Desvendando o processo de remodelação na rinossinusite crônica com polipose nasal através da ressonância magnética
Data
2023-03-31
Autores
Garcez, Débora de Carvalho 
Orientadores
Pezato, Rogerio
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A rinossinusite crônica com polipose nasal é uma doença inflamatória crônica, complexa e dinâmica, caracterizada pelo crescimento excessivo da mucosa de forma benigna, gerando o desenvolvimento de pólipos nas fossas nasais. É uma doença sustentada por uma inflamação crônica e um processo de remodelação tecidual alterado. O processo de remodelação nos pólipos nasais tem sido abordado principalmente pela histologia. Este processo avalia uma porção limitada do pólipo e requer remoção de tecido, sendo necessário um método mais viável, que permita uma visão completa da remodelação do pólipo nasal. Objetivo: O presente estudo tem como objetivo avaliar a capacidade da ressonância magnética para avaliar o processo de remodelação em pacientes com rinossinusite crônica com polipose nasal. Métodos: Participaram do estudo 30 pacientes com rinossinusite crônica com polipose nasal. Os pacientes realizaram ressonância magnética, foram submetidos a procedimento cirúrgico com obtenção de amostra tecidual e, então, foi realizada a correlação dos achados de imagem com os achados histológicos do pólipo nasal e hemograma. No estudo de ressonância magnética, dois radiologistas avaliaram as diferenças teciduais da polipose, com ênfase na identificação e localização dos componentes predominantemente edematosos e fibróticos. Então, separadamente, os radiologistas classificaram quanto à presença de edema e fibrose (graduando de 0 a 2 para fibrose e de 0 a 3 para edema) a porção mais anterior do tecido polipoide (periférica) e a porção localizada no meato médio (central). Além disso, a avaliação de celularidade tecidual, através da técnica de difusão com medidas de ADC, também foi realizada em ambas as porções do tecido polipoide. Na avaliação histológica, além da graduação de componente fibrótico e edematoso nas amostras obtidas da porção periférica e central do pólipo, foi realizada também a avaliação do predomínio celular no infiltrado inflamatório; a contagem de eosinófilos e neutrófilos; medida da espessura da membrana basal; avaliação de presença de estruturas vasculares, de metaplasia escamosa, de elementos fúngicos e de cristais de Charcot-Leyden. Os radiologistas e o patologista realizaram as avaliações de forma independente, com cruzamento dos achados no final do estudo. Foi realizada a contagem de eosinófilos no sangue de todos os pacientes e a dosagem de IgE em 13 pacientes. Resultados: Este estudo demonstrou um padrão de crescimento dos pólipos nasais, onde as porções periféricas são edematosas, enquanto as porções centrais têm um componente mais fibrótico, tanto na avaliação da ressonância magnética quanto na avaliação histológica. A avaliação histológica demonstrou uma predominância de pólipos eosinofílicos. Além disso, o presente estudo não demonstrou correlação significativa entre o processo de remodelação e a gravidade do processo inflamatório da rinossinusite crônica eosinofílica com polipose nasal. Conclusão: O estudo de ressonância magnética, através de uma avaliação visual na ponderação em T2, ou da aferição de valores de ADC no estudo de difusão sem necessidade de administração de contraste intravenoso, possibilita uma caracterização tecidual crucial na rinossinusite crônica com polipose nasal.
Introduction: Chronic rhinosinusitis with nasal polyposis is a chronic, complex and dynamic inflammatory disease, characterized by benign overgrowth of the mucosa, leading to the development of polyps in the nasal cavities. It is a disease sustained by chronic inflammation and an altered tissue remodeling process. The remodeling process in nasal polyps has been approached mainly through histology. This process evaluates a limited portion of the polyp and requires tissue removal, requiring a more viable method that allows a complete view of the nasal polyp remodeling. Objective: This study aims to evaluate the ability of magnetic resonance imaging to assess the remodeling process in patients with chronic rhinosinusitis with nasal polyposis. Methods: Thirty patients with chronic rhinosinusitis and nasal polyposis participated in the study. The patients underwent magnetic resonance imaging, were submitted to a surgical procedure with tissue sample collection and, then, the correlation of imaging findings with the histological findings of the nasal polyp and blood count was performed. In the magnetic resonance study, two radiologists evaluated the tissue differences of polyposis, with emphasis on the identification and location of predominantly edematous and fibrotic components. Then, separately, the radiologists classified according to the presence of edema and fibrosis (grading from 0 to 2 for fibrosis and from 0 to 3 for edema) the most anterior portion of the polypoid tissue (peripheral) and the portion located in the middle meatus (central). In addition, the evaluation of tissue cellularity, through the diffusion technique with ADC measurements, was also performed in both portions of the polypoid tissue. In the histological evaluation, in addition to grading the fibrotic and edematous component in the samples obtained from the peripheral and central portions of the polyp, an evaluation of the cellular predominance in the inflammatory infiltrate was also performed; eosinophil and neutrophil counts; measurement of basement membrane thickness; evaluation of the presence of vascular structures, squamous metaplasia, fungal elements and Charcot-Leyden crystals. The radiologists and the pathologist performed the evaluations independently, with cross-checking of findings at the end of the study. Blood eosinophils were counted in all patients and IgE levels were measured in 13 patients. Results: This study demonstrated a growth pattern of nasal polyps, where the peripheral portions are edematous, while the central portions have a more fibrotic component, both in the MRI and in the histological evaluation. Histological evaluation demonstrated a predominance of eosinophilic polyps. Furthermore, the present study did not demonstrate a significant correlation between the remodeling process and the severity of the inflammatory process in chronic eosinophilic rhinosinusitis with nasal polyposis. Conclusion: The study of magnetic resonance, through a visual evaluation in T2 weighted image, or the measurement of ADC values in the diffusion study without the need for administration of intravenous contrast, allows a crucial tissue characterization in chronic rhinosinusitis with nasal polyposis.
Introduction: Chronic rhinosinusitis with nasal polyposis is a chronic, complex and dynamic inflammatory disease, characterized by benign overgrowth of the mucosa, leading to the development of polyps in the nasal cavities. It is a disease sustained by chronic inflammation and an altered tissue remodeling process. The remodeling process in nasal polyps has been approached mainly through histology. This process evaluates a limited portion of the polyp and requires tissue removal, requiring a more viable method that allows a complete view of the nasal polyp remodeling. Objective: This study aims to evaluate the ability of magnetic resonance imaging to assess the remodeling process in patients with chronic rhinosinusitis with nasal polyposis. Methods: Thirty patients with chronic rhinosinusitis and nasal polyposis participated in the study. The patients underwent magnetic resonance imaging, were submitted to a surgical procedure with tissue sample collection and, then, the correlation of imaging findings with the histological findings of the nasal polyp and blood count was performed. In the magnetic resonance study, two radiologists evaluated the tissue differences of polyposis, with emphasis on the identification and location of predominantly edematous and fibrotic components. Then, separately, the radiologists classified according to the presence of edema and fibrosis (grading from 0 to 2 for fibrosis and from 0 to 3 for edema) the most anterior portion of the polypoid tissue (peripheral) and the portion located in the middle meatus (central). In addition, the evaluation of tissue cellularity, through the diffusion technique with ADC measurements, was also performed in both portions of the polypoid tissue. In the histological evaluation, in addition to grading the fibrotic and edematous component in the samples obtained from the peripheral and central portions of the polyp, an evaluation of the cellular predominance in the inflammatory infiltrate was also performed; eosinophil and neutrophil counts; measurement of basement membrane thickness; evaluation of the presence of vascular structures, squamous metaplasia, fungal elements and Charcot-Leyden crystals. The radiologists and the pathologist performed the evaluations independently, with cross-checking of findings at the end of the study. Blood eosinophils were counted in all patients and IgE levels were measured in 13 patients. Results: This study demonstrated a growth pattern of nasal polyps, where the peripheral portions are edematous, while the central portions have a more fibrotic component, both in the MRI and in the histological evaluation. Histological evaluation demonstrated a predominance of eosinophilic polyps. Furthermore, the present study did not demonstrate a significant correlation between the remodeling process and the severity of the inflammatory process in chronic eosinophilic rhinosinusitis with nasal polyposis. Conclusion: The study of magnetic resonance, through a visual evaluation in T2 weighted image, or the measurement of ADC values in the diffusion study without the need for administration of intravenous contrast, allows a crucial tissue characterization in chronic rhinosinusitis with nasal polyposis.