Correlação entre achados na tomografia computadorizada de tórax e função pulmonar em pacientes com fibrose cística no estado da Bahia
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Data
2007
Autores
Neves, Carolina Alves [UNIFESP]
Orientadores
Ajzen, Sergio Aron [UNIFESP]
Tipo
Dissertação de mestrado
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Objetivo: Avaliar os achados toracicos da Fibrose Cistica atraves da Tomografia Computadorizada de Torax de Alta Resolucao(TCAR) , dispondo-os na forma de escores, e correlaciona-los com dados de funcao pulmonar, em pacientes do Centro de referencia em Fibrose Cistica no Estado da Bahia. Por ser a Bahia um estado altamente miscigenado, e relevante tentar determinar aspectos peculiares da doenca nesta populacao. Metodos: Estudo transversal onde foram avaliados 35 pacientes no periodo de junho de 2004 a marco de 2006, em fase de estabilidade clinica, com idade variando entre 6 e 25 anos, que realizaram Testes de funcao pulmonar (TFP) e TCAR. A media de idade dos pacientes foi de 11,3 anos. Os nao-brancos representaram 77 por cento desta amostra. Os exames de tomografia foram analisados por dois radiologistas, de forma independente, tendo como base sistema de escore que avaliava a presenca extensao e gravidade das alteracoes. Os escores de tomografia foram correlacionados com o volume expiratorio forcado no primeiro segundo (VEF1), capacidade vital forcada (CVF) e fluxo expiratorio forcado entre 25 por cento e 75 por cento da capacidade vital forcada «FEF25 por cento-75 por cento) . Apos intervalo de tres meses, os radiologistas fizeram nova leitura para definicao do nivel de concordancia intra-observadores. Resultados: Espessamento de parede bronquica (57.14 por cento), bronquiectasias (54.28 por cento) e padrao de perfusao em mosaico (51.43 por cento) foram os achados tomograficos mais frequentes nesta populacao. Uma forte correlacao foi estabelecida entre escores totais de TCAR com 0 VEF1 (r=0.7808, p<0.0001). 0 FEF25 por cento-75 por cento apresentou uma boa correlacao com os escores de TCAR (r=0.6981, p<0.00001), 0 mesmo nao se observando com a CVF (r=0,511, p<0,001). Quando avaliados de forma isolada, alteracoes estruturais descritas a TCAR, tambem apresentam boas correlacoes com 0 VEF1 e com 0 FEF25 por cento-75 por cento. Observou-se, tambem, um excelente nivel de concordancia inter e intra-observadores. Conclusoes: As alteracoes tomograficas mais prevalentes nesta populacao foram o espessamento de paredes bronquicas, as bronquiectasias e o padrao de perfusao em mosaico. Uma forte correlacao foi estabelecida entre escores totais de TCAR com 0 VEF1; 0 FEF25 por cento-75 por cento apresentou uma boa correlacao com os escores de TCAR, o mesmo nao se observando com a CVF. Aspectos avaliados de forma isolada a TCAR tambem apresentaram boas correlacoes com o VEF1 e com FEF25 por cento-75 por cento. Os resultados deste trabalho sugerem que tanto a tomografia quanto a funcao pulmonar podem ser utilizadas como marcadores para o acompanhamento de pacientes com FC, no nosso meio
Purpose: Evaluate pulmonary manifestations of Cystic Fibrosis (CF) on high resolution computed tomography (HRCT), based on a system of scores, and correlate these results with pulmonary function tests (PFT) in patients from a specialized center in CF in Bahia, an area with a highly mixed population. Methods: A cross sectional survey from June 2004 to March 2006, prospectively examined 35 consecutive patients with CF (10 female patients, 25 male patients; mean age, 11,3; age range, 6 to 25 years) with pulmonary function tests (PFT) and HRCT. Any patient with clinical signs of an active acute pulmonary process was excluded from the study. Non-whites accounted for 77% of this serie. The computed tomography scans were analyzed by two independet radiologists. The scores of tomography were correlated with the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25%-75%). After an interval of three months, the radiologists made a second read for definition of intra-observer concordance. Results: Peribronchial wall thickening (57.14%), bronchiectasis (54.28%) and mosaic perfusion (51.43%) were the most frequently tomography finding in this population. A strong correlation was established between total scores of HRCT and FEV1 (r = 0.7808, p <0.0001). The FEF25% -75%had a good correlation with the scores of HRCT (r = 0.6981, p <0.00001), but not with FCV (r = 0.511, p <0.001). When evaluated separately, structural changes described by HRCT, also show good correlation with the FEV1 and with FEF25%-75%. The inter and intra-observers agreements were also excellent. Conclusions: The HRCT findings most common in this population were peribronchial wall thickening, bronchiectasis, and mosaic perfusion. A strong correlation was established between total scores of HRCT with FEV1 and FEF25%-75%, but not with FCV. Structural changes described by HRCT, also show good correlation with the FEV1 and FEF25%-75%. Our results suggest that either HRCT or PFT can be used to follow CF patients in this population.
Purpose: Evaluate pulmonary manifestations of Cystic Fibrosis (CF) on high resolution computed tomography (HRCT), based on a system of scores, and correlate these results with pulmonary function tests (PFT) in patients from a specialized center in CF in Bahia, an area with a highly mixed population. Methods: A cross sectional survey from June 2004 to March 2006, prospectively examined 35 consecutive patients with CF (10 female patients, 25 male patients; mean age, 11,3; age range, 6 to 25 years) with pulmonary function tests (PFT) and HRCT. Any patient with clinical signs of an active acute pulmonary process was excluded from the study. Non-whites accounted for 77% of this serie. The computed tomography scans were analyzed by two independet radiologists. The scores of tomography were correlated with the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25%-75%). After an interval of three months, the radiologists made a second read for definition of intra-observer concordance. Results: Peribronchial wall thickening (57.14%), bronchiectasis (54.28%) and mosaic perfusion (51.43%) were the most frequently tomography finding in this population. A strong correlation was established between total scores of HRCT and FEV1 (r = 0.7808, p <0.0001). The FEF25% -75%had a good correlation with the scores of HRCT (r = 0.6981, p <0.00001), but not with FCV (r = 0.511, p <0.001). When evaluated separately, structural changes described by HRCT, also show good correlation with the FEV1 and with FEF25%-75%. The inter and intra-observers agreements were also excellent. Conclusions: The HRCT findings most common in this population were peribronchial wall thickening, bronchiectasis, and mosaic perfusion. A strong correlation was established between total scores of HRCT with FEV1 and FEF25%-75%, but not with FCV. Structural changes described by HRCT, also show good correlation with the FEV1 and FEF25%-75%. Our results suggest that either HRCT or PFT can be used to follow CF patients in this population.
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Citação
NEVES, Carolina Alves. Correlação entre achados na tomografia computadorizada de tórax e função pulmonar em pacientes com fibrose cística no estado da Bahia. 2007. 72 f. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2007.