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Master's Dissertation
DOI
10.11606/D.17.2018.tde-12042018-113913
Document
Author
Full name
Francisco Valtenor Araujo Lima Junior
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2017
Supervisor
Committee
Muglia, Valdair Francisco (President)
Júnior, Jorge Elias
Reis, Rodolfo Borges dos
Souza, Luís Ronan Marquez Ferreira de
Title in Portuguese
Perda de sinal na sequência "em-fase" da técnica desvio quimico, por ressonância magnética, como critério diagnóstico do carcinoma de células renais, na diferenciação com angiomiolipomas pobres em gordura
Keywords in Portuguese
Não informado
Abstract in Portuguese
INTRODUÇÃO: Neste estudo, avaliou-se a perda de sinal em sequências GRE "emfase", da técnica desvio químico, na diferenciação entre CCR e AML. Na prática clínica, ainda é difícil a diferenciação entre neoplasias renais benignas e malignas, devido à ausência de critérios por imagem bem definidos. Espera-se que o uso de métodos não invasivos possa otimizar o manejo clínico em tais casos, evitando condutas mais agressivas e potencialmente mórbidas. MATERIAIS E MÉTODOS: Este foi um estudo retrospectivo, que incluiu apenas casos confirmados de CCR e pgAML. Dois radiologistas analisaram as imagens, qualitativa e quantitativamente, calculando o Indice de Intensidade de Sinal, como segue: [(ISEF - ISFF) / ISFF] X 100, em que ISEF denota a intensidade de sinal em imagens "em-fase" e ISFF, em imagens Fora-de-fase". Por fim, aplicamos aos resultados testes de associação e ROCs. RESULTADOS: A análise qualitativa mostrou focos de redução de sinal "emfase" em 15 lesões, todas CCR, sendo 8 ccCCR (8/21, 38,1%), 4 pCCR (4/10, 40%) e 3 crCCR (3/8, 37,5%). Nenhum pgAML apresentou o achado, em análise qualitativa, que teve especificidade de 100% no diagnóstico de CCR (IC95%: 71,1100), porém baixa sensibilidade, 38,4% (IC95%: 23,4-55,4). A análise quantitativa não mostrou diferença significativa entre os grupos CCR e AML. A abordagem pela curva ROC confirmou a baixa acurácia diagnóstica da análise quantitativa, para ambos os observadores. Identificamos o valor de 5% como melhor nível de corte para distinção entre CCR e AML. CONCLUSÃO: A análise da perda de sinal, nas sequências "em- fase", permite a distinção entre CCR e pgAML com grande especificidade, confirmando que esse achado pode ser utilizado, em conjunto com outros parâmetros, para melhorar a acuidade diagnóstica da ressonância magnética.
Title in English
Signal loss on "in-phase" images of chemical shift sequence, by magnetic resonance, as a diagnostic criterion for renal cell carcinoma, in the differentiation with lipid-poor angiomyolipomas
Keywords in English
Não informado
Abstract in English
INTRODUCTION: The purpose of this study was to evaluate the diagnostc performance of signal loss on "in-phase" images of chemical shift sequence, in the differentiation between RCC and AML. In clinical practice, it is still difficult to differentiate between benign and malignant renal neoplasms, due to the absence of well defined imaging criteria. It is expected that the use of non-invasive methods can optimize clinical management in these cases, avoiding more aggressive and potentially morbid strategies. MATERIALS AND METHODS: In this retrospective study, only of confirmed cases of RCC and AML were enrolled, yielding 47 patients (50 lesions) with solid renal tumors without macroscopic fat. Two blinded radiologists evaluated the images, qualitative and quantitatively by calculating the Signal Intensity index, as follows: [(Slip - Slop) / Slop] x 100, in which Slip is the signal intensity on "in-phase" images and Slop on "out-of-phase" images. RESULTS: Qualitative assessement revealed focal signal loss on "in-phase" images in 15 lesions, all RCC, being 8 ccRCC (8/21, 38.1%), 4 pRCC (4/10, 40%) and 3 chrRCC (318, 37.5%). None of the IpAML were found the have a decrease in Sl on subjective analysis, which had a specificity of 100% in the diagnosis of RCC (95%CI: 71.1-100), but low sensitivity, 38.4% (95%CI: 23.4-55.4). The quantitative assessment revealed no significant difference between the RCC and AML groups. The ROC curve approach confirmed the low diagnostic accuracy of the quantitative assessment for both observers. The threshold value of 5% was the best cut-off value for the differentiation between RCC and AML. CONCLUSION: The finding of signal loss on "in-phase" images allows the distinction between RCC and IpAML with high specificity, confirming this finding can be used, together with other parameters, to improve the diagnostic accuracy of magnetic resonance imaging.
 
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Publishing Date
2018-07-19
 
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