Avaliação hepática e esplênica por ressonância magnética em pacientes portadores de esquistossomose mansônica crônica

• Autor(a) principal: Bezerra, Alexandre Sérgio de Araújo
• Data de Publicação: 2004
• Outros Autores: D'Ippolito, Giuseppe [UNIFESP], Caldana, Rogério Pedreschi [UNIFESP], Cecin, Alexandre Oliveira [UNIFESP], Szejnfeld, Jacob [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0100-39842004000500003; http://repositorio.unifesp.br/handle/11600/2225
• topic: Parasitic liver disease; Spleen; Schistosomiasis mansoni; Magnetic resonance imaging; Hepatopatias parasitárias; Esplenopatias; Esquistossomose mansoni; Ressonância magnética

OBJECTIVE: To qualitatively and quantitatively evaluate the morphological changes of the liver and spleen using magnetic resonance imaging (MRI) in patients with chronic infection by Schistosoma mansoni and the reproducibility of MRI findings in the hepatosplenic evaluation of these patients. MATERIALS AND METHODS: We prospectively studied 28 schistosomotic patients submitted to MRI of the upper abdomen. The scans were performed using a high field equipment (1.5 T), a body coil and a power injector for administration of intravenous contrast. The scans were interpreted by two independent examiners who evaluated the presence of morphological changes in the liver and spleen. Interobserver and intraobserver agreement were measured using the kappa and intraclass correlation tests. RESULTS: Qualitative variables presented good interobserver and intraobserver agreement (kappa > 0.65 and r > 0.66, respectively). The best interobserver agreement was for the anteroposterior diameter of the spleen (r = 0.98). The observers identified reduction of the right hepatic lobe, enlargement of the left hepatic lobe and caudate lobes associated with splenomegaly in almost all patients, and also identified fissure widening, heterogeneity of hepatic parenchyma, irregularity of hepatic contours, presence of peripheral hepatic vessels and periportal fibrosis in almost all patients. CONCLUSION: Hepatic morphological changes are characterized by reduction of the right lobe and enlargement of the caudate and left lobes, and morphological changes in the spleen are characterized by the presence of splenomegaly and siderotic nodules. MRI presents high reproducibility for the evaluation of these changes in patients with chronic infection by Schistosoma mansoni.