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Master's Dissertation
DOI
Document
Author
Full name
Fabrício Arantes de Almeida
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Santos, Marcel Koenigkam (President)
Júnior, Jorge Elias
Rodrigues, Maria Carolina de Oliveira
Souza Junior, Arthur Soares
Title in Portuguese
Avaliação quantitativa automática de volumes e densidades pulmonares em TCAR de pacientes com esclerose sistêmica antes e após transplante de medula óssea
Keywords in Portuguese
Análise quantitativa
Doença intersticial pulmonar
Esclerose Sistêmica
Tomografia computadorizada do tórax
Transplante de Medula óssea
Abstract in Portuguese
O objetivo deste estudo foi avaliar as medidas de volume e densidade pulmonar em exames de tomografia computadorizada de alta resolução (TCAR) de tórax de pacientes com esclerose sistêmica (ES), antes e após o transplante de medula óssea (TMO). As medidas foram comparadas com a avaliação funcional e resposta ao tratamento. Este foi um estudo retrospectivo observacional. A avaliação clínica e tomográfica foi realizada antes, após 6 e 18 meses do TMO, dos pacientes com ES que realizaram o procedimento entre 2011 e 2017. A análise quantitativa da TCAR foi feita utilizando programa totalmente automatizado (Yacta), capaz de obter o volume pulmonar, a densidade pulmonar média e os percentis de atenuação (P10, P40, P50, P80 e P90). Os dados clínicos, incluindo o resultado das espirometrias, foram obtidos dos prontuários eletrônicos dos pacientes. A capacidade vital forçada (CVF) aos 18 meses foi utilizada para classificar os pacientes em grupo "melhor resposta" (aumento >= 10% dos valores da CVF) ou "resposta estável" (redução, estabilidade ou aumento < 10% na CVF). Nenhum paciente apresentou redução da CVF > 10% pós-TMO. Foram incluídos 33 pacientes, com alteração tomográfica ou da função pulmonar antes da realização do TMO. O grupo "melhor resposta" foi composto por 15 pacientes (45,4%, 4 homens, idade média de 32,1 anos), enquanto o grupo "resposta estável" por 18 pacientes (54,6%, 4 homens, idade média de 37,5 anos). A análise quantitativa das TCAR não demonstrou diferença significativa entre os grupos na fase pré-TMO. No grupo "melhor resposta" houve redução significativa da densidade pulmonar média e dos valores dos percentis de densidade após o TMO, destacando-se os percentis 80 e 90. No grupo "resposta estável" não houve alteração significativa pós-TMO nos valores de volumes e densidades pulmonares. Concluímos que a análise quantitativa automática da TCAR de pacientes com ES foi capaz de identificar redução significativa da densidadepulmonar nos pacientes com melhora significativa da função pulmonar. Inferimos que, além dos volumes e densidades médias, podem ser utilizados também os percentis de densidade como parâmetro no acompanhamento da doença intersticial. Esta ferramenta pode representar um biomarcador na avaliação de tratamento da doença intersticial pulmonar na ES, complementando as provas de função pulmonar.
Title in English
Automatic quantification of pulmonary volumes and densities in HRCT of patients with systemic sclerosis before and after bone marrow transplantation
Keywords in English
Bone Marrow Transplantation
Interstitial lung disease, Chest computed tomography
Quantitative analysis
Systemic Sclerosis
Abstract in English
The purpose of this study was to evaluate pulmonary volume and density measurements in high resolution computed tomography (HRCT) scans of patients with systemic sclerosis (SSc) before and after bone marrow transplantation (BMT). Measurements were compared with functional assessment and response to treatment. This was a retrospective observational study. Clinical and tomographic evaluation of patients was performed before, after 6 and 18 months of BMT, for patients submitted to the procedure between 2011 and 2017. The quantitative analysis of HRCT scans was performed using a fully automated program (Yacta), capable of obtaining lung volume, density and attenuation percentiles (P10, P40, P50, P80 and P90). Clinical data, including the results of spirometry, were obtained from patients' electronic records. Forced vital capacity (FVC) at 18 months was used to classify patients into "best response" group (>= 10% increase in FVC values) or "stable response" (reduction, stability or FVC increase < 10%). No patient had FVC reduction > 10% after BMT. Thirty-three patients were included, with tomographic or pulmonary function alterations before the BMT. The "best response" group consisted of 15 patients (45.4%, 4 men, mean age 32.1 years), while the "stable response" group comprised 18 patients (54.6%, 4 men, mean age of 37.5 years). Quantitative analysis of HRCT did not show a significant difference between the groups in the pre-BMT evaluation. In the "best response" group there was a significant reduction in mean lung density and density percentile values after BMT, with emphasis on the 80th and 90th percentiles. In the "stable response" group there was no significant post-BMT change in lung volumes and pulmonary densities. We conclude that the quantitative automatic HRCT analysis of patients with ES identified a significant reduction in pulmonary density in patients with improved pulmonary function. We speculate that, in addition to the mean volumes and densities, density percentiles may also be used as a parameter in the follow-up ofpatients with interstitial lung disease. This tool may represent a biomarker in the evaluation of interstitial lung disease treatment in patients with SSc, complementing pulmonary function tests.
 
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Publishing Date
2019-08-30
 
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