Papel da Imagem na Coluna - jornadamedicinafisica.com.br · Paciente feminina de 72 anos com dor...

Dr Marcelo R de Abreu

RADIOLOGISTA SISTEMA OSTEARTICULAR E COLUNA

Papel da Imagem na Coluna Avanccedilos

CLINOSON

Avanccedilos em Radiologia de Coluna

bull Abordaremos

ndash Abordagem Atual da Coluna por Imagem

ndash Lombalgia e Radiculopatia

ndash Utilizaccedilatildeo de Teacutecnicas novas jaacute integradas na

nossa rotina

Natildeo discutiremos exames de imagem nas casos de

lombalgia ou lomboctiatalgia simples usualmente

manejados clinicamente

bull Dor por compressatildeo nervosa

bull Dor por inflamaccedilatildeo nervosa

Dor no sistema Osteoarticular e Coluna Dor Discogecircnica subcondral articular neuropaacutetica

Onde estaacute a dor

TOMOGRAFIA ALTERACcedilOtildeES DEGENERATIVAS

OSTEOacuteFITOS causam compressatildeo sobre foramens

Discopatia Degenerativa ENVELHECIMENTO x NORMAL

bull Desidratacao

bull Desestrututacao

bull Alteracoes subcondrais

bull Osteofitos marginais

bull Instabilidade

Cascata Degenerativa

Normal x Patoloacutegico Alteraccedilotildees da Idade Sintomaacuteticos

LOMBALGIA E CITALGIA DESAFIO

cintlilografia

ACHADOS de IMAGEM

MARCADORES DE DOR

ALTERACcedilOtildeES QUE QUANDO

ENCONTRADAS TEM ALTA

PROBABILIDADE DE ESTAREM

CAUSANDO DOR

Densidade de Hidrogecircnio (densidade de proacutetons)

1000 H

100000 H

0 H

Brilho

bull eacute diferente entre

tecidos diferentes

bull eacute diferente no mesmo

tecido quando alterado

RESSONAcircNCIA MAGNEacuteTICA

Como satildeo adquiras imagens

SINAL (informaccedilatildeo)

RESSONANCIA

UTILIZACcedilAtildeO DE TEacuteCNICAS COM

SATURACcedilAcircO DE GORDURA

ACHADOS de IMAGEM MARCADORES DE DOR

Hiperemia edema

1

2

3 4

5

6

Imagem por RM

Ponderaccedilotildees das Sequumlecircncias de Pulso

T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua

T1 fs Vascularizaccedilatildeo

Sangue

Sag T2 242 Axial T1 130

Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation

Paciente feminina de 72 anos com dor lombar que irradia para o membro

inferior esquerdo

Na imagem coronal T2 identifica-se heacuternia de disco lateral esquerda com

sinais de denervaccedilatildeo da musculatura paravertebral por compressatildeo radicular


inferior esquerdo

RESSONANCIA




BME

Dor a d alta

fratura de stress parcial da pars de L3 (espondiloacutelise

incompleta)

FRFSE T2

Fat Saturation

SIacuteNDROME FACETAacuteRIA

FRFSE T2

Fat Saturation


Alteraccedilatildeo Degenerativa CARTILAGEM HIALINA

BME

Edema ~ Severidade da dor e nuacutemero de microfraturas

RESSONANCIA




BME Doenccedilas inflamatoacuterias

M BENJAMIN1 AND D McGONAGLE The anatomical basis for disease localisation in seronegative

spondyloarthropathy at entheses and related sites J Anat (2001)

FIBROCARTILAGEM

ESPONDILOARTROPATIAS

Achados Precoces na Coluna

LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey

From Resnick UCSD Research Lab 2000

STIR T1

FRFSE T2

Fat Saturation



Relevacircncia Cliacutenica da presenccedila de Lesotildees

inflamatoacuterias (entesites)

ge2 CIL = LR 12 Sens 69 Spec 94

ge1 LIL = positive LR 11 Sens 31 Spec 79

1Weber U et al Arthritis Rheum 200961900

CIL frequentes em 26 de assintomaacuteticos

Relevacircncia cliacutenica de likelihood ratio (LR) 2

5-10 moderada

gt10 alta 2Jaeschke R et al JAMA 1994271703

CORONAL T2 FRFSE Fs para screening

Valor do coronal na rotina da cls USEFULNESS OF T2 WEIGHTED CORONAL FAST RECOVERY FAST

SPIN ECHO (FRFSE) WITH FAT SUPPRESION SEQUENCE IN ROUTINE

MR IMAGING OF THE LUMBAR SPINE

Abreu M Oliane C Moraes G Krebs C Heckman H ndash Hospital Matildee de Deus Brazil

bull975 patients

bullCoronal FRFSE fs 50s 6mm 8 slices

bull42 (42975) presented important diagnostic findings in coronal T2 FRFSE fs not

seen in other sequences

bull5 pts with sacroileiitis

Skeletal Radiol 2011

The impact of MRI on the clinical management of

inflammatory arthritides Weber U Oslashstergaard M Lambert RG Maksymowych WP

Rheumatology University of Alberta

bull MRI has gained a major role in inflammatory arthritides particularly in

spondyloarthritis (SpA) rheumatoid arthritis (RA) and osteoarthritis (OA)

bull MRI is regarded as the most sensitive imaging modality for detecting early SpA

bull Positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA

together with at least one clinical feature of SpA (ASAS group)

RESSONAcircNCIA

Impregnaccedilatildeo Contraste Gadoliacutenio

DISCO ACHADOS de IMAGEM MARCADORES DE DOR

UTILIZACcedilAtildeO DE CONTRASTE NA DETECCcedilAtildeO DE NEOVASCULARIZACcedilAtildeO

Heacuternia de Disco IMPREGNACcedilAtildeO PERIFEacuteRICA

DOR NEUROPAacuteTICA

RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E


Lumbar Annular Fissures Correlation between

Unenhanced and Enhanced MR Imaging Features

and Pain Response at Provocation Diskography

Am Soc Spine Rad meeting 2010

Hoang M

bullAnnular fissure on post-contrast MR correlates with diskogenic low back

bullAnnular fissures may be missed on sagital T2

bullPost-contrast MR imaging improve prediction of diskogenic low back pain

bullDiscordant pain might represent disks that have undergone partial healing

Ressonacircncia Magneacutetica

Contraste

Fatores que aumentam precisatildeo do

radiologista no diagnoacutestico da origem da dor

bull Especializaccedilatildeo do radiologista

bull Experiecircncia

bull Conhecimento cliacutenico e diagnoacutestico

diferencial

bull CONTATO com meacutedico solicitante

bull Aparelhagem diagnoacutestico

SEQUENCIA DE NEUROGRAFIA Dor a esquerda poacutes-op denervaccedilatildeo paravertebral

esquerda e irritaccedilatildeo da raiacutez esquerda de L5

SEQUENCIA DE NEUROGRAFIA

73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer

Whole-Body Magnetic Resonance Neurography

Yamashita T MD Tokai University Kanagawa Japan

Kwee T MD University Utrecht Utrecht the Netherlands

NEJM 2010

NEUROGRAFIA

992012 - POA

Paciente feminina de 50 anos com lombociatalgia agrave esquerda apresentando

desidrataccedilatildeo discal nas sequencias T2 sagital e axial

A sequecircncia coronal T2 demonstra importante espessamento e hiperintesidade

das raizes nervosas relacionadas a poliradiculopatia inflamatoria

desmieliniziante CIDP

Neurografia c tractografia

FA=016 FA=020

CORTESY OF DR ANE COTTEN LILE UNIV FRANCE

Clinical correlation

bull Increase of MD correlated with increase of VAS (p=0006)

Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral

root Right root Left root

Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]

Hipoacutetese para aumento difusatildeo

Edema neural

Aumento da permeabilidade nervosa com ruptura da barreira nervo-

bainha

Ruptura do endoneurium com aumento da pressatildeo endoneural

Desmielizaccedilatildeo isquemia degeneraccedilatildeo Walleriana

Nervo Normal Nervo Comprimido

ALTERACcedilOtildeES NO MOVIMENTO DAS

MOLEacuteCULAS DE AacuteGUA

Neurite do Plexo Braquial Direito inespeciacutefica

23 a Masc dor membro superior direito

Caso cliacutenco 30ordf F lipoescultura

bull Importante quando indicado

bull Marcadores da DOR por ressonacircncia mas o diagnoacutestico eacute multifatorial

ndash Gadoliacutenio (neovascularizaccedilatildeo)

ndash Saturaccedilatildeo de Gordura bull BME (AO ARTRITES REACOES SUBCONDRAIS)

bull Neurografia lombar sacral e braquial

Papel da Imagem na Coluna




CLINOSON

Avanccedilos em Radiologia de Coluna

bull Abordaremos

ndash Abordagem Atual da Coluna por Imagem

ndash Lombalgia e Radiculopatia

ndash Utilizaccedilatildeo de Teacutecnicas novas jaacute integradas na

nossa rotina

Natildeo discutiremos exames de imagem nas casos de

lombalgia ou lomboctiatalgia simples usualmente

manejados clinicamente








bull Desidratacao




bull Instabilidade




cintlilografia

ACHADOS de IMAGEM

MARCADORES DE DOR




CAUSANDO DOR


1000 H

100000 H

0 H

Brilho


tecidos diferentes






RESSONANCIA




Hiperemia edema

1

2

3 4

5

6

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON








bull Desidratacao




bull Instabilidade




cintlilografia

ACHADOS de IMAGEM

MARCADORES DE DOR




CAUSANDO DOR


1000 H

100000 H

0 H

Brilho


tecidos diferentes






RESSONANCIA




Hiperemia edema

1

2

3 4

5

6

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON



cintlilografia

ACHADOS de IMAGEM

MARCADORES DE DOR




CAUSANDO DOR


1000 H

100000 H

0 H

Brilho


tecidos diferentes






RESSONANCIA




Hiperemia edema

1

2

3 4

5

6

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

ACHADOS de IMAGEM

MARCADORES DE DOR




CAUSANDO DOR


1000 H

100000 H

0 H

Brilho


tecidos diferentes






RESSONANCIA




Hiperemia edema

1

2

3 4

5

6

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


1000 H

100000 H

0 H

Brilho


tecidos diferentes






RESSONANCIA




Hiperemia edema

1

2

3 4

5

6

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

RESSONANCIA




Hiperemia edema

1

2

3 4

5

6

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

1

2

3 4

5

6

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

Imagem por RM


T1 Adiposo

T2 Adiposo

Agua

T2 fs Agua


Sangue


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


Sag T1 58s

Axial T2 300

Cor T2 130

T2 fat sat

15t 8CH

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

FRFSE T2

Fat Saturation


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


inferior esquerdo




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON




inferior esquerdo

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

RESSONANCIA




BME

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

Dor a d alta


incompleta)

FRFSE T2

Fat Saturation


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


FRFSE T2

Fat Saturation



BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


BME


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


RESSONANCIA







FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON



FIBROCARTILAGEM



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON



LLA

Fibras de

Sharpey

Anel Fibroso

Fibras de

Sharpey


STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

STIR T1

FRFSE T2

Fat Saturation










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON










5-10 moderada







bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON






bull975 patients














RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON










RESSONAcircNCIA






RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON




RESSONAcircNCIA


T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

T2

Gadoliacutenio

DISCO

F 45 A RADICULO E






Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON





Hoang M






Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


Contraste






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON






diferencial






73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON




73-year-old man

with chronic

inflammatory

demyelinating

polyneuropathy

(CIDP)

healthy 23-year-old

male volunteer




NEJM 2010

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON

NEUROGRAFIA

992012 - POA







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON







FA=016 FA=020




Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON



Compressed root

MD 121

PATIENTS VOLUNTEERS

Compressed

root

Controlateral


Mean FA 0186 [0015] 0220 [0016] 0218 [0012] 0219 [0013]

Mean

diffusivity 0986 [0219] 0817 [014] 0817 [014] 0891 [0126]


Edema neural


bainha


















CLINOSON


Edema neural


bainha


















CLINOSON













CLINOSON

Papel da Imagem na Coluna - jornadamedicinafisica.com.br · Paciente feminina de 72 anos com dor...

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Transcript of Papel da Imagem na Coluna - jornadamedicinafisica.com.br · Paciente feminina de 72 anos com dor...