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Manifestaciones en sistema nervioso central en imágenes diagnósticas de pacientes pediátricos post-trasplante de células madre hematopoyéticas con complicaciones neurológicas en la Fundación Hospital de la Misericordia en 2016-2022
dc.rights.license | Atribución-NoComercial 4.0 Internacional |
dc.contributor.advisor | Moreno Gómez, Luz Ángela |
dc.contributor.author | Gómez Medina, Andrés Felipe |
dc.coverage.temporal | 2016-2022 |
dc.date.accessioned | 2024-02-12T21:10:32Z |
dc.date.available | 2024-02-12T21:10:32Z |
dc.date.issued | 2023-12 |
dc.identifier.uri | https://repositorio.unal.edu.co/handle/unal/85688 |
dc.description | ilustraciones a blanco y negro, fotografías |
dc.description.abstract | El trasplante de células madre hematopoyéticas es parte de las líneas de tratamiento de múltiples condiciones neoplásicas, desórdenes genéticos, errores innatos del metabolismo, entre otras. Algunas de estas condiciones con mayor incidencia en la población pediátrica como las enfermedades linfoproliferativas y aplasias medulares. En estos pacientes, existe un porcentaje significativo de complicaciones neurológicas asociadas tanto al estado inmunológico como al tratamiento. Estas complicaciones contribuyen de manera significativa a la morbimortalidad y poseen un espectro amplio de desenlaces. En este estudio se obtuvieron 31 pacientes que presentaron alguna sintomatología neurológica y fueron llevados a realización de resonancia magnética cerebral (RM). Con estas imágenes y los datos clínicos se establecen asociaciones de posibles factores de riesgo, concordancia entre los hallazgos imagenológicos y el diagnóstico clínico de la complicación neurológica, categorizada principalmente en causas infecciosas, cerebrovasculares, asociadas al tratamiento, metabólicas, y carcinogénesis post- trasplante. Se incluyo en la valoración de las imágenes la propuesta de una medida objetiva de valores de intensidad de señal del mapa de ADC (Coeficiente de difusión aparente) de las lesiones en resonancia magnética, estudiando su asociación con pronóstico neurológico, siendo los principales desenlaces objetivo: Recuperación completa, secuelas neurológicas o muerte. (Texto tomado de la fuente) |
dc.description.abstract | Hematopoietic stem cell transplantation is part of the treatment strategies for multiple neoplastic conditions, genetic disorders, inborn errors of metabolism, among others. Some of these conditions with a higher incidence in the pediatric population include lymphoproliferative diseases and bone marrow aplasia. In these patients, there is a significant percentage of neurological complications associated with both the immune status and the treatment. These complications contribute significantly to morbidity and mortality and have a broad spectrum of outcomes. In this study, 31 patients who presented neurological symptoms and underwent brain magnetic resonance imaging (MRI) were included. Associations of possible risk factors, concordance between imaging findings and the clinical diagnosis of neurological complications were established based on these images and clinical data, categorized primarily into infectious, cerebrovascular, treatment-related, metabolic, and post-transplant carcinogenesis causes. The assessment of the images included the proposal of an objective measure of apparent diffusion coefficient (ADC map) signal intensity values of lesions in magnetic resonance imaging, studying its association with neurological prognosis, with the main objective outcomes being complete recovery, neurological sequelae, or death. |
dc.format.extent | xiii, 70 páginas |
dc.format.mimetype | application/pdf |
dc.language.iso | spa |
dc.publisher | Universidad Nacional de Colombia |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/4.0/ |
dc.subject.ddc | 610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría |
dc.subject.ddc | 610 - Medicina y salud::616 - Enfermedades |
dc.subject.ddc | 610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología |
dc.title | Manifestaciones en sistema nervioso central en imágenes diagnósticas de pacientes pediátricos post-trasplante de células madre hematopoyéticas con complicaciones neurológicas en la Fundación Hospital de la Misericordia en 2016-2022 |
dc.type | Trabajo de grado - Especialidad Médica |
dc.type.driver | info:eu-repo/semantics/masterThesis |
dc.type.version | info:eu-repo/semantics/acceptedVersion |
dc.publisher.program | Bogotá - Medicina - Especialidad en Radiología e Imágenes Diagnósticas |
dc.coverage.city | Bogotá, Colombia |
dc.description.degreelevel | Especialidades Médicas |
dc.description.degreename | Especialista en Radiología e Imágenes Diagnósticas |
dc.description.methods | De acuerdo con el objetivo, se realizó un estudio observacional de corte transversal con componente analítico. Pacientes menores de 18 años que hayan sido sometidos a trasplante de células madre hematopoyéticas y hayan presentado alguna complicación neurológica posterior a la realización del procedimiento en la Fundación Hospital de la Misericordia - HOMI. Selección de pacientes por conveniencia - no probabilístico, se tomarán todos los pacientes que cumplan los criterios de inclusión entre los años 2016 y 2022, de manera sistemática. Se realiza el estudio con el servicio de servicio de trasplante de progenitores hematopoyéticos y radiología pediátrica de la Fundación Hospital de la Misericordia (HOMI), durante el periodo comprendido entre enero de 2016 a diciembre de 2022. Se revisó la base de datos de pacientes sometidos a TCMH menores de 18 años. Por tratarse de un estudio retrospectivo, se utilizaron las imágenes disponibles en la base de datos DICOM® (Digital Imaging and Communication on Medicine) del aplicativo PACS IndiGO® vigente en HOMI y de los aplicativos de historias clínicas HIS-ISIS® e Indira®. Posteriormente, se seleccionaron los pacientes que contaban con imágenes disponibles de resonancia magnética cerebral. De estos pacientes se realizó la revisión de historias clínicas. En la revisión de las imágenes se contaba con secuencias de resonancia magnética en protocolo de rutina para cerebro, simple o contrastado en un equipo Philips de de 1.5 T. Se obtuvieron secuencias espin-eco T1 sagital volumétrica, axial T2 y FLAIR, coronal T2 y volumétrica T1 posterior a la administración de gadolinio. Secuencia eco-gradiente axial T2, imágenes axiales de difusión con valores b0 y b1000; y el mapa de coeficiente de difusión aparente (ADC). Las variables radiológicas se definieron basadas en la interpretación y los reportes oficiales de las imágenes. Para la obtención de los valores de ADC se descargaron las imágenes en formato DICOM® y se evaluaron en el software visor RadiAnt®, se obtuvo un promedio de tres ROIs con valores de intensidad de señal de la región mayormente afectada basado en una inspección visual. Esto se correlaciono con tres áreas contralaterales o equivalentes no afectadas de parénquima normal obteniendo un resultado de la razón entre estos dos valores. Se introdujeron los datos en un instrumento de recolección en Excel y posteriormente se realizó analisis de datos en el software de estadística R®. |
dc.description.researcharea | Neurorradiología pediátrica |
dc.identifier.instname | Universidad Nacional de Colombia |
dc.identifier.repo | Repositorio Institucional Universidad Nacional de Colombia |
dc.identifier.repourl | https://repositorio.unal.edu.co/ |
dc.publisher.faculty | Facultad de Medicina |
dc.publisher.place | Bogotá, Colombia |
dc.publisher.branch | Universidad Nacional de Colombia - Sede Bogotá |
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dc.rights.accessrights | info:eu-repo/semantics/openAccess |
dc.subject.decs | Hematopoietic stem cell transplantation |
dc.subject.decs | Trasplante de células madre hematopoyéticas |
dc.subject.decs | Imagen por resonancia magnética |
dc.subject.decs | Magnetic resonance imaging |
dc.subject.decs | Cuidados posoperatorios - Efectos adversos |
dc.subject.decs | Postoperative care - Adverse effects |
dc.subject.proposal | Trasplante de células madre hematopoyéticas |
dc.subject.proposal | Pediatría |
dc.subject.proposal | Resonancia magnética |
dc.subject.proposal | Mapa ADC |
dc.subject.proposal | Complicaciones neurológicas post-trasplante |
dc.subject.proposal | DWI |
dc.subject.proposal | Diffusion weighted imaging DWI |
dc.subject.proposal | Pediatrics |
dc.subject.proposal | Post-transplant neurological complications |
dc.subject.proposal | Magnetic resonance imaging |
dc.subject.proposal | ADC map |
dc.subject.proposal | Trasplante de progenitores hematopoyéticos |
dc.title.translated | Central nervous system manifestations in diagnostic images of pediatric patients after hematopoietic stem cell transplant with neurological complications at: Fundación Hospital de la Misericordia from 2016-2022 |
dc.type.coar | http://purl.org/coar/resource_type/c_bdcc |
dc.type.coarversion | http://purl.org/coar/version/c_ab4af688f83e57aa |
dc.type.content | Text |
dc.type.redcol | http://purl.org/redcol/resource_type/TM |
oaire.accessrights | http://purl.org/coar/access_right/c_abf2 |
dcterms.audience.professionaldevelopment | Estudiantes |
dcterms.audience.professionaldevelopment | Investigadores |
dcterms.audience.professionaldevelopment | Maestros |
dc.contributor.cvlac | Gómez Medina, Andrés Felipe [0001863965] |
dc.subject.umls | Radiología pediátrica |
dc.subject.umls | Pediatric radiology specialty |
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