente relacionados à cobertura limitada das sequências. Das LPFs estudadas, 19 eram malignas, 17 eram benignas e três casos foram excluídos da análise de precisão de malignidade por falta de um diagnóstico definitivo. A relaxometria T1 LL não conseguiu distinguir entre lesões benignas e malignas, mas a análise da intensidade do sinal do primeiro tempo de inversão (160 ms) diferiu entre os grupos. A T2 AR foi considerada a melhor sequência para avaliar características morfológicas específicas, especialmente pseudocavidades e apêndices pleurais. A ressonância magnética teve melhor precisão em comparação com a tomografia computadorizada (86% e 74%, respectivamente). Conclusão: Ambas as sequências são viáveis na avaliação de LPFs. Imagens a 160 ms da sequência T1 LL ajudaram a distinguir lesões benignas de malignas, e a T2 AR foi considerada a melhor sequência na avaliação de algumas características morfológicas específicas.

"Interstitial lung abnormalities": translation to and use in Portuguese.

Objective: To conduct a survey on the use of the term "interstitial lung abnormalities" in radiology reports in Brazil, propose an appropriate Portuguese-language translation for the term, and provide a brief review of the literature on the topic. Materials and Methods: A survey was sent via electronic message to various radiologists in Brazil, asking about their familiarity with the term, which translation of the term they use in Portuguese, and whether they use the criteria proposed by the Fleischner Society. Results: A total of 163 responses were received, from all regions of Brazil. Although the vast majority (88%) of the respondents stated that they were familiar with the term "interstitial lung abnormalities", there was considerable variation regarding the equivalent term they used in Portuguese. Conclusion: We suggest that the term "anormalidades pulmonares intersticiais" be used in order to standardize radiology reports and disseminate knowledge of these findings in Brazil.

Objetivo: Fazer um levantamento sobre o uso do termo interstitial lung abnormalities nos laudos radiológicos no Brasil, propor uma tradução para o termo e fazer uma breve revisão sobre o tema. Materiais e Métodos: Foi enviada uma pesquisa, por meio de mensagem eletrônica, para diversos radiologistas de todo o Brasil, questionando sobre a familiarização com o termo, qual tradução em português utilizam e se usam os critérios propostos pela diretriz da Sociedade Fleischner. Resultados: Foram recebidas 163 respostas de todas as regiões do Brasil e a grande maioria dos radiologistas respondeu estar familiarizado com o termo interstitial lung abnormalities (88%), mas houve grande variação em relação ao termo utilizado como tradução para o português. Conclusão: Sugerimos a padronização do termo "anormalidades pulmonares intersticiais", a fim de uniformizar os relatórios radiológicos e difundir esta entidade no País.

Pulmonary inflammation and viral replication define distinct clinical outcomes in fatal cases of COVID-19.

COVID-19 has affected more than half a billion people worldwide, with more than 6.3 million deaths, but the pathophysiological mechanisms involved in lethal cases and the host determinants that determine the different clinical outcomes are still unclear. In this study, we assessed lung autopsies of 47 COVID-19 patients and examined the inflammatory profiles, viral loads, and inflammasome activation. Additionally, we correlated these factors with the patient's clinical and histopathological conditions. Robust inflammasome activation was detected in the lungs of lethal cases of SARS-CoV-2. Experiments conducted on transgenic mice expressing hACE2 and infected with SARS-CoV-2 showed that Nlrp3-/- mice were protected from disease development and lethality compared to Nlrp3+/+ littermate mice, supporting the involvement of this inflammasome in disease exacerbation. An analysis of gene expression allowed for the classification of COVID-19 patients into two different clusters. Cluster 1 died with higher viral loads and exhibited a reduced inflammatory profile than Cluster 2. Illness time, mechanical ventilation time, pulmonary fibrosis, respiratory functions, histopathological status, thrombosis, viral loads, and inflammasome activation significantly differed between the two clusters. Our data demonstrated two distinct profiles in lethal cases of COVID-19, thus indicating that the balance of viral replication and inflammasome-mediated pulmonary inflammation led to different clinical outcomes. We provide important information to understand clinical variations in severe COVID-19, a process that is critical for decisions between immune-mediated or antiviral-mediated therapies for the treatment of critical cases of COVID-19.

Look-Locker T1 relaxometry and high-resolution T2 in the evaluation of lung lesions: a single-center prospective study / Relaxometria T1 baseada em Look-Locker e T2 de alta resolução na avaliação de lesões pulmonares: um estudo prospectivo unicêntrico

Abstract Objective: To explore the feasibility of two magnetic resonance imaging (MRI) sequences—high-resolution T2-weighted (HR T2) and Look-Locker T1 (LL T1) relaxometry—for the investigation focal lung lesions (FLLs). As a secondary objective, we analyzed the diagnostic accuracy of these sequences. Materials and Methods: This was a prospective observational study involving 39 subjects with FLLs scanned in a 1.5-T MRI system with LL T1 relaxometry and HR T2 sequences focused on the FLL region, in addition to a conventional protocol. All images were evaluated by two radiologists, working independently, who were blinded to other findings. Results: Most of the examinations (31 of the LL T1 relaxometry sequences and 36 of the HR T2 sequences) were of adequate diagnostic quality. Nondiagnostic examinations were considered so mainly because of limited coverage of the sequences. Of the FLLs studied, 19 were malignant, 17 were benign, and three were excluded from the accuracy analysis because there was no definitive diagnosis. Although LL T1 relaxometry could not distinguish between benign and malignant lesions, the signal intensity at its first inversion time (160 ms) differed between the two groups. The HR T2 sequence was considered the best sequence for assessing specific morphological characteristics, especially pseudocavities and pleural tags. We found that MRI showed better accuracy than did computed tomography (86% vs. 74%). Conclusion: Both MRI sequences are feasible for the evaluation of FLLs. Images at 160 ms of the LL T1 relaxometry sequence helped distinguish between benign and malignant lesions, and the HR T2 sequence was considered the best sequence for evaluating specific morphological characteristics.

Resumo Objetivo: Explorar a viabilidade de imagens de alta resolução T2 (T2 AR) e relaxometria T1 Look-Locker (T1 LL) para lesões pulmonares focais (LPFs). Como objetivo secundário, analisamos a precisão diagnóstica dessas sequências. Materiais e Métodos: Este é um estudo observacional prospectivo com 39 sujeitos com LPFs examinados em um sistema de ressonância magnética 1.5T com imagens T1 LL e T2 AR focadas na região das LPFs, além de um protocolo convencional. As imagens foram avaliadas por dois radiologistas independentes e cegos para o estudo. Imagens de tomografia computadorizada estavam disponíveis, mas foram avaliadas sem conhecimento dos outros resultados. Resultados: A maioria dos exames apresentou qualidade diagnóstica adequada em ambas as sequências (T1 LL em 31 exames e T2 AR em 36). Exames considerados não diagnósticos estavam principalmente relacionados à cobertura limitada das sequências. Das LPFs estudadas, 19 eram malignas, 17 eram benignas e três casos foram excluídos da análise de precisão de malignidade por falta de um diagnóstico definitivo. A relaxometria T1 LL não conseguiu distinguir entre lesões benignas e malignas, mas a análise da intensidade do sinal do primeiro tempo de inversão (160 ms) diferiu entre os grupos. A T2 AR foi considerada a melhor sequência para avaliar características morfológicas específicas, especialmente pseudocavidades e apêndices pleurais. A ressonância magnética teve melhor precisão em comparação com a tomografia computadorizada (86% e 74%, respectivamente). Conclusão: Ambas as sequências são viáveis na avaliação de LPFs. Imagens a 160 ms da sequência T1 LL ajudaram a distinguir lesões benignas de malignas, e a T2 AR foi considerada a melhor sequência na avaliação de algumas características morfológicas específicas.

"Interstitial lung abnormalities": translation to and use in Portuguese / Anormalidades pulmonares intersticiais: tradução e uso na língua portuguesa

Abstract Objective: To conduct a survey on the use of the term "interstitial lung abnormalities" in radiology reports in Brazil, propose an appropriate Portuguese-language translation for the term, and provide a brief review of the literature on the topic. Materials and Methods: A survey was sent via electronic message to various radiologists in Brazil, asking about their familiarity with the term, which translation of the term they use in Portuguese, and whether they use the criteria proposed by the Fleischner Society. Results: A total of 163 responses were received, from all regions of Brazil. Although the vast majority (88%) of the respondents stated that they were familiar with the term "interstitial lung abnormalities", there was considerable variation regarding the equivalent term they used in Portuguese. Conclusion: We suggest that the term "anormalidades pulmonares intersticiais" be used in order to standardize radiology reports and disseminate knowledge of these findings in Brazil.

Resumo Objetivo: Fazer um levantamento sobre o uso do termo interstitial lung abnormalities nos laudos radiológicos no Brasil, propor uma tradução para o termo e fazer uma breve revisão sobre o tema. Materiais e Métodos: Foi enviada uma pesquisa, por meio de mensagem eletrônica, para diversos radiologistas de todo o Brasil, questionando sobre a familiarização com o termo, qual tradução em português utilizam e se usam os critérios propostos pela diretriz da Sociedade Fleischner. Resultados: Foram recebidas 163 respostas de todas as regiões do Brasil e a grande maioria dos radiologistas respondeu estar familiarizado com o termo interstitial lung abnormalities (88%), mas houve grande variação em relação ao termo utilizado como tradução para o português. Conclusão: Sugerimos a padronização do termo "anormalidades pulmonares intersticiais", a fim de uniformizar os relatórios radiológicos e difundir esta entidade no País.

Effects of nandrolone decanoate on telomere length and clinical outcome in patients with telomeropathies: a prospective trial.

Androgens have been reported to elongate telomeres in retrospective and prospective trials with patients with telomeropathies, mainly with bone marrow failure. In our single-arm prospective clinical trial (clinicaltrials gov. Identifier: NCT02055456), 17 patients with short telomeres and/or germline pathogenic variants in telomere biology genes associated with at least one cytopenia and/or radiologic diagnosis of interstitial lung disease were treated with 5 mg/kg of intramuscular nandrolone decanoate every 15 days for 2 years. Ten of 13 evaluable patients (77%) showed telomere elongation at 12 months by flow-fluorescence in situ hybridization (average increase, 0.87 kb; 95% confidence interval: 0.20-1.55 kb; P=0.01). At 24 months, all ten evaluable patients showed telomere elongation (average increase, 0.49 kb; 95% confidence interval: 0.24-1.23 kb; P=0.18). Hematologic response was achieved in eight of 16 patients (50%) with marrow failure at 12 months, and in ten of 16 patients (63%) at 24 months. Seven patients had interstitial lung disease at baseline, and two and three had pulmonary response at 12 and 24 months, respectively. Two patients died due to pulmonary failure during treatment. In the remaining evaluable patients, the pulmonary function remained stable or improved, but showed consistent decline after cessation of treatment. Somatic mutations in myeloid neoplasm-related genes were present in a minority of patients and were mostly stable during drug treatment. The most common adverse events were elevations in liver function test levels in 88%, acne in 59%, and virilization in 59%. No adverse events grade ≥4 was observed. Our findings indicate that nandrolone decanoate elongates telomeres in patients with telomeropathies, which correlated with clinical improvement in some cases and tolerable adverse events.

Correlation among clinical, functional and morphological indexes of the respiratory system in non-cystic fibrosis bronchiectasis patients.

BACKGROUND: Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous disease, which assessment and severity can't be defined by one particular instrument but using a multidimensional score. Thus, in additional to traditional methods, alternative tools have been developed to assist these patients' evaluation. OBJECTIVE: To correlate functional and morphological indexes with severity and dyspnea in NCFB patients, focusing on the correlation between the impulse oscillometry system (IOS) and the quantitative analysis of computed tomography (CT). METHODS: Clinically stable NCFB patients, between 18 and 80 years old were submitted to clinical, functional and morphological evaluations assessed by Bronchiectasis Severity Index (BSI) and Medical Research Council (MRC) scale; spirometry and IOS; and subjective and quantitative Chest CT scans analysis, respectively. RESULTS: This study included 38 patients. The best correlations obtained between functional and morphological airway indexes were: resistance at 5 Hz-R5 and the normalized thickness of bronchial walls-Pi10 (r = 0.57), and the mean forced expiratory flow (FEF25-75%) and CT score (r = -0.39). BSI as well as MRC showed higher correlations with the quantitative automated analysis of CT (BSI and Pi10: r = 0.41; MRC and Pi10: r = 0.35) than with subjective CT score (BSI and CT score: r = 0.41; MRC and CT score: r = 0.15); and moderate and weak correlations were obtained on both functional airway indexes (BSI and peripheral airways resistance - R5-R20: r = 0.53; BSI and forced expiratory volume at the first second-FEV1: R = -0,64; MRC and R5-R20: r = 0.42; and MRC and VEF1: r = -0.45). CONCLUSION: In NCFB patients, compartmentalized methods for assessing the respiratory system (IOS and the automated quantitative CT analysis) have a good correlation with severity and dyspnea.

Electrocardiogram abnormalities in chronic Chagas cardiomyopathy correlate with scar mass and left ventricular dysfunction as assessed by cardiac magnetic resonance imaging.

Electrocardiographic (ECG) abnormalities are frequently identified in Chronic Chagas cardiomyopathy (CCC) patients and advanced abnormalities are related to a worse prognosis. Cardiac Magnetic Resonance (CMR) can precisely assess ventricular systolic dysfunction and quantify myocardial fibrosis (MF), both identified as prognostic factors. We sought to investigate if ECG abnormalities in CCC patients were associated with more severe myocardial involvement as evaluated by CMR. METHODS: CCC patients with 12­lead ECG and CMR closely obtained were included. ECG analysis evaluated rhythm, presence, and type of intraventricular conduction disturbances (IVCD) and, ventricular premature beats (VPB). CMR short-axis cine and late gadolinium enhancement images were evaluated to obtain left and right ventricular ejection fractions and MF mass, respectively. Statistical significance was set in 5%. RESULTS: 194 CCC patients (98 women, 56 ± 14 years) were evaluated, and no IVCD was detected in 71. The most common IVCD was the association of right bundle branch block and left anterior fascicular block (RBBB+LAFB) in 58 patients, followed by isolated RBBB in 34, isolated LAFB in 17, and left bundle branch block (LBBB) in 14 patients. Of patients with no IVCD, 63% had MF and the burden of fibrosis (no IVCD - 7.4 ± 8.6%; RBBB - 6.6 ± 6.5%; p = 1.00), as well as left ventricular ejection fraction (LVEF) (no IVCD - 52 ± 14%; RBBB - 55 ± 10%; p = 1.00) were similar to patients with isolated RBBB. Left conduction system impairment was associated with lower LVEF (LAFB - 39 ± 15%; RBBB+LAFB- 41 ± 15%; and LBBB - 35 ± 15%; p < 0.001) and more MF (RBBB+LAFB - 12.2 ± 10.4%; LBBB - 10.6 ± 7.5%; and LAFB - 12.0 ± 7.0%; p < 0.001). The univariable model showed that the presence of MF was related to RBBB+LAFB (OR 5.0; p = 0.001) and VPB (OR 6.3; p = 0.014). After adjustment for age, gender, and different risk factors in a multivariable model, the same findings were still significantly related to CMR myocardial fibrosis (RBBB+LAFB OR 5.0; p = 0.002 / VPB OR 6.9; p = 0.015). CONCLUSIONS: ECG without IVCD does not exclude serious cardiac abnormalities in CCC, and isolated RBBB seems to have a benign course. The presence of VPB and left branch conduction impairment, especially LAFB associated with RBBB, indicate a more severe cardiac involvement.

SARS-Cov-2 pneumonia phenotyping on imaging exams of patients submitted to minimally invasive autopsy.

Background: Correlation between pathology and imaging of the new SARS-Cov-2 disease (COVID-19) is scarce. This study aimed to characterize SARS-Cov-2 pneumonia on imaging of patients submitted to minimally invasive autopsy (MIA). Methods: This unicentric retrospective observational study included 46 consecutive patients with confirmed COVID-19 who underwent MIA. All clinical chest images were reviewed and classified for the presence and grade of viral pneumonia, as well as disease evolution. On CT, phenotypes were described as consistent with mild, moderate, or severe viral pneumonia, with or without radiological signs of organizing pneumonia (OP). In severe pneumonia, CT could also be classified as diffuse progressive OP or radiological diffuse alveolar damage (DAD). Specific features on CT were noted, including fibroproliferative signs that could indicate potential or initial fibrosis. Results: MIA showed a heterogeneous panel of alterations, with a high prevalence of OP and acute fibrinous and organizing pneumonia (AFOP). Also, signs of interstitial fibrosis corresponded to the most prevalent pathological feature. Initial chest radiography (CXR) findings were mainly consistent with moderate or severe viral pneumonia. Most patients showed stability or improvement (reduction of opacities) on imaging. CTs were performed on 15 patients. Consolidations were found in most patients, frequently showing features consistent with an OP phenotype. Fibroproliferative changes were also prevalent on CT. Conclusions: In this study, SARS-Cov-2 pneumonia showed heterogeneous radiological and pathological patterns. Signs of organization and potential or initial fibrosis were prevalent on both imaging and pathology. Imaging phenotyping may help to predict post-infection fibrosing interstitial pneumonitis in COVID-19.

Long-Term Symptoms among COVID-19 Survivors in Prospective Cohort Study, Brazil.

We conducted a prospective cohort study in a population with diverse ethnic backgrounds from Brazil to assess clinically meaningful symptoms after surviving coronavirus disease. For most of the 175 patients in the study, clinically meaningful symptoms, including fatigue, dyspnea, cough, headache, and muscle weakness, persisted for >120 days after disease onset.

Cannabidiol for COVID-19 Patients with Mild to Moderate Symptoms (CANDIDATE Study): A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Importance: Owing to its anti-inflammatory properties and antiviral "in vitro" effect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cannabidiol (CBD) has been proposed as a potential treatment for coronavirus disease 2019 (COVID-19). Objective: To investigate the safety and efficacy of CBD for treating patients with mild to moderate COVID-19. Design: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted between July 7 and October 16, 2020, in two sites in Brazil. Setting: Patients were recruited in an emergency room. Participants: Block randomized patients (1:1 allocation ratio-by a researcher not directly involved in data collection) with mild and moderate COVID-19 living in Ribeirão Preto, Brazil, seeking medical consultation, and those who voluntarily agreed to participate in the study. Interventions: Patients received 300 mg of CBD or placebo added to standard symptomatic care during 14 days. Main Outcome and Measure: The primary outcome was reduction or prevention of the deterioration in clinical status from mild/moderate to severe/critical measured with the COVID-19 Scale or the natural course of the resolution of typical clinical symptoms. Primary study outcome was assessed on days 14, 21, and 28 after enrollment. Results: A total of 321 patients were recruited and assessed for eligibility, and 105 were randomly allocated either in CBD (n=49) or in placebo (n=42) group. Ninety-one participants were included in the analysis of efficacy. There were no baseline between-group differences regarding disease severity (χ2=0.025, p=0.988) and median time to symptom resolution (12 days [95% confidence interval, CI, 6.5-17.5] in the CBD group, 9 days [95% CI, 4.8-13.2] in the placebo group [χ2=1.6, p=0.205 by log-rank test]). By day 28, 83.3% in the CBD group and 90.2% in the placebo group had resolved symptoms. There were no between-group differences on secondary measures. CBD was well tolerated, producing mostly mild and transient side effects (e.g., somnolence, fatigue, changes in appetite, lethargy, nausea, diarrhea, and fever), with no significant differences between CBD and placebo treatment groups. Conclusions and Relevance: Daily administration of 300 mg CBD for 14 days failed to alter the clinical evolution of COVID-19. Further trials should explore the therapeutic effect of CBD in patients with severe COVID-19, possibly trying higher doses than the used in our study. Trial Registration: ClinicalTrials.gov identifier NCT04467918 (date of registration: July 13, 2020).

Radiomic analysis of lung cancer for the assessment of patient prognosis and intratumor heterogeneity.

OBJECTIVE: To determine whether the radiomic features of lung lesions on computed tomography correlate with overall survival in lung cancer patients. MATERIALS AND METHODS: This was a retrospective study involving 101 consecutive patients with malignant neoplasms confirmed by biopsy or surgery. On computed tomography images, the lesions were submitted to semi-automated segmentation and were characterized on the basis of 2,465 radiomic variables. The prognostic assessment was based on Kaplan-Meier analysis and log-rank tests, according to the median value of the radiomic variables. RESULTS: Of the 101 patients evaluated, 28 died (16 dying from lung cancer), and 73 were censored, with a mean overall survival time of 1,819.4 days (95% confidence interval [95% CI]: 1,481.2-2,157.5). One radiomic feature (the mean of the Fourier transform) presented a difference on Kaplan-Meier curves (p < 0.05). A high-risk group of patients was identified on the basis of high values for the mean of the Fourier transform. In that group, the mean survival time was 1,465.4 days (95% CI: 985.2-1,945.6), with a hazard ratio of 2.12 (95% CI: 1.01-4.48). We also identified a low-risk group, in which the mean of the Fourier transform was low (mean survival time of 2,164.8 days; 95% CI: 1,745.4-2,584.1). CONCLUSION: A radiomic signature based on the Fourier transform correlates with overall survival, representing a prognostic biomarker for risk stratification in patients with lung cancer.

OBJETIVO: Associar características radiômicas de lesões pulmonares em imagens de tomografia computadorizada com a sobrevida global de pacientes com câncer de pulmão. MATERIAIS E MÉTODOS: Estudo retrospectivo composto por 101 pacientes consecutivos com neoplasia maligna confirmada por biópsia/cirurgia. As lesões foram semiautomaticamente segmentadas e caracterizadas por 2.465 variáveis radiômicas. A avaliação prognóstica foi baseada na análise de Kaplan-Meier e no teste log-rank, de acordo com a mediana dos valores das variáveis. RESULTADOS: Vinte e oito pacientes faleceram (16 por câncer de pulmão) e 73 foram censurados, com tempo médio de sobrevida de 1.819,4 dias (intervalo de confiança 95% [IC 95%]: 1.481,2-2.157,5). Uma característica radiômica (média de Fourier) apresentou diferença nas curvas de Kaplan-Meier (p < 0,05). Um grupo de pacientes de maior risco foi identificado a partir de valores altos da variável: sobrevida de 1.465,4 dias (IC 95%: 985,2-1.945,6) e razão de risco de 2,12 (IC 95%: 1,01-4,48). Um grupo de menor risco foi identificado a partir de valores baixos da variável (sobrevida de 2.164,8 dias; IC 95%: 1.745,4-2.584,1). CONCLUSÃO: Este estudo apresentou uma assinatura radiômica em imagens de tomografia computadorizada, baseada na transformada de Fourier, correlacionada com a sobrevida global de pacientes com câncer de pulmão, representando assim um biomarcador prognóstico.

Radiomic analysis of lung cancer for the assessment of patient prognosis and intratumor heterogeneity / Análise radiômica do câncer de pulmão para avaliação prognóstica do paciente e da heterogeneidade intratumoral

Abstract Objective: To determine whether the radiomic features of lung lesions on computed tomography correlate with overall survival in lung cancer patients. Materials and Methods: This was a retrospective study involving 101 consecutive patients with malignant neoplasms confirmed by biopsy or surgery. On computed tomography images, the lesions were submitted to semi-automated segmentation and were characterized on the basis of 2,465 radiomic variables. The prognostic assessment was based on Kaplan-Meier analysis and log-rank tests, according to the median value of the radiomic variables. Results: Of the 101 patients evaluated, 28 died (16 dying from lung cancer), and 73 were censored, with a mean overall survival time of 1,819.4 days (95% confidence interval [95% CI]: 1,481.2-2,157.5). One radiomic feature (the mean of the Fourier transform) presented a difference on Kaplan-Meier curves (p < 0.05). A high-risk group of patients was identified on the basis of high values for the mean of the Fourier transform. In that group, the mean survival time was 1,465.4 days (95% CI: 985.2-1,945.6), with a hazard ratio of 2.12 (95% CI: 1.01-4.48). We also identified a low-risk group, in which the mean of the Fourier transform was low (mean survival time of 2,164.8 days; 95% CI: 1,745.4-2,584.1). Conclusion: A radiomic signature based on the Fourier transform correlates with overall survival, representing a prognostic biomarker for risk stratification in patients with lung cancer.

Resumo Objetivo: Associar características radiômicas de lesões pulmonares em imagens de tomografia computadorizada com a sobrevida global de pacientes com câncer de pulmão. Materiais e Métodos: Estudo retrospectivo composto por 101 pacientes consecutivos com neoplasia maligna confirmada por biópsia/cirurgia. As lesões foram semiautomaticamente segmentadas e caracterizadas por 2.465 variáveis radiômicas. A avaliação prognóstica foi baseada na análise de Kaplan-Meier e no teste log-rank, de acordo com a mediana dos valores das variáveis. Resultados: Vinte e oito pacientes faleceram (16 por câncer de pulmão) e 73 foram censurados, com tempo médio de sobrevida de 1.819,4 dias (intervalo de confiança 95% [IC 95%]: 1.481,2-2.157,5). Uma característica radiômica (média de Fourier) apresentou diferença nas curvas de Kaplan-Meier (p < 0,05). Um grupo de pacientes de maior risco foi identificado a partir de valores altos da variável: sobrevida de 1.465,4 dias (IC 95%: 985,2-1.945,6) e razão de risco de 2,12 (IC 95%: 1,01-4,48). Um grupo de menor risco foi identificado a partir de valores baixos da variável (sobrevida de 2.164,8 dias; IC 95%: 1.745,4-2.584,1). Conclusão: Este estudo apresentou uma assinatura radiômica em imagens de tomografia computadorizada, baseada na transformada de Fourier, correlacionada com a sobrevida global de pacientes com câncer de pulmão, representando assim um biomarcador prognóstico.

Post-Traumatic Giant Left Ventricular Pseudoaneurysm: a Multimedia Presentation.

Traumatic left ventricular pseudoaneurysms are rare and surgical correction is the treatment of choice. In this article, it is reported a case of a myocardial stab injury with primary suture and development of a giant pseudoaneurysm, five years later, that underwent surgical repair.

Post-traumatic giant left ventricular pseudoaneurysm: a multimedia presentation

Abstract Traumatic left ventricular pseudoaneurysms are rare and surgical correction is the treatment of choice. In this article, it is reported a case of a myocardial stab injury with primary suture and development of a giant pseudoaneurysm, five years later, that underwent surgical repair.

CT-based radiomics for prediction of histologic subtype and metastatic disease in primary malignant lung neoplasms.

PURPOSE: As some of the most important factors for treatment decision of lung cancer (which is the deadliest neoplasm) are staging and histology, this work aimed to associate quantitative contrast-enhanced computed tomography (CT) features from malignant lung tumors with distant and nodal metastases (according to clinical TNM staging) and histopathology (according to biopsy and surgical resection) using radiomics assessment. METHODS: A local cohort of 85 patients were retrospectively (2010-2017) analyzed after approval by the institutional research review board. CT images acquired with the same protocol were semiautomatically segmented by a volumetric segmentation method. Tumors were characterized by quantitative CT features of shape, first-order, second-order, and higher-order textures. Statistical and machine learning analyses assessed the features individually and combined with clinical data. RESULTS: Univariate and multivariate analyses identified 40, 2003, and 45 quantitative features associated with distant metastasis, nodal metastasis, and histopathology (adenocarcinoma and squamous cell carcinoma), respectively. A machine learning model yielded the highest areas under the receiver operating characteristic curves of 0.92, 0.84, and 0.88 to predict the same previous patterns. CONCLUSION: Several radiomic features (including wavelet energies, information measures of correlation and maximum probability from co-occurrence matrix, busyness from neighborhood intensity-difference matrix, directionalities from Tamura's texture, and fractal dimension estimation) significantly associated with distant metastasis, nodal metastasis, and histology were discovered in this work, presenting great potential as imaging biomarkers for pathological diagnosis and target therapy decision.

Avaliação por ressonância magnética de massas cardíacas / Magnetic resonance imaging evaluation of cardiac masses

FUNDAMENTO: Tumores cardíacos são extremamente raros; no entanto, quando há suspeita clínica, é necessária a correta avaliação diagnóstica, para planejar o tratamento mais adequado. Nesse contexto, a ressonância magnética cardiovascular tem um papel importante, permitindo uma abrangente caracterização de tais lesões. OBJETIVO: Revisar os casos encaminhados a um Serviço de Ressonância Magnética para investigação de massas cardíacas e paracardíacas. Descrever a série de casos positivos, juntamente de uma breve revisão da literatura para cada tipo de lesão e sobre o papel da ressonância magnética cardiovascular em sua avaliação. MÉTODOS: Entre agosto de 2008 e dezembro de 2011, foram revistos todos os casos de pacientes encaminhados a ressonância magnética com suspeita de neoplasia envolvendo o coração. Foram selecionados aqueles com confirmação histopatológica, evolução ou resposta terapêutica compatíveis com a suspeita clínica e achados de imagem. RESULTADOS: Entre os 13 pacientes incluídos neste estudo, oito (62%) tiveram confirmação histopatológica. Foram descritas cinco neoplasias benignas (mixomas, rabdomioma e fibromas), cinco neoplasias malignas (sarcoma, linfoma, síndrome de Richter cardíaca e doença metastática) e três lesões não neoplásicas (cisto pericárdico, trombo intracardíaco e vegetação infecciosa). CONCLUSÃO: A informação disponível sobre essa questão é escassa. Estudos prospectivos adicionais são necessários para elucidar o papel desses nutrientes no risco cardiovascular de pacientes com diabetes.

BACKGROUND: Cardiac tumors are extremely rare; however, when there is clinical suspicion, proper diagnostic evaluation is necessary to plan the most appropriate treatment. In this context, cardiovascular magnetic resonance imaging (CMRI) plays an important role, allowing a comprehensive characterization of such lesions. OBJECTIVE: To review cases referred to a CMRI Department for investigation of cardiac and paracardiac masses. To describe the positive case series with a brief review of the literature for each type of lesion and the role of cardiovascular magnetic resonance imaging in evaluation. METHODS: Between August 2008 and December 2011, all cases referred for CMRI with suspicion of tumor involving the heart were reviewed. Cases with positive histopathological diagnosis, clinical evolution or therapeutic response compatible with the clinical suspicion and imaging findings were selected. RESULTS: Among the 13 cases included in our study, eight (62%) had histopathological confirmation. We describe five benign tumors (myxomas, rhabdomyoma and fibromas), five malignancies (sarcoma, lymphoma, Richter syndrome involving the heart and metastatic disease) and three non-neoplastic lesions (pericardial cyst, intracardiac thrombus and infectious vegetation). CONCLUSIONS: CMRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, contributing to a more accurate diagnosis in a noninvasive manner and assisting in treatment planning, allowing safe clinical follow-up with good reproducibility.