{ "schemaVersion": "2026-09-07.3", "idioma": "en", "licenca": "https://sonoaireport.com/termos", "aviso": "Reference values for documentation support. They are not clinical management: confirm with the literature and the responsible physician’s judgment.", "topicos": [ { "metodo": "US", "chave": "vias_urinarias", "slug": "vias-urinarias", "url": "https://sonoaireport.com/en/referencias-ultrassom/vias-urinarias", "nome": "Urinary tract / Kidneys", "temPaginaPublica": true, "medidas": [ { "id": "vias_urinarias.0", "grupo": "vias_urinarias", "ruleId": "renal.length.adult", "rotulo": "Adult kidney — bipolar length", "valor": "9–12", "unidade": "cm", "nota": "varies with height, sex, age and body habitus", "fonte": "StatPearls / Radiology Key / Rumack", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "9–12 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/context", "valor": "8–9 ou 12–13 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely abnormal", "valor": "<8 ou >13 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "vias_urinarias.1", "grupo": "vias_urinarias", "ruleId": null, "rotulo": "Length difference between kidneys", "valor": "≤ 1,5", "unidade": "cm", "nota": "larger difference suggests unilateral disease or anatomic variation to correlate", "fonte": "StatPearls / AccessMedicine", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "≤1,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "abnormal", "valor": ">1,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "vias_urinarias.2", "grupo": "vias_urinarias", "ruleId": "renal.parenchyma.thickness", "rotulo": "Renal parenchyma — thickness", "valor": "1,3–2,5", "unidade": "cm", "nota": "less than 1.0 cm is compatible with relevant thinning", "fonte": "PMC Doppler kidney disease / StatPearls", "faixas": [ { "status": "green", "rotulo": "preserved", "valor": "≥1,3 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "1,0–1,2 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "thinned", "valor": "<1,0 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "vias_urinarias.3", "grupo": "vias_urinarias", "ruleId": null, "rotulo": "Renal cortex — thickness", "valor": "7–15", "unidade": "mm", "nota": "varies by technique; interpret with echogenicity and kidney size", "fonte": "StatPearls / nephrology ultrasound reviews", "faixas": [ { "status": "green", "rotulo": "preserved", "valor": "≥10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "technique/age zone", "valor": "7–9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "marked thinning", "valor": "<7 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "vias_urinarias.4", "grupo": "vias_urinarias", "ruleId": "bladder.wall.thickness", "rotulo": "Bladder wall — full bladder", "valor": "≤ 3", "unidade": "mm", "nota": "3–5 mm depends on filling; >5 mm with a full bladder is suspicious", "fonte": "EFSUMB bladder chapter / StatPearls", "faixas": [ { "status": "green", "rotulo": "normal full", "valor": "≤3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/filling", "valor": "3–5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "thickened", "valor": ">5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "vias_urinarias.5", "grupo": "vias_urinarias", "ruleId": null, "rotulo": "Bladder volume for evaluation", "valor": "200–300", "unidade": "mL", "nota": "partially full bladder improves wall and lesion assessment", "fonte": "EFSUMB bladder chapter", "faixas": [] }, { "id": "vias_urinarias.6", "grupo": "vias_urinarias", "ruleId": null, "rotulo": "Bladder volume calculation", "valor": "comprimento × largura × profundidade × 0,52", "unidade": null, "nota": "some protocols use different coefficients depending on bladder shape", "fonte": "StatPearls PVR / bladder volume studies", "faixas": [] }, { "id": "vias_urinarias.7", "grupo": "vias_urinarias", "ruleId": "bladder.postvoid.residual", "rotulo": "Post-void residual", "valor": "<50 (elevado ≥100)", "unidade": "mL", "nota": "no formal consensus (ICS 2016; ICI-RS 2023); the most used binary cut-off is ≥100 mL, and that is what the automatic check applies. The local service protocol is stricter: >30 mL is already recorded as abnormal. Measure soon after voiding and interpret with symptoms and pre-void volume — a single measurement varies widely.", "fonte": "ICS teaching module 2016 / ICI-RS 2023 / EAU / Lukacz 2006 / Milleman 2004 / Wong 2017 / Protocolo local", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "<50 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual zone", "valor": "50–99 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "elevated", "valor": "≥100 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "inadequate emptying", "valor": ">200 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "chronic retention (AUA)", "valor": ">300 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "vias_urinarias.c0", "grupo": "vias_urinarias", "nome": "Post-void residual — consensus reading", "nota": "Use the calculator above with post-void volume in mL. Pre-void volume is optional and calculates residual percentage.", "fonte": "Protocolo local / Ministério da Saúde BR 2020 / ICS teaching module / StatPearls PVR / AUA white paper", "colunas": [ "Range", "Reading", "Comment" ], "linhas": [ { "status": "green", "celulas": [ "< 50 mL", "Normal", "Normal in the literature. The local service protocol is stricter and already records >30 mL as abnormal." ] }, { "status": "yellow", "celulas": [ "50–99 mL", "Contextual zone", "Interpret with symptoms and pre-void volume. There is no formal consensus (ICS 2016; ICI-RS 2023)." ] }, { "status": "red", "celulas": [ "≥ 100 mL", "Elevated residual", "Most used binary cut-off in the literature (Lukacz 2006; Milleman 2004; Wong 2017) and the one applied by the automatic check." ] }, { "status": "red", "celulas": [ "> 200 mL", "Inadequate emptying", "Suggests voiding dysfunction or obstruction, depending on context." ] }, { "status": "red", "celulas": [ "> 300 mL", "Chronic retention", "AUA uses persistent >300 mL as a volumetric definition of chronic retention." ] }, { "status": "red", "celulas": [ "> 400 mL", "Urinary retention", "Generally treated as urinary retention." ] } ] }, { "id": "vias_urinarias.c1", "grupo": "vias_urinarias", "nome": "Hydronephrosis — ultrasound grading", "nota": "Grading is partly subjective; differentiate from extrarenal pelvis and parapelvic cysts.", "fonte": "StatPearls Urinary Tract Ultrasound / SFU concepts", "colunas": [ "Grade", "Finding", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Absent", "Nondilated collecting system", "Normal when there is no obstructive context." ] }, { "status": "yellow", "celulas": [ "Mild", "Early calyceal/pelvic dilatation, papillae preserved", "Real finding, but may depend on hydration, full bladder or variant." ] }, { "status": "yellow", "celulas": [ "Moderate", "Rounded calyces and effaced papillae", "Higher suspicion for obstruction; correlate with pain, ureter and ureteric jet." ] }, { "status": "red", "celulas": [ "Severe", "Confluent calyces and thinned cortex (<1 cm)", "Consensus important abnormality; look for obstructive cause." ] } ] }, { "id": "vias_urinarias.c2", "grupo": "vias_urinarias", "nome": "Bosniak 2019 — renal cysts", "nota": "Bosniak was created for contrast CT/MRI. On noncontrast ultrasound, use as descriptive triage and recommend contrast imaging if complex.", "fonte": "Bosniak v2019 (Radiology/RSNA) / StatPearls Urinary Tract Ultrasound", "colunas": [ "Class", "Description", "Malig. risk", "Note" ], "linhas": [ { "status": null, "celulas": [ "I", "Simple cyst: anechoic, thin wall and posterior enhancement", "~0%", "No follow-up when typical." ] }, { "status": null, "celulas": [ "II", "Few thin septa or fine calcification, no solid component", "<1%", "Generally benign." ] }, { "status": null, "celulas": [ "IIF", "More septa or mild thickening: needs follow-up", "~5–10%", "Gray zone; CT/MRI or contrast improves characterization." ] }, { "status": null, "celulas": [ "III", "Thick or irregular enhancing wall/septa", "~50%", "Indeterminate/suspicious." ] }, { "status": "red", "celulas": [ "IV", "Enhancing solid component", "~90–100%", "High suspicion." ] } ] } ] }, { "metodo": "US", "chave": "abdome", "slug": "abdome", "url": "https://sonoaireport.com/en/referencias-ultrassom/abdome", "nome": "Abdomen (total / upper)", "temPaginaPublica": true, "medidas": [ { "id": "abdome.0", "grupo": "abdome", "ruleId": "liver.length", "rotulo": "Liver — craniocaudal length at the midclavicular line", "valor": "≤ 15", "unidade": "cm", "nota": "15–16 cm is a technique/body-habitus zone; measure in the largest reproducible axis", "fonte": "Clinical Ultrasound in Hepatology / Radlines", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "≤15 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": ">15–16 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely hepatomegaly", "valor": ">16 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.1", "grupo": "abdome", "ruleId": "spleen.length", "rotulo": "Spleen — adult long axis", "valor": "≤ 12", "unidade": "cm", "nota": "12–13 cm varies with height, sex and technique; above 13 cm is usually abnormal", "fonte": "EFSUMB spleen / StatPearls", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "≤12 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/body habitus", "valor": ">12–13 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely splenomegaly", "valor": ">13 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.2", "grupo": "abdome", "ruleId": null, "rotulo": "Common bile duct with gallbladder present", "valor": "≤ 6–7", "unidade": "mm", "nota": "age over 60 years and opioids may explain mild nonobstructive dilation", "fonte": "EFSUMB hepatobiliary / Cleveland Clinic J Med 2022", "faixas": [ { "status": "green", "rotulo": "strict normal", "valor": "≤6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/context", "valor": ">6–7 mm ou idoso ≤8 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely dilated", "valor": ">7 mm sem contexto benigno", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.3", "grupo": "abdome", "ruleId": null, "rotulo": "Common bile duct after cholecystectomy", "valor": "≤ 8–10", "unidade": "mm", "nota": "may increase over time after surgery; symptoms and bilirubin change management", "fonte": "EFSUMB hepatobiliary / Cleveland Clinic J Med 2022", "faixas": [ { "status": "green", "rotulo": "post-surgical normal", "valor": "≤8 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "accepted by some sources", "valor": ">8–10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "relevant dilation", "valor": ">10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.4", "grupo": "abdome", "ruleId": null, "rotulo": "Intrahepatic bile ducts", "valor": "não visíveis / ≤ 1", "unidade": "mm", "nota": "some references use >2 mm as intrahepatic dilatation", "fonte": "EFSUMB hepatobiliary / Abdominal Radiology", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "não visíveis ou ≤1 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "technical zone", "valor": "1–2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "dilatation", "valor": ">2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.5", "grupo": "abdome", "ruleId": "gallbladder.wall.thickness", "rotulo": "Gallbladder — fasting wall thickness", "valor": "≤ 3", "unidade": "mm", "nota": "pseudothickening occurs when the gallbladder is contracted or not fasting", "fonte": "EFSUMB hepatobiliary / StatPearls", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "≤3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/context", "valor": ">3–4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "thickened", "valor": ">4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.6", "grupo": "abdome", "ruleId": null, "rotulo": "Incidental gallbladder polyp", "valor": "< 6 baixo risco; ≥10–15 alto risco", "unidade": "mm", "nota": "SRU is less interventionist; European guidelines treat ≥10 mm more cautiously", "fonte": "SRU 2022 Radiology / ESGAR-EAES-EFISDS-ESGE 2022", "faixas": [ { "status": "green", "rotulo": "low risk", "valor": "<6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "follow-up/risk", "valor": "6–9 mm ou 10–14 mm baixo risco SRU", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "consider surgery", "valor": "≥10 mm com risco ou ≥15 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.7", "grupo": "abdome", "ruleId": "portal.vein.diameter", "rotulo": "Portal vein — resting diameter", "valor": "6–13", "unidade": "mm", "nota": "deep inspiration may reach 16 mm; interpret with spleen, collaterals and flow direction", "fonte": "Polish Ultrasound Society / StatPearls", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "6–13 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/context", "valor": ">13–16 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suggestive dilatation", "valor": ">16 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.8", "grupo": "abdome", "ruleId": null, "rotulo": "Portal vein — mean velocity", "valor": "16–40", "unidade": "cm/s", "nota": "should be hepatopetal; hepatofugal flow is abnormal regardless of the number", "fonte": "Polish Ultrasound Society / liver Doppler reviews", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "16–40 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline slow", "valor": "12–16 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely abnormal", "valor": "<12, >40 ou hepatofugal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.9", "grupo": "abdome", "ruleId": "pancreatic.duct.diameter", "rotulo": "Main pancreatic duct", "valor": "cabeça 3 / corpo 2 / cauda 1–1,5", "unidade": "mm", "nota": "increases slightly with age; measure in the body near the head when possible", "fonte": "EFSUMB pancreas / Pancreatic ultrasound update 2024", "faixas": [ { "status": "green", "rotulo": "normal in body", "valor": "≤2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "high-normal/context", "valor": ">2–3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely dilatation", "valor": ">3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.10", "grupo": "abdome", "ruleId": null, "rotulo": "Pancreas — approximate thickness", "valor": "cabeça ~2; corpo/cauda 1–2", "unidade": "cm", "nota": "isolated size is not robust; prioritize duct, contour and focal lesions", "fonte": "EFSUMB pancreas", "faixas": [] }, { "id": "abdome.11", "grupo": "abdome", "ruleId": "aorta.abdominal.diameter", "rotulo": "Abdominal aorta — maximum diameter", "valor": "< 3", "unidade": "cm", "nota": "3.0 cm defines aneurysm; usual repair threshold: ≥5.5 cm men and ≥5.0 cm women", "fonte": "USPSTF / ACC-AHA 2022 / SVS", "faixas": [ { "status": "green", "rotulo": "usual diameter", "valor": "<2,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "ectasia", "valor": "2,5–2,9 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "aneurysm", "valor": "≥3,0 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.12", "grupo": "abdome", "ruleId": null, "rotulo": "Inferior vena cava — diameter and inspiratory collapse", "valor": "< 2,1 cm + colapso >50%", "unidade": null, "nota": "criteria estimate right atrial pressure, not isolated volume status", "fonte": "ASE chamber quantification / POCUS Academy", "faixas": [ { "status": "green", "rotulo": "low/normal pressure", "valor": "<2,1 cm + >50%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate", "valor": "achados discordantes", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely elevated pressure", "valor": ">2,1 cm + <50%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.13", "grupo": "abdome", "ruleId": null, "rotulo": "Abdominal Doppler — minimum technique", "valor": "fasting 4-6 h when possible; color and pulsed Doppler; angle up to 60 degrees; direction, velocity and waveform documented", "unidade": null, "nota": "Flow direction and vascular patency carry as much weight as the velocity number. Adjust gain, scale and wall filter so slow flow is not mistaken for thrombosis.", "fonte": "ACR-AIUM-SPR-SRU abdomen parameter / StatPearls Liver Doppler", "faixas": [ { "status": "green", "rotulo": "adequate", "valor": "direction + spectrum + angle documented", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "limited", "valor": "poor window, unreliable angle or nonfasting", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "incomplete", "valor": "vascular concern without pulsed Doppler or flow direction", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.14", "grupo": "abdome", "ruleId": null, "rotulo": "Hepatic artery — resistive index", "valor": "0,50–0,70", "unidade": null, "nota": "Outside transplant, interpret with context; in transplant and postoperative settings, extreme values, absent flow or tardus-parvus pattern are relevant.", "fonte": "StatPearls Liver Doppler / AJR liver Doppler", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "0,50–0,70", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/contextual", "valor": "0,70–0,80 ou 0,45–0,50", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "alert", "valor": ">0,80, <0,45, ausência de fluxo ou tardus-parvus", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.15", "grupo": "abdome", "ruleId": null, "rotulo": "Hepatic veins — spectral pattern", "valor": "triphasic or phasic with the cardiac cycle", "unidade": null, "nota": "Loss of phasicity may occur with cirrhosis, congestion, technique or respiration; absent flow, thrombus or obstruction suggests hepatic venous disease.", "fonte": "StatPearls Liver Doppler / liver Doppler reviews", "faixas": [ { "status": "green", "rotulo": "phasic", "valor": "physiologic triphasic or biphasic", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual monophasic", "valor": "cirrhosis, technique or congestion without thrombus", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "obstructive", "valor": "no flow, thrombus, stenosis or venous collaterals", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "abdome.16", "grupo": "abdome", "ruleId": null, "rotulo": "Transjugular intrahepatic portosystemic shunt — velocity", "valor": "90–190", "unidade": "cm/s", "nota": "Use only when a shunt is present. Out-of-range velocity, focal gradient or turbulence suggests dysfunction according to local protocol.", "fonte": "StatPearls Liver Doppler / institutional TIPS protocols", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "90–190 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "caution zone", "valor": "50–90 ou 190–250 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely dysfunction", "valor": "<50 ou >250 cm/s, oclusão ou gradiente focal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "abdome.c0", "grupo": "abdome", "nome": "Calculator — LI-RADS US (HCC surveillance)", "nota": "Visualization score A/B/C measures study limitation (steatosis, ascites, body habitus). Severe visualization C may warrant alternative imaging. Apply only in at-risk patients (cirrhosis, hepatitis B).", "fonte": "ACR LI-RADS US Surveillance v2024 / AASLD", "colunas": [ "Category", "Meaning", "Management" ], "linhas": [ { "status": "green", "celulas": [ "US-1", "Negative", "Semiannual US surveillance (± AFP)." ] }, { "status": "yellow", "celulas": [ "US-2", "Subthreshold (nodule <10 mm)", "Repeat US in 3–6 months." ] }, { "status": "red", "celulas": [ "US-3", "Positive (nodule ≥10 mm or new thrombus)", "Multiphase CT/MRI or CEUS LI-RADS." ] } ] }, { "id": "abdome.c1", "grupo": "abdome", "nome": "Calculator — acute cholecystitis (Tokyo TG18)", "nota": "Severity guides the timing of cholecystectomy and the need for drainage/support.", "fonte": "Tokyo Guidelines TG18 (J Hepatobiliary Pancreat Sci 2018)", "colunas": [ "Criterion/grade", "Definition" ], "linhas": [ { "status": "yellow", "celulas": [ "A — local inflammation", "Sonographic Murphy; wall >4 mm, distension or impacted stone." ] }, { "status": "yellow", "celulas": [ "B — systemic inflammation", "Fever, elevated CRP or WBC." ] }, { "status": "red", "celulas": [ "Diagnosis", "A + B = definite acute cholecystitis." ] }, { "status": "red", "celulas": [ "Severity I/II/III", "III = organ dysfunction; II = WBC >18k, mass, >72 h or marked local inflammation; I = mild." ] } ] }, { "id": "abdome.c2", "grupo": "abdome", "nome": "Hepatic CEUS — enhancement of focal lesions", "nota": "CEUS assesses real-time enhancement without radiation; early/late washout helps separate benign from malignant. Microbubble contrast is purely intravascular.", "fonte": "CEUS LI-RADS v2017 / EFSUMB CEUS guidelines 2020", "colunas": [ "Pattern", "Phases", "Suggests" ], "linhas": [ { "status": "green", "celulas": [ "Peripheral discontinuous nodular + centripetal fill-in", "Arterial→late", "Hemangioma" ] }, { "status": "green", "celulas": [ "Homogeneous with central scar", "Arterial", "Focal nodular hyperplasia" ] }, { "status": "red", "celulas": [ "Arterial hyperenhancement + late washout", "Arterial→late", "HCC (use CEUS LI-RADS)" ] }, { "status": "red", "celulas": [ "Early, marked washout", "Early portal", "Metastasis/cholangiocarcinoma" ] } ] }, { "id": "abdome.c3", "grupo": "abdome", "nome": "Quick calculator — upper abdomen", "nota": "The calculator classifies isolated measurements; it does not replace the report, comparison, labs or associated signs.", "fonte": "CBR / EFSUMB / SRU / USPSTF / ACC-AHA / ASE", "colunas": [ "Color", "Practical range", "How to use" ], "linhas": [ { "status": null, "celulas": [ "Green", "Liver ≤15 cm; spleen ≤12 cm; common bile duct ≤6 mm; gallbladder wall ≤3 mm; aorta <2.5 cm; portal vein 6–13 mm and 16–40 cm/s; pancreatic duct in body ≤2 mm.", "Values references tend to agree are usual." ] }, { "status": null, "celulas": [ "Yellow", "Liver >15–16; spleen >12–13; common bile duct >6–7 or older adult; post-cholecystectomy 8–10; wall >3–4; aorta 2.5–2.9; portal vein 13–16 or 12–16 cm/s; duct 2–3.", "Divergent zone or dependent on age, fasting, body habitus, inspiration and symptoms." ] }, { "status": null, "celulas": [ "Red", "Common bile duct >7 mm without benign context or >10 mm after cholecystectomy; intrahepatic ducts >2 mm; gallbladder wall >4 mm; spleen >13 cm; aorta ≥3 cm; pancreatic duct >3 mm.", "Ranges where sources converge toward abnormality or investigation according to clinical context." ] } ] }, { "id": "abdome.c4", "grupo": "abdome", "nome": "Bile ducts — common bile duct and intrahepatic ducts", "nota": "Measure inner wall to inner wall and follow the duct to the pancreatic head when possible.", "fonte": "EFSUMB hepatobiliary chapter / Cleveland Clinic J Med 2022", "colunas": [ "Category", "Measurement", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "Consensus normal", "Common bile duct ≤6 mm with gallbladder; intrahepatic ducts not visible or ≤1 mm.", "Without other signs, usually normal." ] }, { "status": null, "celulas": [ "Context zone", "Common bile duct >6–7 mm; up to 8 mm in older adults; 8–10 mm after cholecystectomy; intrahepatic ducts 1–2 mm.", "Correlate with age, opioids, surgery, pain, fever and bilirubin." ] }, { "status": null, "celulas": [ "Likely dilatation", "Common bile duct >7 mm with gallbladder and no benign cause; >10 mm after cholecystectomy; intrahepatic ducts >2 mm.", "Look for obstruction, distal stone, mass or stricture depending on presentation." ] } ] }, { "id": "abdome.c5", "grupo": "abdome", "nome": "Gallbladder — wall and polyps", "nota": "SRU 2022 uses morphology categories and tends to reduce follow-up; European guidelines are more cautious at ≥10 mm.", "fonte": "SRU Radiology 2022 / ESGAR-EAES-EFISDS-ESGE 2022", "colunas": [ "Finding", "Range", "Reference approach" ], "linhas": [ { "status": null, "celulas": [ "Fasting wall", "≤3 mm", "Normal when the gallbladder is well distended." ] }, { "status": null, "celulas": [ "Fasting wall", ">3–4 mm", "Borderline; check fasting, contraction, ascites, liver disease and pain." ] }, { "status": null, "celulas": [ "Fasting wall", ">4 mm", "Relevant thickening, especially with stone, pericholecystic fluid or sonographic Murphy sign." ] }, { "status": null, "celulas": [ "Low-risk polyp", "<6 mm", "Low risk in most guidelines." ] }, { "status": null, "celulas": [ "Intermediate polyp", "6–9 mm ou 10–14 mm baixo risco SRU", "SRU versus Europe divergence; consider morphology, growth and risk factors." ] }, { "status": null, "celulas": [ "High-risk polyp", "≥10 mm com fatores de risco ou ≥15 mm", "Consider surgery/referral according to guideline and clinical context." ] } ] }, { "id": "abdome.c6", "grupo": "abdome", "nome": "Abdominal aorta — aneurysm screening", "nota": null, "fonte": "USPSTF / ACC-AHA 2022 / Society for Vascular Surgery", "colunas": [ "Range", "Classification", "Note" ], "linhas": [ { "status": "green", "celulas": [ "<2,5 cm", "Usual diameter", "Below ectasia." ] }, { "status": "yellow", "celulas": [ "2,5–2,9 cm", "Ectasia", "Does not meet classic aneurysm criterion, but should be documented." ] }, { "status": "red", "celulas": [ "≥3,0 cm", "Abdominal aortic aneurysm", "Criterion used in ultrasound screening programs." ] }, { "status": "red", "celulas": [ "≥5,0 cm mulher / ≥5,5 cm homem", "Usual repair threshold", "Depends on symptoms, growth, anatomy and surgical risk." ] } ] }, { "id": "abdome.c7", "grupo": "abdome", "nome": "Portal vein — diameter, velocity and direction", "nota": null, "fonte": "Polish Ultrasound Society portal system standards / StatPearls", "colunas": [ "Color", "Criterion", "Reading" ], "linhas": [ { "status": null, "celulas": [ "Green", "6–13 mm, velocity 16–40 cm/s, hepatopetal flow", "Usual range." ] }, { "status": null, "celulas": [ "Yellow", "13–16 mm with deep inspiration or post-prandial state; velocity 12–16 cm/s", "Correlate with spleen, ascites, collaterals and liver surface." ] }, { "status": null, "celulas": [ "Red", ">16 mm, velocity <12 cm/s, hepatofugal flow or thrombosis", "Suggests portal hypertension or vascular disease depending on context." ] } ] }, { "id": "abdome.c8", "grupo": "abdome", "nome": "Pancreas and inferior vena cava — useful limits", "nota": null, "fonte": "EFSUMB pancreas / Pancreatic ultrasound update 2024 / ASE chamber quantification", "colunas": [ "Structure", "Normal", "Alert" ], "linhas": [ { "status": null, "celulas": [ "Main pancreatic duct in body", "≤2 mm", "Usual range in pancreatic body." ] }, { "status": null, "celulas": [ "Main pancreatic duct", ">2–3 mm", "High-normal/borderline, especially in older adults or at the head." ] }, { "status": null, "celulas": [ "Main pancreatic duct", ">3 mm", "Likely dilatation; consider cross-sectional imaging according to symptoms and findings." ] }, { "status": null, "celulas": [ "Inferior vena cava", "<2,1 cm + colapso >50%", "Compatible with low/normal right atrial pressure." ] }, { "status": null, "celulas": [ "Inferior vena cava", "discordant findings", "Indeterminate; use secondary indices and context." ] }, { "status": null, "celulas": [ "Inferior vena cava", ">2,1 cm + colapso <50%", "Suggests elevated right atrial pressure." ] } ] }, { "id": "abdome.c9", "grupo": "abdome", "nome": "Quick assistant — abdominal Doppler", "nota": "Do not use velocity alone as the conclusion. Combine direction, patency, waveform, diameter, spleen, ascites, collaterals, technique and clinical indication.", "fonte": "StatPearls Liver Doppler / Radiographics liver Doppler / portal hypertension reviews", "colunas": [ "Output", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Preserved Doppler", "Green", "Patent portal vein with flow toward the liver, usual velocity, hepatic artery with usual resistive index and phasic hepatic veins." ] }, { "status": "yellow", "celulas": [ "Contextual or limited finding", "Yellow", "Slow portal flow, borderline hepatic artery, monophasic hepatic vein without thrombus, isolated ascites/splenomegaly or technical limitation." ] }, { "status": "red", "celulas": [ "Abnormal vascular finding", "Red", "Hepatofugal portal flow, absent flow, thrombosis, cavernoma, portosystemic collaterals, hepatic vein/caval obstruction or shunt dysfunction." ] } ] }, { "id": "abdome.c10", "grupo": "abdome", "nome": "Technical protocol — hepatoportal Doppler", "nota": null, "fonte": "ACR-AIUM-SPR-SRU abdomen parameter / StatPearls Liver Doppler", "colunas": [ "Item", "Record", "Why it matters" ], "linhas": [ { "status": "green", "celulas": [ "Main portal vein and branches", "Patency, direction toward or away from the liver, velocity and diameter.", "Basis for portal hypertension, thrombosis and collateral flow." ] }, { "status": "green", "celulas": [ "Hepatic artery", "Resistive index, systolic velocity and systolic upstroke when indicated.", "Helps in transplant, portal thrombosis, stenosis and arterial compensation." ] }, { "status": "yellow", "celulas": [ "Hepatic veins and inferior vena cava", "Phasicity, patency, thrombus, compression or dilation.", "Assesses congestion, Budd-Chiari, right-heart disease and venous obstruction." ] }, { "status": "yellow", "celulas": [ "Splenic vein and portal confluence", "Patency, direction, thrombus and collaterals.", "Important in portal/splenic thrombosis and segmental portal hypertension." ] }, { "status": "yellow", "celulas": [ "Technique", "Fasting, acoustic window, angle up to 60 degrees, scale/filter and limitations.", "Avoids false diagnosis of thrombosis from slow flow." ] } ] }, { "id": "abdome.c11", "grupo": "abdome", "nome": "Portal hypertension and thrombosis — Doppler signs", "nota": null, "fonte": "StatPearls Liver Doppler / Doppler flow patterns in cirrhosis reviews", "colunas": [ "Color", "Sign", "Comment" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Patent portal vein, flow toward the liver, 16-40 cm/s, no collaterals.", "Compatible with usual hemodynamics when B-mode agrees." ] }, { "status": "yellow", "celulas": [ "Yellow", "Velocity 12-16 cm/s, diameter 13-16 mm, enlarged spleen or isolated ascites.", "Context zone; look for a combination of signs." ] }, { "status": "red", "celulas": [ "Red", "Flow away from the liver, absent flow, thrombus, cavernoma, recanalized umbilical vein or collaterals.", "Strong findings for advanced portal hypertension or thrombosis." ] } ] }, { "id": "abdome.c12", "grupo": "abdome", "nome": "Hepatic artery, hepatic veins and inferior vena cava — practical reading", "nota": "These thresholds are most useful in the right context. Transplant and shunt exams have their own protocols and serial comparison is essential.", "fonte": "StatPearls Liver Doppler / institutional TIPS protocols / AJR liver Doppler", "colunas": [ "Structure", "Green", "Yellow", "Red" ], "linhas": [ { "status": "yellow", "celulas": [ "Hepatic artery", "Resistive index 0.50-0.70 and present diastole.", "0.70-0.80 or 0.45-0.50 without another warning.", ">0.80, <0.45, absent flow or tardus-parvus." ] }, { "status": "yellow", "celulas": [ "Hepatic veins", "Triphasic/phasic.", "Monophasic with cirrhosis, technique or likely congestion.", "Thrombus, absent flow, stenosis or venous collaterals." ] }, { "status": "yellow", "celulas": [ "Inferior vena cava", "Patent, compressible/phasic according to respiration and heart.", "Dilated with reduced collapse in congestion.", "Thrombus, tumor compression or thrombus extension." ] }, { "status": "yellow", "celulas": [ "Transjugular intrahepatic portosystemic shunt", "90-190 cm/s without focal gradient.", "50-90 or 190-250 cm/s.", "<50, >250 cm/s, occlusion or focal turbulence/gradient." ] } ] } ] }, { "metodo": "US", "chave": "doppler_hepatico_transplante", "slug": "doppler-hepatico-transplante", "url": "https://sonoaireport.com/en/referencias-ultrassom/doppler-hepatico-transplante", "nome": "Hepatic Doppler / liver transplant", "temPaginaPublica": true, "medidas": [ { "id": "doppler_hepatico_transplante.0", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Transplant hepatic artery — resistive index", "valor": "0,55–0,80", "unidade": null, "nota": "High values may be transient in the first 48-72 h; low index with tardus-parvus favors stenosis.", "fonte": "Radiographics/RSNA liver transplant Doppler / Clinical Imaging review / institutional transplant protocols", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "0,55–0,80", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline or transient", "valor": "0,50–0,55 ou >0,80 nas primeiras 72 h sem outro alerta", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high risk", "valor": "<0,50 com tardus-parvus, ausência de fluxo ou piora clínica", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.1", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Hepatic artery — systolic acceleration time", "valor": "< 80", "unidade": "ms", "nota": "Above 80 ms is used with low resistive index and tardus-parvus waveform to suspect stenosis.", "fonte": "Radiographics/RSNA / AJR liver transplant Doppler", "faixas": [ { "status": "green", "rotulo": "brisk upstroke", "valor": "<80 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "technical zone", "valor": "80–100 ms sem baixo índice de resistência", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "stenosis concern", "valor": ">80 ms + índice baixo/tardus-parvus", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.2", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Hepatic artery — focal peak systolic velocity", "valor": "< 200", "unidade": "cm/s", "nota": "Velocity >=200 cm/s at the jet/anastomosis, especially with aliasing and distal waveform change, favors stenosis.", "fonte": "Radiographics/RSNA / liver transplant Doppler reviews", "faixas": [ { "status": "green", "rotulo": "no focal elevation", "valor": "<150 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "caution", "valor": "150–199 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "strong concern", "valor": "≥200 cm/s com gradiente/turbulência", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.3", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Hepatic artery — absent flow", "valor": "critical abnormality if confirmed", "unidade": null, "nota": "Confirm with low/high gain, slow scale, power Doppler and intra/extrahepatic search.", "fonte": "Radiographics/RSNA / Clinical Imaging review", "faixas": [ { "status": "red", "rotulo": "communicate", "valor": "arterial thrombosis until proven otherwise in transplant", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.4", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Portal vein — flow direction", "valor": "toward the liver", "unidade": null, "nota": "Flow away from the liver or no flow is abnormal in the graft unless there is an intended shunt.", "fonte": "StatPearls Liver Doppler / transplant Doppler protocols", "faixas": [ { "status": "green", "rotulo": "expected", "valor": "toward the liver", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "very slow or to-and-fro", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "abnormal", "valor": "away from liver, thrombus or no flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.5", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Transplanted portal vein — anastomotic velocity", "valor": "< 125", "unidade": "cm/s", "nota": "Some protocols accept high velocities early postoperatively; ratio and turbulence increase specificity.", "fonte": "Radiographics/RSNA / liver transplant Doppler reviews", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "<100 cm/s sem turbulência", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "observe", "valor": "100–124 cm/s ou edema precoce", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "stenosis concern", "valor": "≥125 cm/s com aliasing ou razão elevada", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.6", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Portal vein — anastomosis/reference ratio", "valor": "< 3:1", "unidade": null, "nota": "Ratio >=3:1 is a strong criterion when there is focal narrowing, turbulence or serial change.", "fonte": "Radiographics/RSNA / transplant Doppler protocols", "faixas": [ { "status": "green", "rotulo": "no gradient", "valor": "<2:1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "2–2,9:1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "significant", "valor": "≥3:1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.7", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Hepatic veins and inferior vena cava — waveform", "valor": "phasic/triphasic", "unidade": null, "nota": "Isolated monophasic waveform can be nonspecific; absent flow, focal jet and elevated ratio suggest outflow obstruction.", "fonte": "Radiographics/RSNA / UW Liver Transplant Doppler protocol", "faixas": [ { "status": "green", "rotulo": "reassuring", "valor": "phasic or triphasic", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual", "valor": "monophasic without jet/congestion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely obstruction", "valor": "no flow, thrombus, focal jet or ratio >=3:1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_hepatico_transplante.8", "grupo": "doppler_hepatico_transplante", "ruleId": null, "rotulo": "Transjugular intrahepatic portosystemic shunt — velocity", "valor": "90–190", "unidade": "cm/s", "nota": "Included for differentiation; do not confuse a shunt with the transplant portal anastomosis.", "fonte": "StatPearls Liver Doppler / TIPS institutional protocols", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "90–190 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "caution zone", "valor": "50–90 ou 190–250 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely dysfunction", "valor": "<50, >250, oclusão ou gradiente focal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "doppler_hepatico_transplante.c0", "grupo": "doppler_hepatico_transplante", "nome": "Interactive assistant — hepatic and transplant Doppler", "nota": "The assistant calculates ratios and color-codes results. In transplant, comparison with baseline Doppler can be more important than an isolated number.", "fonte": "Radiographics/RSNA / Clinical Imaging / AJR / UW and UT Southwestern transplant Doppler protocols", "colunas": [ "Output", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Preserved pattern", "Green", "Patent hepatic artery, usual resistive index, brisk upstroke, portal flow toward the liver and phasic hepatic veins." ] }, { "status": "yellow", "celulas": [ "Borderline/contextual zone", "Yellow", "High index early postoperatively, intermediate velocity, isolated monophasic waveform or technical limitation." ] }, { "status": "red", "celulas": [ "Vascular alert", "Red", "Absent arterial flow, tardus-parvus with low index, arterial velocity >=200 cm/s, portal thrombus, portal/venous ratio >=3:1 or venous obstruction." ] } ] }, { "id": "doppler_hepatico_transplante.c1", "grupo": "doppler_hepatico_transplante", "nome": "Minimum technical protocol — native liver and transplant", "nota": null, "fonte": "ACR-AIUM-SPR-SRU abdomen parameter / UW Liver TX Doppler / UTSW transplant protocol", "colunas": [ "Vessel/step", "Record", "Why it matters" ], "linhas": [ { "status": "green", "celulas": [ "Main hepatic artery and intrahepatic branches", "Patency, resistive index, systolic velocity, systolic upstroke and sample location.", "Main screening for post-transplant arterial thrombosis or stenosis." ] }, { "status": "green", "celulas": [ "Main portal vein, anastomosis and branches", "Direction, jet velocity and reference velocity before/after.", "Differentiates transient hyperflow from anastomotic stenosis." ] }, { "status": "yellow", "celulas": [ "Hepatic veins and inferior vena cava", "Phasicity, focal jet, anastomotic velocity, ratio and residual flow.", "Assesses outflow obstruction and graft congestion." ] }, { "status": "yellow", "celulas": [ "Surgical context", "Transplant date, graft type, caval technique, stent, angioplasty and baseline exam.", "Changes thresholds and avoids false positives early postoperatively." ] }, { "status": "yellow", "celulas": [ "Doppler technique", "Angle up to 60 degrees, low scale for slow flow, adjusted gain, power Doppler when needed.", "Avoids simulating thrombosis from slow flow or poor window." ] } ] }, { "id": "doppler_hepatico_transplante.c2", "grupo": "doppler_hepatico_transplante", "nome": "Post-transplant hepatic artery — color reading", "nota": "Isolated high index early postoperatively is a known pitfall; the same late finding or with graft dysfunction carries more weight.", "fonte": "Radiographics/RSNA liver transplant Doppler / Clinical Imaging 2014", "colunas": [ "Color", "Criterion", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Flow present, index 0.55-0.80, acceleration time <80 ms, no focal jet.", "Compatible with arterial patency when the tracing is reliable." ] }, { "status": "yellow", "celulas": [ "Yellow", "Index >0.80 in the first 72 h, velocity 150-199 cm/s or technically limited tracing.", "Repeat/follow, compare with baseline and correlate with labs." ] }, { "status": "red", "celulas": [ "Red", "No flow, index <0.50 with tardus-parvus, time >80 ms with low index, focal velocity >=200 cm/s.", "Priority communication; consider complementary imaging or intervention according to protocol." ] } ] }, { "id": "doppler_hepatico_transplante.c3", "grupo": "doppler_hepatico_transplante", "nome": "Transplanted portal vein — stenosis, thrombosis and hyperflow", "nota": null, "fonte": "Radiographics/RSNA / Doppler ultrasound in liver transplant complications", "colunas": [ "Color", "Finding", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Flow toward the liver, no thrombus, velocity <100 cm/s and ratio <2:1.", "Usual pattern when there is no focal aliasing." ] }, { "status": "yellow", "celulas": [ "Yellow", "Velocity 100-124 cm/s, ratio 2-2.9:1 or high early postoperative velocity without narrowing.", "Zone dependent on edema, caliber and comparison." ] }, { "status": "red", "celulas": [ "Red", "Velocity >=125 cm/s with aliasing, ratio >=3:1, thrombus or absent flow.", "Suggests portal stenosis, thrombosis or critical flow." ] } ] }, { "id": "doppler_hepatico_transplante.c4", "grupo": "doppler_hepatico_transplante", "nome": "Graft venous outflow — hepatic veins and inferior vena cava", "nota": null, "fonte": "UW Liver TX Doppler / RSNA transplant imaging reviews", "colunas": [ "Color", "Finding", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Phasic/triphasic hepatic veins and patent cava.", "Against important outflow obstruction when the rest agrees." ] }, { "status": "yellow", "celulas": [ "Yellow", "Isolated monophasic waveform, mild damping or poor respiratory/technical exam.", "Nonspecific; repeat and correlate with ascites, pleural effusion and congestion." ] }, { "status": "red", "celulas": [ "Red", "No flow, thrombus, focal jet, important aliasing or ratio >=3:1.", "Suggests venous outflow stenosis/occlusion." ] } ] }, { "id": "doppler_hepatico_transplante.c5", "grupo": "doppler_hepatico_transplante", "nome": "Native liver — hepatic Doppler outside transplant", "nota": "In the native liver, isolated numbers rarely make the diagnosis; flow direction, thrombus, collaterals and clinical context dominate.", "fonte": "StatPearls Liver Doppler / Radiographics liver Doppler", "colunas": [ "Structure", "Consensus normal", "Alert" ], "linhas": [ { "status": "yellow", "celulas": [ "Portal vein", "Flow toward the liver, diameter 6-13 mm, mean velocity 16-40 cm/s.", "Flow away from liver, thrombus, cavernoma, collaterals or very slow flow." ] }, { "status": "yellow", "celulas": [ "Hepatic artery", "Resistive index 0.50-0.70 outside transplant, with present diastole.", "Absent flow, extreme index or tardus-parvus in the right context." ] }, { "status": "yellow", "celulas": [ "Hepatic veins", "Phasic/triphasic tracing.", "No flow, thrombus, compression or obstructive pattern." ] } ] }, { "id": "doppler_hepatico_transplante.c6", "grupo": "doppler_hepatico_transplante", "nome": "Pitfalls and when to escalate", "nota": null, "fonte": "Radiographics/RSNA / Clinical Imaging review / transplant protocols", "colunas": [ "Situation", "Error risk", "How to reduce" ], "linhas": [ { "status": "yellow", "celulas": [ "First 72 hours", "High arterial index may reflect edema, spasm or transient increased resistance.", "Compare serially and weigh graft function." ] }, { "status": "yellow", "celulas": [ "Slow flow", "High scale or high wall filter may simulate thrombosis.", "Lower scale, adjust gain and use power Doppler." ] }, { "status": "red", "celulas": [ "No arterial flow in transplant", "May represent arterial thrombosis, a time-sensitive event.", "Confirm technically and communicate immediately according to local workflow." ] }, { "status": "red", "celulas": [ "Late arterial stenosis", "May cause biliary ischemia, abscesses or progressive dysfunction.", "Integrate Doppler with bile ducts, collections and labs." ] } ] }, { "id": "doppler_hepatico_transplante.c7", "grupo": "doppler_hepatico_transplante", "nome": "Report checklist — hepatic/transplant Doppler", "nota": null, "fonte": "CBR reporting principles / ACR-AIUM practice parameter / transplant Doppler literature", "colunas": [ "Block", "Text that should not be missing", "Color if absent" ], "linhas": [ { "status": "yellow", "celulas": [ "Identification", "Time after transplant, graft/anastomosis type if known, prior comparison.", "Yellow" ] }, { "status": "red", "celulas": [ "Hepatic artery", "Patency, resistive index, velocity, acceleration time and presence/absence of tardus-parvus.", "Red if transplant" ] }, { "status": "red", "celulas": [ "Portal vein", "Direction, anastomotic velocity, ratio if suspicious, thrombus and branches.", "Red if vascular concern" ] }, { "status": "yellow", "celulas": [ "Venous outflow", "Hepatic veins, cava, phasicity, focal jet and ratio when stenosis is suspected.", "Yellow/red according to finding" ] }, { "status": "yellow", "celulas": [ "Associated findings", "Bile ducts, collections, ascites, pleural effusion and technical limitation.", "Yellow" ] } ] } ] }, { "metodo": "US", "chave": "tireoide", "slug": "tireoide", "url": "https://sonoaireport.com/en/referencias-ultrassom/tireoide", "nome": "Thyroid / cervical", "temPaginaPublica": true, "medidas": [ { "id": "tireoide.0", "grupo": "tireoide", "ruleId": null, "rotulo": "Right/left lobe — length", "valor": "4–6", "unidade": "cm", "nota": "adult; measure each lobe separately", "fonte": "PMC Thyroid ultrasound / Endotext", "faixas": [] }, { "id": "tireoide.1", "grupo": "tireoide", "ruleId": null, "rotulo": "Right/left lobe — width", "valor": "1–2", "unidade": "cm", "nota": null, "fonte": "PMC Thyroid ultrasound / Intedia", "faixas": [] }, { "id": "tireoide.2", "grupo": "tireoide", "ruleId": null, "rotulo": "Right/left lobe — anteroposterior thickness", "valor": "1,3–1,8", "unidade": "cm", "nota": "up to ~2.0 cm may be accepted by some references", "fonte": "PMC Thyroid ultrasound / ATA teaching material", "faixas": [] }, { "id": "tireoide.3", "grupo": "tireoide", "ruleId": null, "rotulo": "Total thyroid volume — female", "valor": "10–15", "unidade": "mL", "nota": "usual range; classic upper limit for goiter: >18 mL", "fonte": "PMC Thyroid ultrasound / EJE 2025", "faixas": [] }, { "id": "tireoide.4", "grupo": "tireoide", "ruleId": null, "rotulo": "Total thyroid volume — male", "valor": "12–18", "unidade": "mL", "nota": "25 mL is better treated as a classic upper limit, not as a normality target", "fonte": "PMC Thyroid ultrasound / EJE 2025", "faixas": [] }, { "id": "tireoide.5", "grupo": "tireoide", "ruleId": null, "rotulo": "Volume calculation for each lobe", "valor": "C × L × E × 0,479", "unidade": null, "nota": "length, width and thickness in cm; add both lobes", "fonte": "WHO/ICCIDD ultrasound volume formula", "faixas": [] }, { "id": "tireoide.6", "grupo": "tireoide", "ruleId": "thyroid.isthmus.thickness", "rotulo": "Isthmus — thickness", "valor": "≤ 3–4", "unidade": "mm", "nota": null, "fonte": "Intedia / Endotext", "faixas": [] }, { "id": "tireoide.7", "grupo": "tireoide", "ruleId": null, "rotulo": "Thyroid parenchyma — color Doppler", "valor": "sparse to moderate and symmetric", "unidade": null, "nota": "Marked diffuse hypervascularity is abnormal and should be correlated with TSH, free T4 and antibodies.", "fonte": "Ralls AJR 1988 / QJM 2025", "faixas": [] }, { "id": "tireoide.8", "grupo": "tireoide", "ruleId": null, "rotulo": "Thyroid arteries — peak systolic velocity", "valor": "see bands", "unidade": "cm/s", "nota": "There is no universal cutoff: 30 to 70 cm/s is an overlap zone across studies; above ~70 cm/s favors Graves hyperflow when the pattern is diffuse.", "fonte": "Frontiers Endocrinol 2024 meta-analysis / Arch Endocrinol Metab 2019", "faixas": [ { "status": "green", "rotulo": "Green — no relevant hyperflow", "valor": "<30 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow — overlap zone", "valor": "30–69 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — marked hyperflow", "valor": "≥70 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "tireoide.c0", "grupo": "tireoide", "nome": "Calculator — EU-TIRADS (European alternative)", "nota": "High-risk signs (EU-TIRADS 5): markedly hypoechoic, irregular margins, taller-than-wide, microcalcifications. Always compare with ACR TI-RADS.", "fonte": "EU-TIRADS — Russ, Eur Thyroid J 2017 (ETA)", "colunas": [ "Category", "Risk", "FNA from" ], "linhas": [ { "status": "green", "celulas": [ "EU-TIRADS 2", "~0% (anechoic/spongiform)", "—" ] }, { "status": "green", "celulas": [ "EU-TIRADS 3", "2–4% (low risk)", "≥20 mm" ] }, { "status": "yellow", "celulas": [ "EU-TIRADS 4", "6–17% (intermediate)", "≥15 mm" ] }, { "status": "red", "celulas": [ "EU-TIRADS 5", "26–87% (high risk)", "≥10 mm" ] } ] }, { "id": "tireoide.c1", "grupo": "tireoide", "nome": "Calculator — Bethesda (thyroid cytology)", "nota": "Bethesda is cytology (FNA); US (ACR/EU-TIRADS) decides WHO to biopsy. Risks assume no NIFTP; molecular testing refines III and IV.", "fonte": "The Bethesda System, 3rd ed. 2023", "colunas": [ "Category", "Malignancy risk", "Usual management" ], "linhas": [ { "status": "yellow", "celulas": [ "I", "5–20% (nondiagnostic)", "Repeat US-guided FNA." ] }, { "status": "green", "celulas": [ "II", "0–3% (benign)", "Follow-up per sonographic risk." ] }, { "status": "yellow", "celulas": [ "III", "6–18% (AUS)", "Repeat FNA, molecular test or lobectomy." ] }, { "status": "yellow", "celulas": [ "IV", "10–40% (follicular neoplasm)", "Molecular test or diagnostic lobectomy." ] }, { "status": "red", "celulas": [ "V", "45–60% (suspicious)", "Surgery per extent." ] }, { "status": "red", "celulas": [ "VI", "94–99% (malignant)", "Surgery + staging." ] } ] }, { "id": "tireoide.c2", "grupo": "tireoide", "nome": "ACR TI-RADS 2017 — feature scoring", "nota": "Choose one option for composition, echogenicity, shape and margin. For echogenic foci, add all findings present; if none, use 0 points.", "fonte": "ACR TI-RADS white paper 2017 / ACR TI-RADS Atlas", "colunas": [ "Feature", "Finding", "Points", "Practical note" ], "linhas": [ { "status": null, "celulas": [ "Composition", "Cystic or almost completely cystic", "0", "Does not add suspicion points in ACR." ] }, { "status": null, "celulas": [ "Composition", "Spongiform", "0", "Multiple microcysts occupying more than 50% of the nodule." ] }, { "status": null, "celulas": [ "Composition", "Mixed cystic and solid", "1", "Score by the described predominant composition." ] }, { "status": null, "celulas": [ "Composition", "Solid or almost completely solid", "2", "Feature that increases the score but does not define the level alone." ] }, { "status": null, "celulas": [ "Echogenicity", "Anechoic", "0", "Applies to a cystic nodule." ] }, { "status": null, "celulas": [ "Echogenicity", "Isoechoic or hyperechoic", "1", "Compare with adjacent thyroid parenchyma." ] }, { "status": null, "celulas": [ "Echogenicity", "Hypoechoic", "2", "Darker than thyroid, but not darker than muscle." ] }, { "status": null, "celulas": [ "Echogenicity", "Very hypoechoic", "3", "Darker than the anterior neck musculature." ] }, { "status": null, "celulas": [ "Echogenicity", "Cannot be determined", "1", "ACR assigns 1 point when echogenicity cannot be determined." ] }, { "status": null, "celulas": [ "Shape", "Wider-than-tall", "0", "Assess on the transverse plane." ] }, { "status": null, "celulas": [ "Shape", "Taller-than-wide", "3", "Higher-suspicion sign in ACR TI-RADS." ] }, { "status": null, "celulas": [ "Margin", "Smooth", "0", "Regular margin." ] }, { "status": null, "celulas": [ "Margin", "Ill-defined", "0", "Not the same as irregular; does not score in ACR." ] }, { "status": null, "celulas": [ "Margin", "Lobulated or irregular", "2", "Scores as a suspicious margin." ] }, { "status": null, "celulas": [ "Margin", "Extrathyroidal extension", "3", "Frank invasion beyond the thyroid capsule." ] }, { "status": null, "celulas": [ "Margin", "Cannot be determined", "0", "Use when the margin cannot be assessed confidently." ] }, { "status": null, "celulas": [ "Echogenic foci", "None or large comet-tail artifact", "0", "Large colloid artifact is benign in the system." ] }, { "status": null, "celulas": [ "Echogenic foci", "Macrocalcifications", "1", "Larger calcified focus with posterior shadowing." ] }, { "status": null, "celulas": [ "Echogenic foci", "Peripheral rim calcifications", "2", "Score if present; may coexist with other foci." ] }, { "status": null, "celulas": [ "Echogenic foci", "Punctate echogenic foci", "3", "May represent microcalcifications; add with other foci present." ] } ] }, { "id": "tireoide.c3", "grupo": "tireoide", "nome": "ACR TI-RADS 2017 — thyroid nodule", "nota": "Add composition, echogenicity, shape, margin and echogenic foci. Management uses the nodule largest dimension.", "fonte": "ACR TI-RADS — JACR 2017", "colunas": [ "Level", "Points", "Risk", "FNA from", "Imaging follow-up" ], "linhas": [ { "status": null, "celulas": [ "TR1", "0", "0,3%", "—", "—" ] }, { "status": null, "celulas": [ "TR2", "1–2", "1,5%", "—", "—" ] }, { "status": null, "celulas": [ "TR3", "3", "4,8%", "≥ 2,5 cm", "≥ 1,5 cm: 1, 3 e 5 anos" ] }, { "status": null, "celulas": [ "TR4", "4–6", "9,1%", "≥ 1,5 cm", "≥ 1,0 cm: 1, 2, 3 e 5 anos" ] }, { "status": null, "celulas": [ "TR5", "≥ 7", "35%", "≥ 1,0 cm", "≥ 0,5 cm: anual por 5 anos" ] } ] }, { "id": "tireoide.c4", "grupo": "tireoide", "nome": "Thyroid Doppler — quick reading", "nota": "Doppler does not replace laboratory tests or scintigraphy when needed. Use this reading to guide description and clinical correlation.", "fonte": "Frontiers Endocrinol 2024 meta-analysis / Arch Endocrinol Metab 2019 / QJM 2025", "colunas": [ "Category", "Range / pattern", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Parenchyma", "Sparse to moderate symmetric vascularity", "Expected pattern when there is no diffuse hyperemia." ] }, { "status": "yellow", "celulas": [ "Parenchyma", "Mild/moderate, focal or asymmetric increase", "Overlap finding: correlate with grayscale, pain, TSH, free T4 and antibodies." ] }, { "status": "red", "celulas": [ "Parenchyma", "Marked diffuse hyperflow (“thyroid inferno”)", "Abnormal; in diffusely enlarged thyroid it favors Graves when laboratory tests agree." ] }, { "status": "green", "celulas": [ "Peak systolic velocity", "<30 cm/s", "Green range because it matches resting values in several series." ] }, { "status": "yellow", "celulas": [ "Peak systolic velocity", "30–69 cm/s", "Borderline zone: studies use 30 or 40 cm/s, but a recent meta-analysis points to a higher cutoff." ] }, { "status": "red", "celulas": [ "Peak systolic velocity", "≥70 cm/s", "Marked hyperflow; strengthens Graves hypothesis if the increase is diffuse." ] } ] }, { "id": "tireoide.c5", "grupo": "tireoide", "nome": "Chammas — nodule vascularization (Doppler)", "nota": "Nodule vascular Doppler is complementary: a European study showed vascularity does not improve overall ACR TI-RADS stratification. Chammas IV/V patterns are specific but poorly sensitive.", "fonte": "Chammas et al. / AEM-SBEM 2009 / Eur Thyroid J 2021", "colunas": [ "Pattern", "Description", "Color", "Practical note" ], "linhas": [ { "status": "green", "celulas": [ "I", "No flow", "Green", "Lower Doppler suspicion; still apply ACR TI-RADS by grayscale." ] }, { "status": "green", "celulas": [ "II", "Peripheral/perinodular only", "Green", "Relatively lower-suspicion pattern." ] }, { "status": "yellow", "celulas": [ "III", "Peripheral equal to or greater than central", "Yellow", "Intermediate finding; does not change management alone." ] }, { "status": "red", "celulas": [ "IV", "Central greater than peripheral", "Red", "Higher specificity for malignant cytology, but low sensitivity." ] }, { "status": "red", "celulas": [ "V", "Exclusively central", "Red", "Higher adjunct Doppler suspicion; does not replace cytology." ] } ] }, { "id": "tireoide.c6", "grupo": "tireoide", "nome": "Cervical lymph node — suspicious signs", "nota": null, "fonte": "Critérios sonográficos consagrados", "colunas": [ "Sign", "Suspicious finding" ], "linhas": [ { "status": null, "celulas": [ "Shape", "Rounded: long axis less than twice the short axis" ] }, { "status": null, "celulas": [ "Hilum", "Absent" ] }, { "status": null, "celulas": [ "Vascularity", "Peripheral/chaotic" ] }, { "status": null, "celulas": [ "Echotexture", "Microcalcifications, cystic, hyperechoic" ] } ] } ] }, { "metodo": "US", "chave": "doppler_venoso", "slug": "doppler-venoso", "url": "https://sonoaireport.com/en/referencias-ultrassom/doppler-venoso", "nome": "Venous Doppler and mapping — limbs, jugular and subclavian veins", "temPaginaPublica": true, "medidas": [ { "id": "doppler_venoso.0", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Lower limbs — thrombosis assessment", "valor": "serial compression", "unidade": null, "nota": "Document common femoral vein, saphenofemoral junction, proximal/mid/distal femoral vein, popliteal vein, posterior tibial and peroneal veins; add gastrocnemius, soleal and superficial veins when symptomatic.", "fonte": "ACR-AIUM-SPR-SRU 2026 / IAC Vascular Testing / CBR-SBACV-SP 2020", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "compressible, patent, phasic and without intraluminal material", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "incomplete or indeterminate", "valor": "segment not seen, limited calf or post-thrombotic change", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "consensus abnormal", "valor": "noncompressible vein, thrombus or absent flow after technical optimization", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.1", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Venous mapping for varicose veins — technique", "valor": "standing + standardized maneuvers", "unidade": null, "nota": "Assess reflux preferably standing. Use Valsalva at the common femoral vein and saphenofemoral junction; use distal compression/release for the other segments. Record position, maneuver and reflux time on spectral Doppler.", "fonte": "CBR-SBACV-SP 2020 / SVS-AVF-AVLS 2023 / ESVS 2022", "faixas": [ { "status": "green", "rotulo": "adequate technique", "valor": "standing or dependent position, documented maneuver", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "technical limitation", "valor": "not standing, pain, dressing, obesity or poor maneuver", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "do not interpret as complete mapping", "valor": "reflux assessed only supine without justification", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.2", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Great saphenous vein — minimum mapping points", "valor": "junction + thigh + calf", "unidade": null, "nota": "Document the saphenofemoral junction, anteroposterior great saphenous caliber in thigh and calf, reflux extent, source, drainage, tributaries, accessory saphenous veins and any subdermal or hypoplastic course.", "fonte": "CBR-SBACV-SP 2020 / CBR documentação mínima / SVS-AVF-AVLS 2023", "faixas": [ { "status": "green", "rotulo": "complete map", "valor": "calibers + reflux + source/drainage by segment", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "incomplete map", "valor": "no calibers, no source/drainage or no accessory-vein description", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "associated critical finding", "valor": "thrombosis, stump ascending to deep junction or suspected deep extension", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.3", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Small saphenous vein — minimum mapping points", "valor": "junction + knee distance + calf", "unidade": null, "nota": "The saphenopopliteal junction is variable; record distance to the knee joint line/crease, small saphenous caliber by segment, cranial extension, Giacomini vein and reflux drainage.", "fonte": "CBR-SBACV-SP 2020 / Caggiati nomenclature / ESVS 2022", "faixas": [ { "status": "green", "rotulo": "useful description", "valor": "junction, knee distance, caliber and cranial extension described", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "variable anatomy", "valor": "no typical junction, cranial extension/Giacomini or complex drainage", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "complication", "valor": "superficial thrombosis near deep junction or extension into deep system", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.4", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Saphenous vein mapping for graft", "valor": "caliber + continuity + compressibility", "unidade": null, "nota": "Describe by segment: diameter, compressibility, continuity, varicosities, thrombosis, bifurcations, superficial course and usable length. Acceptable caliber varies by service; as a teaching safety rule, less than 2 mm is red, 2-2.9 mm yellow and 3 mm or more green if wall and course are suitable.", "fonte": "CBR-SBACV-SP 2020 / vascular lab vein mapping protocols", "faixas": [ { "status": "green", "rotulo": "favorable", "valor": "≥3 mm, compressible, continuous and without varicosity/thrombosis", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "2-2.9 mm or short usable segment", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "unfavorable", "valor": "<2 mm, thrombosed, markedly varicose or discontinuous", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.5", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Superficial reflux — saphenous, accessory and tributary veins", "valor": "> 0,5", "unidade": "s", "nota": "Preferably assess standing or in dependent position, with standardized provocation and reflux time measured on spectral Doppler.", "fonte": "CBR-SBACV-SP 2020 / SVS-AVF-AVLS 2023 / CMS LCD", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "up to 0.5 s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/technical", "valor": "0.45-0.50 s or inadequate maneuver/position", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "pathologic reflux", "valor": "greater than 0.5 s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.6", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Deep reflux — femoropopliteal segment", "valor": "> 1,0", "unidade": "s", "nota": "For common femoral, femoral and popliteal veins, many consensus documents use greater than 1.0 s; other deep segments use greater than 0.5 s.", "fonte": "CBR-SBACV-SP 2020 / SVS-AVF / CMS LCD", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "up to 1.0 s in the femoropopliteal segment", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "0.8-1.0 s or inconsistent technique", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "deep reflux", "valor": "greater than 1.0 s in the femoropopliteal segment", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.7", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Perforator veins", "valor": "> 0,35–0,50", "unidade": "s", "nota": "There is divergence between 0.35 s and 0.50 s. Brazilian consensus accepts greater than 0.35 s; international treatment criteria often require greater than 0.5 s and diameter greater than 3.5 mm, especially beneath ulcerated or damaged skin.", "fonte": "CBR-SBACV-SP 2020 / SVS-AVF / CMS LCD", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "less than 0.35 s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "guideline divergence", "valor": "0.35-0.50 s or without diameter/context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "more accepted abnormal", "valor": "greater than 0.50 s with diameter above 3.5 mm or related skin/ulcer change", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.8", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Upper limbs, jugular and subclavian veins", "valor": "compression when possible + Doppler", "unidade": null, "nota": "Internal jugular, axillary, brachial, basilic and cephalic veins should be compressed when possible; the subclavian vein is partly limited by the clavicle and relies more on color, spectral waveform, phasicity and contralateral comparison.", "fonte": "SVU 2019 / ACR Appropriateness Criteria 2020 / AVF 2026", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "compressible where possible, spontaneous, phasic and symmetric flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "anatomic limitation", "valor": "subclavian vein not fully compressible but normal Doppler", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "obstruction/thrombosis", "valor": "noncompressible, absent filling, collaterals or asymmetric continuous waveform", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "doppler_venoso.9", "grupo": "doppler_venoso", "ruleId": null, "rotulo": "Superficial venous thrombosis", "valor": "noncompressibility + thrombus", "unidade": null, "nota": "Describe extent, distance from the deep junction, involved vein and inflammatory signs. Proximity to the saphenofemoral/saphenopopliteal junction or extension into the deep system increases severity.", "fonte": "ACR-AIUM-SPR-SRU / CBR-SBACV-SP", "faixas": [ { "status": "green", "rotulo": "absent", "valor": "compressible and patent superficial vein", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "localized superficial", "valor": "superficial thrombus away from deep system", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high risk", "valor": "near deep junction, extensive, ascending or with associated deep thrombosis", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "doppler_venoso.c0", "grupo": "doppler_venoso", "nome": "Interactive assistant — thrombosis, reflux and venous obstruction", "nota": "The calculator does not replace clinical probability, D-dimer, serial follow-up or venography/CT/MR venography when central suspicion remains high.", "fonte": "SRU 2018 / ACR-AIUM-SPR-SRU / IAC / AVF 2026", "colunas": [ "Output", "Color", "Practical use" ], "linhas": [ { "status": "green", "celulas": [ "Patent/normal", "Green", "Preserved compressibility, phasic/symmetric flow and reflux below accepted cutoffs." ] }, { "status": "yellow", "celulas": [ "Indeterminate, limited or post-thrombotic", "Yellow", "Use when there is technical limitation, anatomically noncompressible subclavian vein, borderline reflux or post-thrombotic scarring." ] }, { "status": "red", "celulas": [ "Thrombosis, obstruction or pathologic reflux", "Red", "Noncompressible vein, thrombus, absent flow, central collaterals, asymmetric continuous waveform or reflux clearly above cutoffs." ] } ] }, { "id": "doppler_venoso.c1", "grupo": "doppler_venoso", "nome": "Varicose-vein mapping — technical checklist", "nota": "The map should be anatomic and functional: where reflux starts, where it travels, where it drains and which segments are treatable.", "fonte": "CBR-SBACV-SP 2020 / SVS-AVF-AVLS 2023 / ESVS 2022", "colunas": [ "Step", "What to document", "Teaching color" ], "linhas": [ { "status": "green", "celulas": [ "Deep system first", "Compressibility, patency, phasicity and deep reflux when the study is for venous insufficiency.", "Green if complete and normal" ] }, { "status": "green", "celulas": [ "Great saphenous vein", "Saphenofemoral junction, thigh and calf caliber, terminal/preterminal/segmental reflux, source and drainage.", "Green if no reflux and well documented" ] }, { "status": "yellow", "celulas": [ "Small saphenous vein", "Saphenopopliteal junction, distance to knee, caliber, cranial extension, Giacomini vein and drainage.", "Yellow when anatomy is variable" ] }, { "status": "yellow", "celulas": [ "Tributaries and accessory veins", "Map the source and drainage of reflux; do not call every channel saphenous without identifying the involved trunk.", "Yellow if topography is missing" ] }, { "status": "yellow", "celulas": [ "Perforator veins", "Site, distance from knee or sole, diameter, reflux and relationship to skin/ulcer.", "Yellow/red according to reflux and diameter" ] }, { "status": "red", "celulas": [ "Thrombosis or deep extension", "Noncompressible vein, saphenous thrombus near deep junction, extension into the deep system or phlegmasia.", "Red" ] } ] }, { "id": "doppler_venoso.c2", "grupo": "doppler_venoso", "nome": "Saphenous veins — reflux patterns for reporting", "nota": null, "fonte": "CBR-SBACV-SP 2020 / Caggiati nomenclature / local report corpus", "colunas": [ "Pattern", "How to recognize", "How to report" ], "linhas": [ { "status": "red", "celulas": [ "Terminal reflux", "Incompetent terminal valve/junction with reflux entering the saphenous trunk.", "State junction, cranio-caudal extent and drainage into tributaries/perforators." ] }, { "status": "yellow", "celulas": [ "Preterminal reflux", "Competent terminal valve, but reflux below the junction through tributary, accessory vein or perforator.", "Differentiate from junction incompetence to avoid overtreatment." ] }, { "status": "yellow", "celulas": [ "Segmental reflux", "Limited saphenous segment with reflux and normal segments above/below.", "Describe start, end and connections." ] }, { "status": "yellow", "celulas": [ "Tributary or accessory-vein reflux", "The saphenous trunk may be competent, but reflux is present in an anterior/posterior accessory or tributary vein.", "Name the vein and its relationship to the saphenous compartment." ] }, { "status": "yellow", "celulas": [ "Giacomini vein or cranial extension of the small saphenous", "Connection of the small saphenous vein with thigh veins/great saphenous vein.", "Record course and drainage direction." ] }, { "status": "yellow", "celulas": [ "Post-surgical or recurrent varices", "Stump, neovascularization, residual saphenous vein, incompetent accessory vein or incompetent perforator.", "Report recurrence source instead of only “varices”." ] } ] }, { "id": "doppler_venoso.c3", "grupo": "doppler_venoso", "nome": "Perforators — color reading", "nota": "Brazilian consensus accepts greater than 0.35 s as perforator reflux; international treatment criteria more often use reflux greater than 0.5 s plus diameter greater than 3.5 mm.", "fonte": "CBR-SBACV-SP 2020 / SVS-AVF-AVLS 2023 / ESVS 2022 / CMS LCD", "colunas": [ "Color", "Criterion", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Green", "No reflux or reflux less than 0.35 s.", "Do not call it an incompetent perforator by diameter alone." ] }, { "status": "yellow", "celulas": [ "Yellow", "Reflux 0.35-0.50 s, isolated diameter greater than 3.5 mm or incomplete topography.", "Divergence zone: document and correlate with skin, ulcer and varices." ] }, { "status": "red", "celulas": [ "Red", "Reflux greater than 0.50 s with diameter greater than 3.5 mm, especially beneath skin change or ulcer.", "More accepted criterion for pathologic/treatable perforator." ] } ] }, { "id": "doppler_venoso.c4", "grupo": "doppler_venoso", "nome": "Saphenous graft mapping — practical table", "nota": null, "fonte": "vascular lab vein mapping protocols / CBR-SBACV-SP 2020", "colunas": [ "Color", "Finding", "Report action" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Continuous, compressible saphenous vein without thrombosis/marked varicosity and generally 3 mm or larger.", "Report usable length and segmental calibers." ] }, { "status": "yellow", "celulas": [ "Yellow", "Caliber 2-2.9 mm, bifurcations, short segment, superficial course or irregular wall.", "Describe limitations without universally rejecting; decision is surgical." ] }, { "status": "red", "celulas": [ "Red", "Caliber less than 2 mm, thrombosis, marked varicosity, discontinuity or post-ablation.", "Flag as unfavorable and look for an alternative if requested." ] } ] }, { "id": "doppler_venoso.c5", "grupo": "doppler_venoso", "nome": "Venous thrombosis assessment — color reading", "nota": null, "fonte": "SRU 2018 / ACR-AIUM-SPR-SRU / IAC", "colunas": [ "Color", "Finding", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Compressible vein, no intraluminal material, color flow and phasic waveform.", "Normal in the assessed segment if the study was complete." ] }, { "status": "yellow", "celulas": [ "Yellow", "Equivocal partial compression, unseen segment, limited calf or chronic wall-adherent change.", "Report limitation and consider serial follow-up or complementary imaging according to clinical risk." ] }, { "status": "red", "celulas": [ "Red", "Noncompressible vein, intraluminal material, absent filling, free-floating thrombus or proximal extension.", "Compatible with thrombosis/occlusion until proven otherwise; communicate according to local protocol." ] } ] }, { "id": "doppler_venoso.c6", "grupo": "doppler_venoso", "nome": "Venous reflux — teaching cutoffs by segment", "nota": "Always record patient position, maneuver and reflux source/drainage. Reversed flow from proximal obstruction should not be called valvular reflux.", "fonte": "CBR-SBACV-SP 2020 / SVS-AVF / ESVS 2022 / CMS LCD", "colunas": [ "Segment", "Green", "Yellow", "Red" ], "linhas": [ { "status": "red", "celulas": [ "Saphenous, accessory and tributary veins", "up to 0.5 s", "0.45-0.50 s or poor technique", "greater than 0.5 s" ] }, { "status": "red", "celulas": [ "Common femoral, femoral and popliteal veins", "up to 1.0 s", "0.8-1.0 s or inadequate maneuver", "greater than 1.0 s" ] }, { "status": "yellow", "celulas": [ "Perforator veins", "less than 0.35 s", "0.35-0.50 s or no clinical context", "greater than 0.50 s, especially if diameter greater than 3.5 mm" ] }, { "status": "yellow", "celulas": [ "Deep veins below the knee", "up to 0.5 s in many references", "technique-dependent", "greater than 0.5 s when reproducible" ] } ] }, { "id": "doppler_venoso.c7", "grupo": "doppler_venoso", "nome": "Jugular, subclavian and suspected central obstruction", "nota": null, "fonte": "ACR Appropriateness Criteria 2020 / SVU 2019 / AVF 2026", "colunas": [ "Site", "Practical assessment", "Warning sign" ], "linhas": [ { "status": "green", "celulas": [ "Internal jugular vein", "Direct compression, color and spectral Doppler.", "Noncompressibility or thrombus." ] }, { "status": "yellow", "celulas": [ "Subclavian vein", "Compression limited by clavicle; use color filling, phasicity, pulsatility and comparison with the opposite side.", "Asymmetric continuous/monophasic waveform, little respiratory variation or collaterals." ] }, { "status": "red", "celulas": [ "Brachiocephalic veins and superior vena cava", "Usually indirect assessment; consider CT, MRI or venography if suspicion remains high.", "Face/arm edema, chest-wall collaterals, catheter or pacemaker with abnormal central waveform." ] } ] }, { "id": "doppler_venoso.c8", "grupo": "doppler_venoso", "nome": "CEAP clinical classification — chronic venous disease", "nota": "CEAP is a clinical classification; color here is educational and does not replace the complete clinical category with etiology, anatomy and pathophysiology.", "fonte": "AVF CEAP 2020 / ESVS 2022", "colunas": [ "Class", "Clinical finding", "Teaching color" ], "linhas": [ { "status": "green", "celulas": [ "C0", "No visible or palpable signs", "Green" ] }, { "status": "yellow", "celulas": [ "C1", "Telangiectasias or reticular veins", "Yellow if symptomatic" ] }, { "status": "yellow", "celulas": [ "C2", "Varicose veins", "Yellow" ] }, { "status": "yellow", "celulas": [ "C3", "Venous edema", "Yellow" ] }, { "status": "red", "celulas": [ "C4", "Skin changes from venous disease", "Red" ] }, { "status": "red", "celulas": [ "C5", "Healed venous ulcer", "Red" ] }, { "status": "red", "celulas": [ "C6", "Active venous ulcer", "Red" ] } ] }, { "id": "doppler_venoso.c9", "grupo": "doppler_venoso", "nome": "Useful differentials when it is not thrombosis", "nota": null, "fonte": "SRU 2018 / ACR-AIUM-SPR-SRU / CBR-SBACV-SP", "colunas": [ "Scenario", "Possibilities", "Ultrasound clue" ], "linhas": [ { "status": "yellow", "celulas": [ "Calf pain and swelling", "Ruptured popliteal cyst, muscle injury, hematoma, cellulitis, lymphedema.", "Compressible veins and explanatory extravascular finding." ] }, { "status": "yellow", "celulas": [ "Bilateral edema", "Cardiac, renal, hepatic, medication-related or lymphatic cause.", "Patent venous flow; assess symmetry and systemic context." ] }, { "status": "red", "celulas": [ "Arm/face edema or chest-wall collaterals", "Central venous obstruction from catheter, pacemaker, mass or central thrombosis.", "Asymmetric continuous waveform, loss of phasicity or collaterals." ] }, { "status": "red", "celulas": [ "Severe pain with very swollen limb", "Extensive thrombosis, phlegmasia, compartment syndrome or severe infection.", "Urgent communication even before completing broad mapping." ] } ] } ] }, { "metodo": "US", "chave": "aorta_iliacas", "slug": "aorta-iliacas", "url": "https://sonoaireport.com/en/referencias-ultrassom/aorta-iliacas", "nome": "Aorta and iliac vessels — arteries and veins", "temPaginaPublica": true, "medidas": [ { "id": "aorta_iliacas.0", "grupo": "aorta_iliacas", "ruleId": null, "rotulo": "Abdominal aorta — maximum outer-to-outer diameter", "valor": "< 3,0", "unidade": "cm", "nota": "Measure perpendicular to the vessel axis at the largest diameter. Aneurysm starts at 3.0 cm; ectasia 2.5-2.9 cm is a yellow zone.", "fonte": "ACC/AHA 2022 / SVS / USPSTF / ESVS 2024", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "<2,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "ectasia", "valor": "2,5–2,9 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "aneurysm", "valor": "≥3,0 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "aorta_iliacas.1", "grupo": "aorta_iliacas", "ruleId": null, "rotulo": "Abdominal aortic aneurysm — usual repair threshold", "valor": "men ≥5.5; women ≥5.0", "unidade": "cm", "nota": "Also consider vascular evaluation if symptomatic, saccular/pseudoaneurysm, rupture signs or rapid growth.", "fonte": "ACC/AHA 2022 / SVS / ESVS 2024", "faixas": [ { "status": "yellow", "rotulo": "surveillance", "valor": "3,0–4,9 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "near threshold", "valor": "5,0–5,4 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "repair threshold", "valor": "≥5.5 cm men; ≥5.0 cm women", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "aorta_iliacas.2", "grupo": "aorta_iliacas", "ruleId": null, "rotulo": "Common iliac artery — diameter", "valor": "< 1.5-1.7", "unidade": "cm", "nota": "There is divergence: ectasia may be defined from 1.5 cm in women or 1.7 cm in men; many services treat ≥2.0 cm as small aneurysm and ≥3.5 cm as a strong repair threshold.", "fonte": "ACC/AHA 2022 / ESVS 2024 / JVS isolated common iliac aneurysm", "faixas": [ { "status": "green", "rotulo": "more consensual normal", "valor": "<1,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "ectasia/divergent", "valor": "1,5–1,9 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "iliac aneurysm", "valor": "≥2,0–2,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "discuss repair", "valor": "≥3,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "aorta_iliacas.3", "grupo": "aorta_iliacas", "ruleId": null, "rotulo": "Aortoiliac arterial stenosis — velocity ratio", "valor": "≥ 2,0", "unidade": null, "nota": "Ratio between jet velocity and normal proximal segment; use angle below 60 degrees and correlate with aliasing, narrowing and distal waveform.", "fonte": "ACR-AIUM-SRU arterial Doppler / Society for Vascular Medicine / vascular lab criteria", "faixas": [ { "status": "green", "rotulo": "no hemodynamic stenosis", "valor": "<1,5", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "mild/technical zone", "valor": "1,5–1,99", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "stenosis ≥50%", "valor": "≥2,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "severe", "valor": ">4,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "aorta_iliacas.4", "grupo": "aorta_iliacas", "ruleId": null, "rotulo": "Iliac/caval venous obstruction — velocity ratio", "valor": "> 2,5", "unidade": null, "nota": "Useful but not absolute criterion: integrate with loss of common femoral phasicity, collaterals, extrinsic compression, thrombus, stent and symptoms.", "fonte": "JVS Venous 2016 / ESVS 2022 / Labropoulos", "faixas": [ { "status": "green", "rotulo": "likely normal", "valor": "<2,0 + onda fásica", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "suspicious/borderline", "valor": "2,0–2,5 ou onda pouco fásica", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "significant obstruction", "valor": ">2,5 ou colaterais/no flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "aorta_iliacas.5", "grupo": "aorta_iliacas", "ruleId": null, "rotulo": "Post-aortic endograft — aneurysm sac", "valor": "stable or shrinking", "unidade": null, "nota": "Sac growth, endoleak, migration, kinking, limb thrombosis or absent iliac limb flow are warning signs.", "fonte": "SVU aortoiliac duplex / ACC-AHA 2022 / SVS", "faixas": [ { "status": "green", "rotulo": "stable", "valor": "sac stable/shrinking, no endoleak", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "type II endoleak without growth", "valor": "follow per local protocol", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "complication", "valor": "type I/III, growth ≥5 mm, thrombosis/occlusion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "aorta_iliacas.c0", "grupo": "aorta_iliacas", "nome": "Interactive assistant — aorta, iliac arteries and iliac/caval veins", "nota": "The assistant classifies ultrasound risk and documentation quality; final management depends on symptoms, sex, growth, anatomy, operative risk and local vascular protocol.", "fonte": "ACC/AHA 2022 / SVS / ESVS 2024 / SVU / IAC / JVS Venous", "colunas": [ "Output", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Normal/preserved patency", "Green", "Aorta <2.5 cm, iliacs without relevant ectasia, arterial ratio <1.5, multiphasic arterial waveform and phasic/symmetric venous waveform." ] }, { "status": "yellow", "celulas": [ "Borderline, technical or divergent", "Yellow", "Aorta 2.5-2.9 cm, iliac 1.5-1.9 cm, poor window, venous ratio 2.0-2.5, mildly damped venous waveform or stable post-repair minor finding." ] }, { "status": "red", "celulas": [ "Aneurysm, stenosis, occlusion or obstruction", "Red", "Aorta ≥3.0 cm, iliac ≥2.0-2.5 cm, arterial ratio ≥2.0, no flow, venous ratio >2.5, collaterals, symptoms or endograft complication." ] } ] }, { "id": "aorta_iliacas.c1", "grupo": "aorta_iliacas", "nome": "Abdominal aorta — screening and follow-up", "nota": null, "fonte": "SVS / ACC-AHA 2022 / USPSTF / ESVS 2024", "colunas": [ "Maximum diameter", "Color", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "<2,5 cm", "Green", "Normal in most adults; if screening was requested, record maximum measurement and visualized segment." ] }, { "status": "yellow", "celulas": [ "2,5–2,9 cm", "Yellow", "Ectasia: below classic aneurysm criterion but should be described; SVS suggests late rescreening when initial screening is >2.5 and <3.0 cm." ] }, { "status": "red", "celulas": [ "3,0–3,9 cm", "Red", "Small aneurysm; imaging surveillance is usually long-interval, for example 3 years in SVS." ] }, { "status": "red", "celulas": [ "4,0–4,9 cm", "Red", "Moderate aneurysm; closer surveillance, often yearly." ] }, { "status": "red", "celulas": [ "5,0–5,4 cm", "Red", "Large or near-threshold aneurysm; usually 6-month surveillance and vascular evaluation." ] }, { "status": "red", "celulas": [ "≥5.5 cm men or ≥5.0 cm women", "Red", "Usual repair threshold in current guidelines if anatomy and risk allow." ] } ] }, { "id": "aorta_iliacas.c2", "grupo": "aorta_iliacas", "nome": "Iliac arteries — diameter and aneurysm", "nota": null, "fonte": "ACC/AHA 2022 / ESVS 2024 / JVS / Radiopaedia", "colunas": [ "Common iliac diameter", "Color", "Comment" ], "linhas": [ { "status": "green", "celulas": [ "<1,5 cm", "Green", "More consensual normality for teaching use." ] }, { "status": "yellow", "celulas": [ "1,5–1,9 cm", "Yellow", "Ectasia or divergent zone: some cutoffs vary by sex and body size." ] }, { "status": "yellow", "celulas": [ "2,0–2,4 cm", "Yellow", "Many studies call this small aneurysm; rupture risk is low, but documentation and comparison matter." ] }, { "status": "red", "celulas": [ "2,5–3,4 cm", "Red", "Established iliac aneurysm in radiology/vascular references; assess growth, bilaterality and associated aorta." ] }, { "status": "red", "celulas": [ "≥3,5 cm", "Red", "Strong threshold for repair discussion in ACC/AHA and ESVS, especially with concomitant aortic aneurysm." ] } ] }, { "id": "aorta_iliacas.c3", "grupo": "aorta_iliacas", "nome": "Aortoiliac arterial stenosis — Doppler", "nota": null, "fonte": "ACR-AIUM-SRU arterial Doppler / Society for Vascular Medicine / SVU", "colunas": [ "Finding", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Velocity ratio <1.5 and multiphasic waveform", "Green", "No hemodynamically relevant stenosis in the assessed segment." ] }, { "status": "yellow", "celulas": [ "Ratio 1.5-1.99 or isolated jet without good reference", "Yellow", "Mild/technical zone: check angle, tortuosity, calcification and normal proximal segment." ] }, { "status": "red", "celulas": [ "Ratio ≥2.0, focal aliasing or damped distal waveform", "Red", "Compatible with hemodynamically significant stenosis, often ≥50%." ] }, { "status": "red", "celulas": [ "Ratio >4.0 or no flow", "Red", "Severe stenosis/occlusion; document extent, distal reconstitution and collaterals." ] } ] }, { "id": "aorta_iliacas.c4", "grupo": "aorta_iliacas", "nome": "Iliac veins and inferior vena cava — obstruction", "nota": "May-Thurner/left common iliac vein compression may be underestimated on transabdominal ultrasound; do not exclude it if clinical suspicion is high.", "fonte": "JVS Venous 2016 / ESVS 2022 / ACR venous guidance / Labropoulos", "colunas": [ "Finding", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Phasic/symmetric common femoral waveform and patent cava/iliac veins", "Green", "Likely normal when the window is adequate and there are no collaterals." ] }, { "status": "yellow", "celulas": [ "Reduced phasicity, ratio 2.0-2.5 or unseen segment", "Yellow", "Suspicion/limitation: ultrasound may be indirect; integrate with unilateral edema, advanced CEAP and thrombosis history." ] }, { "status": "red", "celulas": [ "Venous ratio >2.5, collaterals, thrombus, absent flow or occluded stent", "Red", "Suggests significant iliocaval obstruction; consider CT venography, MR venography, venography or intravascular ultrasound depending on scenario." ] } ] }, { "id": "aorta_iliacas.c5", "grupo": "aorta_iliacas", "nome": "Post aortic/iliac repair — critical points", "nota": null, "fonte": "SVU aortoiliac duplex / ACC-AHA 2022 / SVS", "colunas": [ "Scenario", "Color", "What to document" ], "linhas": [ { "status": "green", "celulas": [ "Sac stable or shrinking, no endoleak", "Green", "Maximum sac diameter, iliac limb patency and velocities without focal jet." ] }, { "status": "yellow", "celulas": [ "Type II endoleak without sac growth", "Yellow", "Probable location, sac flow and comparison with prior examinations; follow local protocol." ] }, { "status": "red", "celulas": [ "Type I/III endoleak, growth ≥5 mm, limb no-flow or migration", "Red", "Communicate as potentially relevant complication and suggest correlation with CT angiography/vascular service." ] } ] } ] }, { "metodo": "US", "chave": "doppler_vascular", "slug": "doppler-vascular", "url": "https://sonoaireport.com/en/referencias-ultrassom/doppler-vascular", "nome": "Vascular Doppler", "temPaginaPublica": true, "medidas": [ { "id": "doppler_vascular.0", "grupo": "doppler_vascular", "ruleId": null, "rotulo": "Venous reflux — pathologic duration", "valor": "> 0,5", "unidade": "s", "nota": "superficial and deep (femoropopliteal may use > 1 s)", "fonte": "Consenso venoso / StatPearls", "faixas": [] }, { "id": "doppler_vascular.1", "grupo": "doppler_vascular", "ruleId": null, "rotulo": "DVT — main criterion", "valor": "—", "unidade": null, "nota": "non-compressible vein (+ absent flow/filling)", "fonte": "StatPearls", "faixas": [] } ], "classificacoes": [ { "id": "doppler_vascular.c0", "grupo": "doppler_vascular", "nome": "Internal carotid stenosis — SRU 2003", "nota": "IAC 2023 update raised the 50% threshold to PSV > 180 cm/s and added a distinct Normal category — check your lab's adopted standard.", "fonte": "SRU Consensus 2003 (Radiology) / Radiopaedia", "colunas": [ "Grade", "PSV (cm/s)", "EDV (cm/s)", "ICA/CCA ratio" ], "linhas": [ { "status": null, "celulas": [ "Normal", "< 125", "< 40", "< 2,0" ] }, { "status": null, "celulas": [ "< 50%", "< 125", "< 40", "< 2,0" ] }, { "status": null, "celulas": [ "50–69%", "125–230", "40–100", "2,0–4,0" ] }, { "status": null, "celulas": [ "≥ 70%", "> 230", "> 100", "> 4,0" ] }, { "status": null, "celulas": [ "Near occlusion", "variable", "—", "—" ] }, { "status": null, "celulas": [ "Occlusion", "no flow", "—", "—" ] } ] }, { "id": "doppler_vascular.c1", "grupo": "doppler_vascular", "nome": "CEAP — clinical classification (venous)", "nota": null, "fonte": "CEAP (StatPearls)", "colunas": [ "Class", "Clinical finding" ], "linhas": [ { "status": null, "celulas": [ "C0", "No visible/palpable signs" ] }, { "status": null, "celulas": [ "C1", "Telangiectasias / reticular veins" ] }, { "status": null, "celulas": [ "C2", "Varicose veins" ] }, { "status": null, "celulas": [ "C3", "Edema" ] }, { "status": null, "celulas": [ "C4", "Skin changes (pigmentation, eczema, lipodermatosclerosis)" ] }, { "status": null, "celulas": [ "C5", "Healed ulcer" ] }, { "status": null, "celulas": [ "C6", "Active ulcer" ] } ] } ] }, { "metodo": "US", "chave": "mama", "slug": "mama", "url": "https://sonoaireport.com/en/referencias-ultrassom/mama", "nome": "Breast", "temPaginaPublica": true, "medidas": [ { "id": "mama.0", "grupo": "mama", "ruleId": null, "rotulo": "Minimum exam coverage", "valor": "breasts and axillae when indicated", "unidade": null, "nota": "In Brazil, CBR/SBM/FEBRASGO recommend axillary extension when there is a nodule or suspicious lesion; billing/coding may be separate.", "fonte": "CBR/SBM/FEBRASGO 2018/2021 / ACR BI-RADS", "faixas": [ { "status": "green", "rotulo": "complete", "valor": "breasts documented and axilla evaluated when indicated", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "acceptable focused exam", "valor": "focused request with clinical area clearly documented", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "incomplete", "valor": "laterality, symptomatic area or indicated axilla not documented", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "mama.1", "grupo": "mama", "ruleId": null, "rotulo": "Location of a focal finding", "valor": "laterality + clock-face position + distance from nipple", "unidade": null, "nota": "For learners, prefer full wording: right breast, 10 o’clock, 35 mm from the nipple.", "fonte": "ACR whole-breast ultrasound parameter / RANZCR SBIR 2023", "faixas": [ { "status": "green", "rotulo": "well localized", "valor": "laterality, clock-face and distance", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "acceptable in screening", "valor": "quadrant/region when there is no focal lesion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "ambiguous", "valor": "no laterality or no relation to palpable area", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "mama.2", "grupo": "mama", "ruleId": null, "rotulo": "Mass measurements", "valor": "3 dimensions in 2 orthogonal planes", "unidade": null, "nota": "Record the largest axis and the plane used; millimetres improve consistency in structured reporting.", "fonte": "ACR whole-breast ultrasound parameter / RANZCR SBIR 2023", "faixas": [ { "status": "green", "rotulo": "ideal", "valor": "three measurements and two planes", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "partial", "valor": "two measurements when the third is not obtained", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "insufficient", "valor": "no measurement or no plane/location", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "mama.3", "grupo": "mama", "ruleId": null, "rotulo": "Background echotexture", "valor": "fatty, fibroglandular or heterogeneous", "unidade": null, "nota": "Affects lesion conspicuity and should be reported in screening/supplemental ultrasound.", "fonte": "ACR whole-breast ultrasound parameter", "faixas": [ { "status": "green", "rotulo": "described", "valor": "composition/echotexture documented", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual", "valor": "omitted in a simple focused exam", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "limits interpretation", "valor": "supplemental screening without echotexture", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "mama.c0", "grupo": "mama", "nome": "Quick assistant — ultrasound BI-RADS", "nota": "Use the assistant as a descriptor checklist. The final category should reflect the most suspicious finding and clinical-imaging concordance.", "fonte": "ACR BI-RADS v2025 / RANZCR SBIR 2023 / StatPearls", "colunas": [ "Output", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "BI-RADS 1–2", "Green", "Consensus normality/benignity when there is no clinical discordance." ] }, { "status": "yellow", "celulas": [ "BI-RADS 0 ou 3", "Yellow", "Incomplete assessment, probable benignity or a zone where guidelines may vary." ] }, { "status": "red", "celulas": [ "BI-RADS 4A–4C, 5 ou 6", "Red", "Suspicious, highly suspicious or biopsy-proven malignancy; usually requires tissue diagnosis or oncology pathway." ] } ] }, { "id": "mama.c1", "grupo": "mama", "nome": "ACR BI-RADS — detailed categories for ultrasound", "nota": "Category 3 should not be used for “doubt”. If there is relevant diagnostic uncertainty, clinical discordance or a suspicious finding, consider category 0 or 4 depending on the scenario.", "fonte": "ACR BI-RADS v2025 / RANZCR SBIR 2023 / StatPearls", "colunas": [ "Category", "Color", "Meaning / management", "Risk" ], "linhas": [ { "status": "yellow", "celulas": [ "0", "Yellow", "Incomplete: needs additional imaging, comparison or diagnostic evaluation.", "—" ] }, { "status": "green", "celulas": [ "1", "Green", "Negative: routine pathway according to age, risk and local policy.", "no suspicious finding" ] }, { "status": "green", "celulas": [ "2", "Green", "Benign: simple cyst, typical intramammary node, stable post-operative finding or equivalent.", "essentially benign" ] }, { "status": "yellow", "celulas": [ "3", "Yellow", "Probably benign: short-interval follow-up, often 6 months, if clinical and imaging findings agree.", "< 2%" ] }, { "status": "red", "celulas": [ "4A", "Red", "Low suspicion: tissue diagnosis is generally indicated.", "> 2–10%" ] }, { "status": "red", "celulas": [ "4B", "Red", "Moderate suspicion: tissue diagnosis is indicated.", "> 10–50%" ] }, { "status": "red", "celulas": [ "4C", "Red", "High suspicion, but not yet classic for category 5.", "> 50–< 95%" ] }, { "status": "red", "celulas": [ "5", "Red", "Highly suggestive of malignancy: biopsy and oncology planning.", "> 95%" ] }, { "status": "red", "celulas": [ "6", "Red", "Biopsy-proven malignancy before definitive treatment.", "confirmed" ] } ] }, { "id": "mama.c2", "grupo": "mama", "nome": "Ultrasound BI-RADS lexicon — mass descriptors", "nota": "The row color reflects the worst listed finding; combine descriptors, comparison with prior exams and indication.", "fonte": "ACR BI-RADS v2025 ultrasound lexicon / Radiology Assistant summary / RANZCR SBIR", "colunas": [ "Descriptor", "Green", "Yellow", "Red" ], "linhas": [ { "status": "yellow", "celulas": [ "Shape", "oval or round if other findings are benign", "isolated round shape or incomplete context", "irregular" ] }, { "status": "yellow", "celulas": [ "Orientation", "parallel to skin", "not described or difficult to assess", "not parallel, taller than wide" ] }, { "status": "red", "celulas": [ "Margin", "circumscribed", "indistinct in a possibly benign context", "angular, microlobulated or spiculated" ] }, { "status": "yellow", "celulas": [ "Echo pattern", "anechoic typical of a simple cyst", "isolated hypoechoic or heterogeneous", "complex cystic-solid or suspicious solid" ] }, { "status": "yellow", "celulas": [ "Posterior feature", "posterior enhancement in a simple cyst", "isolated shadowing may occur in benign findings", "shadowing with suspicious margin/shape" ] }, { "status": "red", "celulas": [ "Echogenic foci and calcifications", "clearly benign macrocalcification", "best correlated with mammography", "foci within the mass or correlated suspicious calcifications" ] }, { "status": "red", "celulas": [ "Associated findings", "absent", "explainable postoperative/inflammatory changes", "distortion, skin/nipple retraction, edema or abnormal axillary node" ] }, { "status": "yellow", "celulas": [ "Elasticity", "soft as an adjunct finding", "intermediate or heterogeneous", "stiff as an adjunct finding; does not replace B-mode" ] } ] }, { "id": "mama.c3", "grupo": "mama", "nome": "Technical protocol — breast and axilla", "nota": null, "fonte": "ACR whole-breast ultrasound parameter / CBR-SBM-FEBRASGO / RANZCR SBIR", "colunas": [ "Situation", "What to document", "Color" ], "linhas": [ { "status": "green", "celulas": [ "Screening or complete bilateral exam", "Quadrants, retroareolar region, composition/echotexture and axillae when indicated.", "Green if complete" ] }, { "status": "yellow", "celulas": [ "Focused exam", "Document the exact complaint, laterality, position and relation to the palpable finding.", "Yellow if justified" ] }, { "status": "red", "celulas": [ "Focal finding", "Two orthogonal projections, three measurements, laterality, clock-face position, distance from nipple and transducer orientation.", "Red if incomplete in a suspicious lesion" ] }, { "status": "yellow", "celulas": [ "Palpable mass with negative imaging", "Apply clinical concordance: lack of imaging finding does not exclude biopsy if clinical concern is suspicious.", "Yellow/red by clinical concern" ] }, { "status": "red", "celulas": [ "Abnormal axillary node", "Treat as a significant lesion: side, level/region, morphology, cortex, hilum, vascularity and associated breast lesion if present.", "Red if suspicious" ] } ] }, { "id": "mama.c4", "grupo": "mama", "nome": "International and regional standards", "nota": null, "fonte": "ACR BI-RADS v2025 / CBR-SBM-FEBRASGO / EUSOBI-ESR / RANZCR SBIR / ACR Appropriateness Criteria", "colunas": [ "Region", "Practical standard", "App application" ], "linhas": [ { "status": "green", "celulas": [ "Global / ACR", "BI-RADS v2025 standardizes terminology, structure, categories and recommendations for mammography, ultrasound, MRI and contrast-enhanced mammography.", "Use BI-RADS as the common core." ] }, { "status": "yellow", "celulas": [ "Brazil", "Ultrasound is complementary to mammography after age 40 when indicated; before age 30 it is commonly the initial exam for a clinical abnormality. Axillae may require separate request/coding.", "Show regional note and avoid omitting indicated axilla." ] }, { "status": "yellow", "celulas": [ "Europe / EUSOBI-ESR", "Uses BI-RADS as common language; screening may be adjusted by density and risk, with specific recommendations for extremely dense breasts.", "Keep BI-RADS category separate from local screening policy." ] }, { "status": "yellow", "celulas": [ "Australia and New Zealand / RANZCR", "BI-RADS-based synoptic report, lesion by lesion, with clinical correlation and management recommendation.", "Emphasize laterality, distance from nipple, three measurements and clinical concordance." ] }, { "status": "yellow", "celulas": [ "Other represented countries", "When national policy differs, keep the BI-RADS category standardized and adapt only screening, recall, biopsy and follow-up interval.", "Do not invent consensus where guidance diverges." ] } ] }, { "id": "mama.c5", "grupo": "mama", "nome": "BI-RADS summary — breast ultrasound", "nota": null, "fonte": "ACR BI-RADS / StatPearls", "colunas": [ "Category", "Meaning / management", "Malig. risk" ], "linhas": [ { "status": null, "celulas": [ "0", "Incomplete — needs mammography, MRI, comparison or repeat evaluation", "—" ] }, { "status": null, "celulas": [ "1", "Negative — routine screening", "0%" ] }, { "status": null, "celulas": [ "2", "Benign finding", "0%" ] }, { "status": null, "celulas": [ "3", "Probably benign — 6-month follow-up", "< 2%" ] }, { "status": null, "celulas": [ "4", "Suspicious — biopsy (4A 2–10% · 4B 10–50% · 4C 50–95%)", "2–95%" ] }, { "status": null, "celulas": [ "5", "Highly suggestive — biopsy", "> 95%" ] }, { "status": null, "celulas": [ "6", "Biopsy-proven malignancy", "—" ] } ] }, { "id": "mama.c6", "grupo": "mama", "nome": "Teaching summary — suspicious signs in a breast mass", "nota": null, "fonte": "ACR BI-RADS US léxico", "colunas": [ "Feature", "Suspicious finding" ], "linhas": [ { "status": null, "celulas": [ "Orientation", "Not parallel (taller-than-wide)" ] }, { "status": null, "celulas": [ "Margins", "Spiculated, angular, microlobulated" ] }, { "status": null, "celulas": [ "Shape", "Irregular" ] }, { "status": null, "celulas": [ "Posterior features", "Acoustic shadowing" ] }, { "status": null, "celulas": [ "Echo/foci", "Markedly hypoechoic; microcalcifications" ] } ] } ] }, { "metodo": "US", "chave": "axilas", "slug": "axilas", "url": "https://sonoaireport.com/en/referencias-ultrassom/axilas", "nome": "Axillae", "temPaginaPublica": true, "medidas": [ { "id": "axilas.0", "grupo": "axilas", "ruleId": null, "rotulo": "Minimum axillary protocol", "valor": "high-frequency linear transducer; side, palpable area, skin, subcutaneous tissue, accessory breast tissue, lymph nodes and vessels when relevant", "unidade": null, "nota": "In breast/oncology context, document the axillary level when possible: lateral to pectoralis minor, posterior to pectoralis minor or medial to pectoralis minor.", "fonte": "ACR Appropriateness Criteria Imaging of the Axilla / AIUM-ACR breast ultrasound parameter", "faixas": [ { "status": "green", "rotulo": "complete", "valor": "side, location, morphology and Doppler when indicated", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "acceptable focused exam", "valor": "symptomatic area only, with limitation clearly described", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "incomplete", "valor": "palpable lump or oncology context without nodal/correlated breast assessment", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "axilas.1", "grupo": "axilas", "ruleId": null, "rotulo": "Typical normal axillary lymph node", "valor": "oval or gently lobulated, thin homogeneous cortex, preserved fatty hilum", "unidade": null, "nota": "Cortex thinner than 3 mm with a central echogenic hilum is the most used normal pattern; size alone is less reliable than morphology.", "fonte": "Dialani et al. Insights Imaging 2015 / UCLA Radiology / Bedi AJR 2008", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "cortex <3 mm, preserved hilum, oval shape", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "cortex 3-5 mm, diffuse and with preserved hilum", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "consensus abnormal", "valor": "absent/replaced hilum, eccentric focal cortex or suspicious rounded shape", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "axilas.2", "grupo": "axilas", "ruleId": null, "rotulo": "Lymph-node cortex", "valor": "<3 normal; 3-5 gray zone; >5 suspicious if there is no clear reactive explanation", "unidade": "mm", "nota": "Some studies use 2.3-3 mm thresholds for sensitivity, but this increases false positives. The table therefore keeps isolated thickening with preserved hilum in yellow.", "fonte": "Bedi AJR 2008 / Deurloo-Br J Cancer / ECR axillary assessment", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "<3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "3–5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious", "valor": ">5 mm ou espessamento excêntrico", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "axilas.3", "grupo": "axilas", "ruleId": null, "rotulo": "Lymph-node shape", "valor": "long-axis/short-axis ratio ≥2 favors benignity; <2 suggests rounding", "unidade": null, "nota": "Avoid abbreviations in learner-facing reports: write long axis and short axis. Round shape carries more weight when paired with hilum loss or eccentric cortex.", "fonte": "Axillary lymph node ultrasound reviews / Vassallo criteria", "faixas": [ { "status": "green", "rotulo": "oval", "valor": "ratio ≥2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate", "valor": "ratio near 2 with preserved hilum", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "rounded", "valor": "ratio <2 with associated suspicious findings", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "axilas.4", "grupo": "axilas", "ruleId": null, "rotulo": "Lymph-node Doppler", "valor": "hilar/central flow is more reassuring; peripheral, mixed or chaotic flow increases suspicion", "unidade": null, "nota": "Doppler is adjunctive: absent flow does not exclude disease, and hyperemia can be reactive with vaccination, infection or hidradenitis.", "fonte": "Axillary node ultrasound morphology reviews", "faixas": [ { "status": "green", "rotulo": "hilar or absent", "valor": "compatible if morphology is benign", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "reactive increase", "valor": "central/hilar in an inflammatory context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "peripheral/disorganized", "valor": "especially with lost hilum or suspicious breast mass", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "axilas.5", "grupo": "axilas", "ruleId": null, "rotulo": "Accessory axillary breast tissue", "valor": "echotexture similar to breast, may contain cysts, fibroadenoma or malignancy like ordinary breast tissue", "unidade": null, "nota": "If there is a true focal lesion in accessory breast tissue, describe it with the breast lexicon and BI-RADS category according to local context.", "fonte": "ACR BI-RADS / axillary mass reviews", "faixas": [ { "status": "green", "rotulo": "typical accessory tissue", "valor": "no focal mass", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "probably benign finding", "valor": "simple cyst or typical fibroadenoma", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious lesion", "valor": "irregular mass, not parallel, suspicious calcifications or skin retraction", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "axilas.6", "grupo": "axilas", "ruleId": null, "rotulo": "Hidradenitis, abscess and axillary skin", "valor": "dermal thickening, tracts/tunnels, collections, debris and peripheral hyperemia", "unidade": null, "nota": "Ultrasound helps separate lymph node, drainable abscess, skin fistula, epidermal cyst and cellulitis. Gas, deep collection or systemic signs increase urgency.", "fonte": "Hidradenitis suppurativa ultrasound reviews / DERMUS", "faixas": [ { "status": "green", "rotulo": "normal skin", "valor": "no collection or tract", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "inflammatory", "valor": "thickening, hyperemia or superficial tract", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "complicated", "valor": "drainable abscess, gas, deep collection or immunosuppression", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "axilas.c0", "grupo": "axilas", "nome": "Quick assistant — axillary lymph node", "nota": "The output is a teaching triage, not a replacement for BI-RADS, local oncology protocol or biopsy decision.", "fonte": "ACR Imaging of the Axilla / Bedi AJR 2008 / EUSOBI 2023", "colunas": [ "Output", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Typical normal", "Green", "Oval, preserved fatty hilum, cortex <3 mm and hilar/absent flow." ] }, { "status": "yellow", "celulas": [ "Reactive/indeterminate", "Yellow", "Cortex 3-5 mm, diffuse thickening with preserved hilum, recent vaccination/infection or incomplete context." ] }, { "status": "red", "celulas": [ "Suspicious", "Red", "Absent/replaced hilum, eccentric focal cortex, round shape, peripheral/chaotic flow or associated breast/oncology finding." ] } ] }, { "id": "axilas.c1", "grupo": "axilas", "nome": "Bedi-like morphologic classification — teaching version", "nota": "Publications vary: some group types 1-4 as benign and 5-6 as suspicious; in this reference type 4 is yellow because it is a decision zone.", "fonte": "Bedi et al. AJR 2008 / axillary node reviews", "colunas": [ "Type", "Color", "Morphology", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "1", "Green", "No visible cortex or extremely thin cortex", "Typical benign if context agrees." ] }, { "status": "green", "celulas": [ "2", "Green", "Thin cortex up to 3 mm, preserved hilum", "Consensus normal." ] }, { "status": "yellow", "celulas": [ "3", "Yellow", "Diffuse cortical thickening, usually >3 mm, preserved hilum", "May be reactive; compare side, vaccination, skin and breast." ] }, { "status": "yellow", "celulas": [ "4", "Yellow", "Lobulated or focal cortical thickening with hilum still identifiable", "More concerning than type 3; depends on context and biopsy access." ] }, { "status": "red", "celulas": [ "5", "Red", "Prominent focal cortex or marked partial hilum replacement", "Suspicious, especially in breast cancer or melanoma." ] }, { "status": "red", "celulas": [ "6", "Red", "Absent/replaced hilum, rounded node or nodal mass", "Consensus morphologic abnormality." ] } ] }, { "id": "axilas.c2", "grupo": "axilas", "nome": "Clinical context — when to raise the color", "nota": null, "fonte": "ACR Appropriateness Criteria / EUSOBI vaccination guidance / oncologic axilla reviews", "colunas": [ "Scenario", "Suggested color", "How to use in the report" ], "linhas": [ { "status": "green", "celulas": [ "No breast finding, no prior cancer, typical nodes", "Green", "Describe as usual-appearing lymph nodes if the symptom area was covered." ] }, { "status": "yellow", "celulas": [ "Recent vaccine or ipsilateral skin infection, no suspicious breast finding", "Yellow", "Report as probably reactive when morphology is not frankly suspicious; follow local policy." ] }, { "status": "yellow", "celulas": [ "Postoperative setting, lymphedema or radiotherapy", "Yellow", "Compare with prior studies and document scar/seroma/sentinel-node change if applicable." ] }, { "status": "red", "celulas": [ "Suspicious breast finding or known breast cancer", "Red", "Describe side, axillary level, cortex, hilum, shape, Doppler and consider sampling according to protocol." ] }, { "status": "red", "celulas": [ "Melanoma, lymphoma, known metastasis or non-nodal solid mass", "Red", "Do not close as reactive without correlation; may need biopsy, MRI or CT according to the hypothesis." ] } ] }, { "id": "axilas.c3", "grupo": "axilas", "nome": "Differential diagnosis of an axillary mass", "nota": null, "fonte": "ACR Imaging of the Axilla / soft-tissue ultrasound reviews", "colunas": [ "Ultrasound pattern", "Possibilities", "Warning" ], "linhas": [ { "status": "green", "celulas": [ "Tissue with breast-like echotexture, no focal mass", "Accessory breast tissue", "Green only if there is no focal lesion." ] }, { "status": "yellow", "celulas": [ "Superficial collection with debris or peripheral hyperemia", "Abscess, hidradenitis, inflamed epidermal cyst", "Red if gas, deep collection, fever or immunosuppression." ] }, { "status": "yellow", "celulas": [ "Compressible superficial fatty lesion", "Lipoma, accessory fat, rare hernia", "Yellow if deep, painful, growing or not fully seen." ] }, { "status": "red", "celulas": [ "Non-fatty solid mass or infiltrative margin", "Metastasis, lymphoma, nerve-sheath tumor, sarcoma, advanced skin lesion", "Requires correlation and planned imaging/sampling." ] }, { "status": "red", "celulas": [ "Vascular, pulsatile or compressible lesion with flow", "Varix, vascular malformation, pseudoaneurysm, fistula", "Color and spectral Doppler before puncture." ] } ] }, { "id": "axilas.c4", "grupo": "axilas", "nome": "Report checklist — axillae", "nota": null, "fonte": "ACR / BI-RADS reporting principles / EUSOBI", "colunas": [ "Item", "Write clearly" ], "linhas": [ { "status": null, "celulas": [ "Side and location", "Right/left axilla; palpable area; axillary level when relevant; relationship to scar or skin." ] }, { "status": null, "celulas": [ "Lymph node", "Long axis, short axis, cortical thickness, fatty hilum, shape, margins and Doppler." ] }, { "status": null, "celulas": [ "Breast context", "Whether there is suspicious breast lesion, prior surgery, radiotherapy, lymphedema, recent vaccine or skin infection." ] }, { "status": null, "celulas": [ "Non-nodal mass", "Anatomic layer, content, vascularity, relationship to skin/fascia/vessels and whether it was fully seen." ] }, { "status": null, "celulas": [ "Conclusion", "Use abbreviation-free wording: typical normal, probably reactive, indeterminate or suspicious; state the local next step." ] } ] } ] }, { "metodo": "US", "chave": "pelvico", "slug": "pelvico", "url": "https://sonoaireport.com/en/referencias-ultrassom/pelvico", "nome": "Pelvic / transvaginal", "temPaginaPublica": true, "medidas": [ { "id": "pelvico.0", "grupo": "pelvico", "ruleId": null, "rotulo": "Prepubertal uterus — length and thickness", "valor": "<4,0–4,5", "unidade": "cm", "nota": "thickness usually <1 cm; length ≤3.2 cm lowers the probability of precocious puberty in referred girls", "fonte": "StatPearls 2025 / Radiologia Brasileira / Frontiers Endocrinol 2021", "faixas": [ { "status": "green", "rotulo": "robust prepubertal", "valor": "≤3.2 cm and thickness ≤1 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": ">3.2–4.5 cm or thickness 1–1.5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "abnormal in context", "valor": ">4.5 cm or thickness >1.5 cm under age 8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.1", "grupo": "pelvico", "ruleId": null, "rotulo": "Pubertal uterus — configuration", "valor": "5–8", "unidade": "cm", "nota": "uterine fundus becomes larger than the cervix; the fundus/cervix ratio alone overlaps between groups", "fonte": "StatPearls 2025 / Radiologia Brasileira / Pediatric Radiology 2024", "faixas": [ { "status": "green", "rotulo": "tubular", "valor": "fundus/cervix ≤1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "transition", "valor": "1–1,45", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "early pubertal if <8 years", "valor": ">1.45 or 2:1–3:1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.2", "grupo": "pelvico", "ruleId": null, "rotulo": "Ovary — volume in pubertal follow-up", "valor": "<1–3.5 prepubertal; >3.5–4 suggests stimulation", "unidade": "cm³", "nota": "there is substantial overlap; interpret with uterus, symmetry and clinical stage", "fonte": "StatPearls 2025 / Radiologia Brasileira / Pediatric Radiology 2024", "faixas": [ { "status": "green", "rotulo": "low", "valor": "≤1 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "divergent", "valor": ">1–3,5 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "pubertal if <8 years", "valor": ">3,5–4 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "investigate mass/cyst", "valor": ">20 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.3", "grupo": "pelvico", "ruleId": null, "rotulo": "Ovarian follicles and cysts", "valor": "<4 microcysts; 4–9 follicles; >9 macrocystic", "unidade": "mm", "nota": "small follicles may be physiologic; a dominant unilateral cyst changes interpretation", "fonte": "Pediatric Radiology 2024 / StatPearls 2025", "faixas": [ { "status": "green", "rotulo": "usual childhood", "valor": "<4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "pubertal transition", "valor": "4–9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual macrocystic", "valor": ">9–20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "dominant/pathologic", "valor": ">20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.4", "grupo": "pelvico", "ruleId": null, "rotulo": "Endometrium and uterine artery Doppler", "valor": "prepubertal: non-visible endometrium and no diastolic flow", "unidade": null, "nota": "Doppler is complementary and pulsatility-index cutoffs vary widely", "fonte": "Radiologia Brasileira / Pediatric Radiology 2024", "faixas": [ { "status": "green", "rotulo": "prepubertal", "valor": "no endometrium and no diastolic flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "transition", "valor": "thin line or intermittent diastole", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "estrogenization if <8 years", "valor": "cyclic endometrium or continuous diastole", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.5", "grupo": "pelvico", "ruleId": null, "rotulo": "Adult pelvis — preparation and route", "valor": "transabdominal with bladder filled if needed; transvaginal with bladder preferably empty", "unidade": null, "nota": "more than one route may be necessary; transrectal or transperineal route is an alternative when transvaginal scanning is not appropriate", "fonte": "AIUM / ACR-ACOG-AIUM-SPR-SRU female pelvis parameter", "faixas": [ { "status": "green", "rotulo": "complete documentation", "valor": "route, bladder, uterus, endometrium, ovaries, adnexa and cul-de-sac", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "technical limitation", "valor": "endometrium or ovary not adequately seen", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "management-changing finding", "valor": "solid mass, torsion, infection, postmenopausal bleeding or extrauterine device", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.6", "grupo": "pelvico", "ruleId": null, "rotulo": "Adult uterus — orienting measurements", "valor": "length 6–10; thickness 3–5; width 4–6", "unidade": "cm", "nota": "varies with age, parity, cycle, fibroids, adenomyosis and technique; describe shape, orientation and volume when useful", "fonte": "AIUM / StatPearls / gynecologic ultrasound reviews", "faixas": [ { "status": "green", "rotulo": "usual in adults", "valor": "no mass or cavity distortion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "enlarged/contextual", "valor": "parity, fibroids or adenomyosis may explain it", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "alert", "valor": "postmenopausal growth, atypical mass or necrosis", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.7", "grupo": "pelvico", "ruleId": null, "rotulo": "Endometrium — reproductive age", "valor": "thin during menses; proliferative 4–8; secretory 7–14(16)", "unidade": "mm", "nota": "do not use one cutoff without cycle phase, hormones and focal pattern; measure the thickest part, excluding intracavitary fluid", "fonte": "AIUM / StatPearls", "faixas": [ { "status": "green", "rotulo": "phase-concordant", "valor": "expected thickness and echotexture", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "unknown phase, hormonal therapy, mild heterogeneity", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "focal abnormal", "valor": "polyp/mass, focal vascularity, persistent bleeding", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.8", "grupo": "pelvico", "ruleId": null, "rotulo": "Endometrium — postmenopausal", "valor": "≤4 if single bleeding episode, low risk and fully seen echo; recurrent bleeding or high risk requires evaluation", "unidade": "mm", "nota": "ACOG 2026 recommends transvaginal ultrasound plus endometrial sampling for most postmenopausal bleeding; incidental thickness without bleeding does not carry the same weight", "fonte": "ACOG 2018/2026 / AIUM", "faixas": [ { "status": "green", "rotulo": "selected low risk", "valor": "≤4 mm, well seen echo, single episode", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "incidental without bleeding, hormonal therapy, tamoxifen or incomplete echo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "investigate", "valor": ">4 mm with bleeding, recurrent bleeding or risk factors", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.9", "grupo": "pelvico", "ruleId": null, "rotulo": "Adult ovaries — measurements and follicles", "valor": "measure in 3 dimensions; follicles up to 25 mm may be physiologic in reproductive age", "unidade": null, "nota": "after menopause ovaries may not be identified; solid mass, papillary projections, thick septa, ascites or suspicious vascularity change interpretation", "fonte": "AIUM / StatPearls / SRU adnexal guidance", "faixas": [ { "status": "green", "rotulo": "physiologic", "valor": "simple follicle compatible with the cycle", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "follow-up/context", "valor": "larger simple cyst or nonvisualized ovary in the right context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious", "valor": "solid component, papillary projections, ascites, torsion or postmenopausal mass", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.10", "grupo": "pelvico", "ruleId": null, "rotulo": "Intrauterine device — ideal position", "valor": "central stem, open arms, top near the fundus/cavity; 3D helps see arms and orientation", "unidade": null, "nota": "there is no universal low-lying definition; studies use >3–4 mm, >5 mm or >20 mm from the fundus, so color depends on location, symptoms and device type", "fonte": "AIUM / Connolly-Fox JUM 2021 / JSIM 2024 / Exxcellence 2025", "faixas": [ { "status": "green", "rotulo": "adequate", "valor": "fundal, central, arms open", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "supracervical low-lying", "valor": "above the internal cervical os, especially if asymptomatic", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "malpositioned", "valor": "cervical/partially expelled, embedded, perforated, extrauterine, arm not open", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelvico.11", "grupo": "pelvico", "ruleId": null, "rotulo": "Fibroids — minimum documentation", "valor": "number, location, relationship to cavity, largest lesion in ≥2 dimensions and FIGO 0–8 when possible", "unidade": null, "nota": "3D, sonohysterography or MRI may help differentiate FIGO 2 from FIGO 3 and map hybrid fibroids", "fonte": "AIUM / FIGO 2018 / MUSA / Merck PALM-COEIN", "faixas": [ { "status": "green", "rotulo": "no fibroid", "valor": "myometrium without focal nodule", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "intramural/subserosal", "valor": "FIGO 3–8 depending on symptoms and size", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "cavity or suspicion", "valor": "FIGO 0–2, cavity distortion, postmenopausal growth or atypical morphology", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "pelvico.c0", "grupo": "pelvico", "nome": "Calculator — O-RADS US v2022 (adnexal mass)", "nota": "Requires a standardized exam (transvaginal, cycle timing). Classic benign lesions (hemorrhagic, endometrioma, dermoid) have their own rules. The color score (flow 1–4) raises the category in multilocular and solid lesions.", "fonte": "ACR O-RADS US v2022 (Radiology 2022)", "colunas": [ "Category", "Malignancy risk", "Usual management" ], "linhas": [ { "status": "green", "celulas": [ "O-RADS 1", "n/a (normal ovary)", "No follow-up." ] }, { "status": "green", "celulas": [ "O-RADS 2", "<1%", "Almost certainly benign; follow-up only per type/size." ] }, { "status": "yellow", "celulas": [ "O-RADS 3", "1–<10%", "Low risk; specialist US or follow-up." ] }, { "status": "red", "celulas": [ "O-RADS 4", "10–<50%", "Intermediate; MRI or gynecologic oncology." ] }, { "status": "red", "celulas": [ "O-RADS 5", "≥50%", "High risk; gynecologic oncology referral." ] } ] }, { "id": "pelvico.c1", "grupo": "pelvico", "nome": "Calculator — IOTA Simple Rules", "nota": "B: unilocular; solid <7 mm; acoustic shadows; smooth multilocular <10 cm; no flow. M: irregular solid; ascites; ≥4 papillae; irregular multilocular-solid ≥10 cm; strong flow.", "fonte": "IOTA Simple Rules — Timmerman, Ultrasound Obstet Gynecol 2008/2016", "colunas": [ "Rule", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Only B features", "Benign." ] }, { "status": "red", "celulas": [ "Only M features", "Malignant." ] }, { "status": "yellow", "celulas": [ "B and M, or none", "Inconclusive (~20%): use expert examiner or the ADNEX model." ] } ] }, { "id": "pelvico.c2", "grupo": "pelvico", "nome": "Interactive calculator — FIGO 0–8 fibroids", "nota": "The interactive table below is educational and assistive. The final category must be checked by the physician, especially with multiple, hybrid fibroids, cavity distortion or suspected adenomyosis.", "fonte": "FIGO 2018 PALM-COEIN / Merck Manual / AIUM / MUSA", "colunas": [ "Input", "How to use", "Limitation" ], "linhas": [ { "status": "green", "celulas": [ "No focal fibroid", "Use when the myometrium has no defined leiomyomatous nodule.", "Does not exclude diffuse adenomyosis or subtle myometrial abnormality." ] }, { "status": "red", "celulas": [ "FIGO 0–2", "Submucosal or intracavitary: greater impact on bleeding, fertility and hysteroscopic planning.", "Differentiating FIGO 2 from FIGO 3 may require 3D, sonohysterography or hysteroscopy." ] }, { "status": "yellow", "celulas": [ "FIGO 3–8", "Maps contact with endometrium, myometrium and serosa; color depends on symptoms, size, growth and morphology.", "The classification is anatomical: it does not replace size, number and vascularity description." ] } ] }, { "id": "pelvico.c3", "grupo": "pelvico", "nome": "Adult and transvaginal female pelvis — minimum protocol", "nota": null, "fonte": "AIUM female pelvis parameter / ACR-ACOG-AIUM-SPR-SRU 2024", "colunas": [ "Step", "What to document", "Color" ], "linhas": [ { "status": "green", "celulas": [ "Route and preparation", "Transabdominal with bladder filled when it improves the acoustic window; transvaginal with bladder preferably empty.", "Green if documented" ] }, { "status": "green", "celulas": [ "Uterus and cervix", "Size, shape, orientation, myometrium, cervix, endometrium and relevant masses in at least two dimensions.", "Green if complete" ] }, { "status": "yellow", "celulas": [ "Incomplete endometrium", "If not fully seen or poorly defined, report the limitation and avoid a falsely precise measurement.", "Yellow" ] }, { "status": "green", "celulas": [ "Ovaries and adnexa", "Try to identify ovaries first, measure in three dimensions when needed, and describe masses by composition, septa, papillary projections, vascularity and relationship to uterus/ovary.", "Green if complete" ] }, { "status": "red", "celulas": [ "Critical finding", "Torsion, suspicious solid mass, abscess, perforated/extrauterine device or high-risk postmenopausal bleeding.", "Red" ] } ] }, { "id": "pelvico.c4", "grupo": "pelvico", "nome": "Intrauterine device — ultrasound location", "nota": null, "fonte": "AIUM / Connolly-Fox JUM 2021 / JSIM 2024 / Exxcellence 2025", "colunas": [ "Finding", "Interpretation", "Descriptive action" ], "linhas": [ { "status": "green", "celulas": [ "Fundal and central", "Stem on the cavity axis, arms open and top near the fundus/cavity.", "Describe type if known and whether 3D confirmed the arms." ] }, { "status": "yellow", "celulas": [ "Low, but above cervix", "Divergent zone: there is no universal distance; studies use 3–4 mm, 5 mm or 20 mm.", "Report distance to fundus, symptoms, device type and relationship to fibroids/cavity." ] }, { "status": "red", "celulas": [ "Cervical or partially expelled", "Higher risk of complete expulsion and contraceptive failure.", "Describe component in the cervical canal and suggest gynecologic evaluation." ] }, { "status": "red", "celulas": [ "Embedded, perforated or extrauterine", "Arm or stem in the myometrium, through the serosa or outside the cavity.", "3D, radiography/CT or hysteroscopy may be needed depending on the case." ] } ] }, { "id": "pelvico.c5", "grupo": "pelvico", "nome": "Adult endometrium — context-based reading", "nota": null, "fonte": "AIUM / ACOG Committee Opinion 2018 / ACOG Clinical Practice Update 2026", "colunas": [ "Context", "Green", "Yellow", "Red" ], "linhas": [ { "status": "yellow", "celulas": [ "Reproductive age", "Thickness and echotexture compatible with cycle phase.", "Unknown phase, hormonal therapy or heterogeneous endometrium without a defined mass.", "Focal lesion, focal vascularity or persistent bleeding." ] }, { "status": "yellow", "celulas": [ "Postmenopausal without bleeding", "Thin, regular and well seen endometrium.", "Incidental thickness greater than 4 mm is not equivalent to postmenopausal bleeding.", "Focal mass, suspicious fluid or important risk factors." ] }, { "status": "red", "celulas": [ "Postmenopausal bleeding", "≤4 mm only in a selected low-risk patient, single episode and fully seen echo.", "Incomplete echo, hormonal therapy, tamoxifen or barrier to prompt follow-up.", ">4 mm, recurrent bleeding or high risk; ACOG 2026 favors sampling in most patients." ] } ] }, { "id": "pelvico.c6", "grupo": "pelvico", "nome": "Fibroids — FIGO 0–8 classification", "nota": "FIGO is anatomical and alone does not include size, number, degeneration, vascularity or sarcoma suspicion. These elements should be reported when relevant.", "fonte": "FIGO PALM-COEIN 2018 / Merck Manual / AIUM / MUSA", "colunas": [ "Type", "Anatomic relationship", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "No fibroid", "Myometrium without a defined leiomyomatous nodule.", "Green: consensus normality for focal fibroid." ] }, { "status": "red", "celulas": [ "FIGO 0", "Pedunculated intracavitary.", "Red: submucosal, usually relevant for bleeding and hysteroscopy." ] }, { "status": "red", "celulas": [ "FIGO 1", "Submucosal with less than 50% intramural.", "Red: distorts the cavity; measure base and intramural component." ] }, { "status": "red", "celulas": [ "FIGO 2", "Submucosal with 50% or more intramural.", "Red: planning depends on myometrial extension." ] }, { "status": "yellow", "celulas": [ "FIGO 3", "100% intramural, contacting the endometrium.", "Yellow: differentiating from FIGO 2 may require 3D or sonohysterography." ] }, { "status": "yellow", "celulas": [ "FIGO 4", "Pure intramural.", "Yellow: impact depends on size, symptoms and distortion." ] }, { "status": "yellow", "celulas": [ "FIGO 5", "Subserosal with 50% or more intramural.", "Yellow: map serosa, wall and mass effect." ] }, { "status": "yellow", "celulas": [ "FIGO 6", "Subserosal with less than 50% intramural.", "Yellow: confirm uterine origin." ] }, { "status": "yellow", "celulas": [ "FIGO 7", "Pedunculated subserosal.", "Yellow: pedicle Doppler helps differentiate from adnexal mass." ] }, { "status": "yellow", "celulas": [ "FIGO 8", "Other: cervical, parasitic, ligamentary or special location.", "Yellow: specify location." ] }, { "status": "yellow", "celulas": [ "Hybrid", "Two numbers separated by a hyphen; first endometrium, second serosa.", "Example 2-5: submucosal and subserosal with measurable components." ] } ] }, { "id": "pelvico.c7", "grupo": "pelvico", "nome": "Calculator — pubertal maturation from female pelvis ultrasound", "nota": "Use as a teaching aid. The conclusion must integrate Tanner stage, growth curve, bone age, hormones and endocrine assessment.", "fonte": "Frontiers Endocrinol 2021 / Pediatric Radiology 2024 / ACR-AIUM-SPR-SRU female pelvis parameter", "colunas": [ "Input", "How the app interprets it", "Limitation" ], "linhas": [ { "status": null, "celulas": [ "Uterine measurements", "Length, thickness, width and fundus/cervix ratio estimate estrogenization.", "They do not define precocious puberty alone." ] }, { "status": null, "celulas": [ "Ovarian volumes", "They help when combined with uterus, follicles and symmetry.", "There is overlap between prepubertal and early pubertal states." ] }, { "status": null, "celulas": [ "Endometrium and Doppler", "Visible endometrium and continuous diastolic flow suggest estrogenization.", "They are complementary markers, not single criteria." ] } ] }, { "id": "pelvico.c8", "grupo": "pelvico", "nome": "Pubertal maturation — ultrasound signs", "nota": null, "fonte": "StatPearls 2025 / Radiologia Brasileira / Pediatric Radiology 2024", "colunas": [ "Marker", "Green", "Yellow", "Red" ], "linhas": [ { "status": null, "celulas": [ "Uterine length", "≤3,2 cm", ">3,2–4,5 cm", ">4.5 cm under age 8" ] }, { "status": null, "celulas": [ "Uterine configuration", "tubular; fundus/cervix ≤1", "fundus/cervix 1–1.45", "dominant fundus, 2:1–3:1 in early context" ] }, { "status": null, "celulas": [ "Ovarian volume", "≤1 cm³", ">1–3,5 cm³", ">3.5–4 cm³ under age 8; >20 cm³ investigate" ] }, { "status": null, "celulas": [ "Follicles/cysts", "<4 mm", "4–20 mm", ">20 mm or dominant unilateral lesion" ] }, { "status": null, "celulas": [ "Endometrium", "not visible", "thin line", "cyclic/thickened under age 8" ] }, { "status": null, "celulas": [ "Uterine Doppler", "no diastole", "intermittent diastole", "continuous diastole under age 8" ] } ] }, { "id": "pelvico.c9", "grupo": "pelvico", "nome": "Precocious puberty versus premature thelarche or pubarche — practical reading", "nota": null, "fonte": "Frontiers Endocrinol 2021 / Radiologia Brasileira / Pediatric Radiology 2024", "colunas": [ "Situation", "Reading", "Next step" ], "linhas": [ { "status": null, "celulas": [ "Pubertal signs before age 8", "Yellow: alert clinical context.", "Correlate with Tanner stage, growth velocity, bone age and hormones." ] }, { "status": null, "celulas": [ "Uterus >3.2 cm", "Raises probability in referred girls, but is not diagnostic.", "Compare with uterine volume/configuration and laboratory tests." ] }, { "status": null, "celulas": [ "Uterus >4.5 cm or pubertal shape under age 8", "Red: strong evidence of early estrogenization.", "Refer/coordinate with pediatric endocrinology." ] }, { "status": null, "celulas": [ "Bilaterally enlarged ovaries with follicles", "Yellow/red depending on age and uterus.", "Consider gonadotropic stimulation if uterus is also pubertal." ] }, { "status": null, "celulas": [ "Dominant unilateral cyst or adrenal/ovarian mass", "Red: may suggest peripheral cause or pathology.", "Assess adnexa/adrenals and recommend targeted workup." ] }, { "status": null, "celulas": [ "Small uterus and small ovaries with isolated thelarche", "Green/yellow: may support isolated premature thelarche.", "Clinical follow-up if progression is slow and tests agree." ] } ] }, { "id": "pelvico.c10", "grupo": "pelvico", "nome": "Technical protocol — pediatric and pubertal female pelvis", "nota": null, "fonte": "ACR-AIUM-SPR-SRU practice parameter / StatPearls 2025", "colunas": [ "Step", "What to document" ], "linhas": [ { "status": null, "celulas": [ "Route", "Transabdominal with full bladder as standard; endocavitary route only when clinically appropriate, consented and compatible with age/local context." ] }, { "status": null, "celulas": [ "Clinical context", "Age, menarche, breast development, pubic hair, bleeding and growth velocity when provided." ] }, { "status": null, "celulas": [ "Uterus", "Length, thickness, width, volume, fundus/cervix ratio, shape and endometrium." ] }, { "status": null, "celulas": [ "Ovaries", "Three diameters or volume of each ovary, largest follicle/cyst, symmetry and focal lesions." ] }, { "status": null, "celulas": [ "Doppler", "Uterine diastolic flow if assessed; do not use as an isolated criterion." ] } ] }, { "id": "pelvico.c11", "grupo": "pelvico", "nome": "International and regional standards — why use color bands", "nota": null, "fonte": "ACR-AIUM-SPR-SRU / Radiologia Brasileira / Frontiers Endocrinol 2021 / Pediatric Radiology 2024", "colunas": [ "Source/region", "Practical message" ], "linhas": [ { "status": null, "celulas": [ "ACR, AIUM, SPR and SRU", "Standardize female pelvis/adnexal documentation and technique, but do not impose one universal pubertal cutoff." ] }, { "status": null, "celulas": [ "International pediatric radiology", "Published cutoffs for uterine length/volume and ovarian volume vary substantially." ] }, { "status": null, "celulas": [ "Brazilian radiology", "Suggests practical prepubertal limits: uterus <4.5 cm, thickness <1 cm and ovary <3 cm³." ] }, { "status": null, "celulas": [ "Endocrinology", "Ultrasound is adjunctive; final diagnosis depends on clinical findings, bone age and hormone testing." ] } ] } ] }, { "metodo": "US", "chave": "prostata", "slug": "prostata", "url": "https://sonoaireport.com/en/referencias-ultrassom/prostata", "nome": "Prostate", "temPaginaPublica": true, "medidas": [ { "id": "prostata.0", "grupo": "prostata", "ruleId": "prostate.volume", "rotulo": "Usual adult prostate volume", "valor": "15–30", "unidade": "mL", "nota": "increases with age; >30 mL suggests benign enlargement in many guidelines", "fonte": "AUA benign prostate enlargement / EAU male urinary symptoms / StatPearls", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "15–30 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "mild/contextual enlargement", "valor": ">30–40 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "enlarged", "valor": ">40 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "large", "valor": ">80 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "prostata.1", "grupo": "prostata", "ruleId": null, "rotulo": "Prostate volume calculation", "valor": "largura × espessura × comprimento × 0,52", "unidade": null, "nota": "ellipsoid formula; g and mL are used almost interchangeably for planning", "fonte": "AIUM / StatPearls / AUA benign prostate enlargement", "faixas": [] }, { "id": "prostata.2", "grupo": "prostata", "ruleId": null, "rotulo": "PSA density", "valor": "PSA ÷ volume", "unidade": "ng/mL/cm³", "nota": "interpretation depends on age, digital rectal exam, family history and MRI", "fonte": "EAU prostate cancer / AUA early detection / StatPearls", "faixas": [ { "status": "green", "rotulo": "strong low risk", "valor": "<0,10", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "low by classic cutoff", "valor": "0,10–0,15", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "suspicious/borderline", "valor": "0,15–0,20", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "elevated", "valor": "≥0,20", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "prostata.3", "grupo": "prostata", "ruleId": null, "rotulo": "Intravesical prostatic protrusion", "valor": "<5", "unidade": "mm", "nota": "measure from bladder base to the tip of the protrusion into the bladder lumen", "fonte": "International Continence Society", "faixas": [ { "status": "green", "rotulo": "grade I", "valor": "0–4,9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "grade II", "valor": "5–10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "grade III", "valor": ">10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "prostata.4", "grupo": "prostata", "ruleId": null, "rotulo": "Seminal vesicles — anteroposterior diameter", "valor": "<15", "unidade": "mm", "nota": "mainly in transrectal/infertility evaluation; >15 mm suggests dilatation", "fonte": "EAA ultrasound study / male infertility reviews", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "<15 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "15–20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "dilated", "valor": ">20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "prostata.c0", "grupo": "prostata", "nome": "Calculator — prostate volume, PSA density and intravesical protrusion", "nota": "Assistive calculator: it does not replace serial PSA, digital rectal exam, MRI, urinary symptoms and urologic assessment.", "fonte": "AIUM / AUA benign prostate enlargement / EAU prostate cancer / ICS", "colunas": [ "Input", "Calculation", "How to interpret" ], "linhas": [ { "status": null, "celulas": [ "Volume", "largura × espessura × comprimento × 0,52", "15–30 mL is commonly the usual adult range." ] }, { "status": null, "celulas": [ "PSA density", "PSA ÷ volume", "0.10–0.20 is context-dependent on MRI, age, digital rectal exam and family history." ] }, { "status": null, "celulas": [ "Intravesical protrusion", "distance in mm into bladder lumen", ">10 mm is ICS grade III and suggests higher obstruction likelihood." ] } ] }, { "id": "prostata.c1", "grupo": "prostata", "nome": "Prostate size — benign enlargement planning", "nota": null, "fonte": "AUA benign prostate enlargement guideline / EAU male urinary symptoms", "colunas": [ "Range", "Reading", "Practical use" ], "linhas": [ { "status": null, "celulas": [ "<30 mL", "Small / usual", "Below classic benign enlargement cutoff." ] }, { "status": null, "celulas": [ "30–40 mL", "Mild enlargement", "Above 30 mL, but progression depends on symptoms, PSA and residual." ] }, { "status": null, "celulas": [ ">40–80 mL", "Enlarged", "EAU uses >40 mL as an example of higher progression risk for considering 5-alpha-reductase inhibitors." ] }, { "status": null, "celulas": [ ">80–150 mL", "Large", "Important category for surgical technique selection." ] }, { "status": null, "celulas": [ ">150 mL", "Very large", "AUA category for treatment planning." ] } ] }, { "id": "prostata.c2", "grupo": "prostata", "nome": "Intravesical prostatic protrusion — ICS", "nota": null, "fonte": "International Continence Society glossary", "colunas": [ "Grade", "Measure", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "I", "0–4,9 mm", "Small protrusion." ] }, { "status": null, "celulas": [ "II", "5–10 mm", "Intermediate; correlate with urinary flow and residual." ] }, { "status": null, "celulas": [ "III", ">10 mm", "Associated with higher chance of bladder outlet obstruction." ] } ] } ] }, { "metodo": "US", "chave": "escroto", "slug": "escroto", "url": "https://sonoaireport.com/en/referencias-ultrassom/escroto", "nome": "Scrotum / testis with Doppler", "temPaginaPublica": true, "medidas": [ { "id": "escroto.0", "grupo": "escroto", "ruleId": null, "rotulo": "Minimum protocol", "valor": "bilateral + comparative + Doppler when indicated", "unidade": null, "nota": "Measure both testes in three axes; assess epididymides, tunics, fluid, scrotal wall, spermatic cord and inguinal canal if pain, mass, hernia or varicocele are suspected.", "fonte": "AIUM-ACR-SPR-SRU scrotal ultrasound 2025", "faixas": [] }, { "id": "escroto.1", "grupo": "escroto", "ruleId": null, "rotulo": "Transducer and Doppler", "valor": "linear ≥12 MHz; Doppler optimized for low flow", "unidade": null, "nota": "Adjust scale, wall filter and gain to detect slow intratesticular flow; always compare with the contralateral side in acute pain.", "fonte": "AIUM-ACR-SPR-SRU scrotal ultrasound 2025", "faixas": [] }, { "id": "escroto.2", "grupo": "escroto", "ruleId": null, "rotulo": "Testis — adult volume by ellipsoid", "valor": "length × width × height × 0.52", "unidade": "mL", "nota": "Ranges vary by population. Use green for 15-25 mL, yellow for 10-14.9 mL or contextual >25 mL, red for <10 mL in adults/postpubertal patients when technique is reliable.", "fonte": "EAA ultrasound study / andrology reference studies", "faixas": [ { "status": "green", "rotulo": "usual adult range", "valor": "15–25 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "low-normal / borderline", "valor": "10–14,9 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "reduced", "valor": "<10 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "escroto.3", "grupo": "escroto", "ruleId": null, "rotulo": "Volume in varicocele — Lambert formula", "valor": "length × width × height × 0.71", "unidade": "mL", "nota": "ESUR-SPIWG prefers Lambert for varicocele assessment and recommends reporting which formula was used.", "fonte": "ESUR-SPIWG varicocele recommendations", "faixas": [] }, { "id": "escroto.4", "grupo": "escroto", "ruleId": null, "rotulo": "Testicular asymmetry", "valor": "<20", "unidade": "%", "nota": "A difference ≥20% is an important yellow zone in adolescents/varicocele; it affects follow-up and clinical decision-making.", "fonte": "EAU Paediatric Urology / ESUR-SPIWG", "faixas": [] }, { "id": "escroto.5", "grupo": "escroto", "ruleId": null, "rotulo": "Epididymis — head", "valor": "≤12", "unidade": "mm", "nota": "An enlarged, hypoechoic and hypervascular head supports epididymitis when painful; isolated enlargement may be cyst/spermatocele.", "fonte": "EAA ultrasound study / scrotal imaging reviews", "faixas": [] }, { "id": "escroto.6", "grupo": "escroto", "ruleId": null, "rotulo": "Varicocele — largest vein standing with Valsalva", "valor": "≥3", "unidade": "mm", "nota": "ESUR considers 3 mm or more diagnostic when measured standing during Valsalva, especially with Doppler reflux.", "fonte": "ESUR-SPIWG varicocele recommendations", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "<2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "2–2,9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "varicocele", "valor": "≥3 mm + refluxo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "escroto.7", "grupo": "escroto", "ruleId": null, "rotulo": "Varicocele — reflux duration", "valor": ">2", "unidade": "s", "nota": "The essential parameter is spectral-Doppler reflux duration; ESUR suggests >2 s standing during Valsalva.", "fonte": "ESUR-SPIWG varicocele recommendations", "faixas": [ { "status": "green", "rotulo": "no pathologic reflux", "valor": "<1 s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "1–2 s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "pathologic", "valor": ">2 s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "escroto.8", "grupo": "escroto", "ruleId": null, "rotulo": "Isolated testicular microlithiasis", "valor": "no routine follow-up", "unidade": null, "nota": "Without a solid mass and risk factors, AUA/ESUR do not recommend routine workup or serial ultrasound.", "fonte": "AUA testicular cancer guideline / ESUR microlithiasis guideline", "faixas": [] } ], "classificacoes": [ { "id": "escroto.c0", "grupo": "escroto", "nome": "Interactive assistant — scrotum, testes and Doppler", "nota": "Use as educational triage. Torsion may retain some residual flow; a solid intratesticular mass should be treated as malignant until proven otherwise.", "fonte": "AIUM-ACR-SPR-SRU 2025 / ACR acute scrotum / AUA testicular cancer / ESUR-SPIWG", "colunas": [ "Input", "How to interpret", "Limitation" ], "linhas": [ { "status": "green", "celulas": [ "Functional normality", "Volumes in usual range, symmetric intratesticular flow, no mass, no pathologic reflux and no complication signs.", "Always depends on clinical indication and bilateral comparison." ] }, { "status": "yellow", "celulas": [ "Gray zone", "Volume 10-14.9 mL, asymmetry ≥20%, vein 2-2.9 mm, reflux 1-2 s, uncomplicated epididymitis, typical extratesticular lesion or microlithiasis with risk.", "Requires context, position, Valsalva and selective follow-up." ] }, { "status": "red", "celulas": [ "Abnormal or urgent", "Reduced/absent flow, whirlpool sign, solid intratesticular mass, abscess/pyocele, rupture, complicated hernia or recent isolated right varicocele.", "Rapid clinical communication may be required." ] } ] }, { "id": "escroto.c1", "grupo": "escroto", "nome": "Varicocele — ESUR-SPIWG documentation", "nota": "Report position, vein level, diameter, Valsalva, reflux duration and whether standing and supine positions were assessed.", "fonte": "ESUR-SPIWG / Royal College of Radiologists audit template / EAU Paediatric Urology", "colunas": [ "Item", "Report", "Color" ], "linhas": [ { "status": "green", "celulas": [ "No varicocele", "Veins <2 mm, no pathologic reflux and no relevant asymmetry.", "Green" ] }, { "status": "yellow", "celulas": [ "Borderline/subclinical", "Vein 2-2.9 mm, short reflux or finding in only one position.", "Yellow" ] }, { "status": "red", "celulas": [ "Ultrasound varicocele", "Largest vein ≥3 mm standing with Valsalva and reflux >2 s on spectral Doppler.", "Red: consensus abnormal." ] }, { "status": "yellow", "celulas": [ "Adolescent or infertility", "Measure both testicular volumes and asymmetry; report the formula used.", "Yellow if no atrophy; red if marked atrophy." ] }, { "status": "red", "celulas": [ "Isolated right-sided or recent onset", "Consider abdominal/renal extension, especially if it does not reduce supine.", "Red because secondary causes must not be missed." ] } ] }, { "id": "escroto.c2", "grupo": "escroto", "nome": "Acute scrotum — Doppler and critical signs", "nota": null, "fonte": "ACR acute scrotum / AIUM-ACR-SPR-SRU 2025 / BMUS acute epididymo-orchitis complications", "colunas": [ "Finding", "Interpretation", "Reporting action" ], "linhas": [ { "status": "red", "celulas": [ "Absent or reduced intratesticular flow", "Torsion or ischemia until proven otherwise.", "Urgent communication." ] }, { "status": "red", "celulas": [ "Whirlpool sign in the cord", "Direct sign of torsion, including partial/intermittent torsion.", "Describe knot location and residual flow." ] }, { "status": "yellow", "celulas": [ "Epididymal/testicular hyperemia", "Favors epididymitis, orchitis or epididymo-orchitis.", "Look for abscess, pyocele and infarction." ] }, { "status": "red", "celulas": [ "Abscess, pyocele, necrosis or infarction", "Relevant infectious/vascular complication.", "Communicate and suggest urologic correlation." ] }, { "status": "red", "celulas": [ "Trauma with tunica rupture", "Risk of testicular loss if delayed.", "Describe discontinuity, hematoma and Doppler viability." ] } ] }, { "id": "escroto.c3", "grupo": "escroto", "nome": "Masses, cysts and microlithiasis", "nota": null, "fonte": "AUA testicular cancer guideline / ESUR microlithiasis guideline / ACR palpable scrotal abnormality", "colunas": [ "Pattern", "Interpretation", "Comment" ], "linhas": [ { "status": "green", "celulas": [ "Simple intratesticular or tunica cyst", "Anechoic, thin wall, posterior enhancement, no solid component and no flow.", "Green if all typical criteria are present." ] }, { "status": "red", "celulas": [ "Solid intratesticular mass", "Manage as malignant until proven otherwise.", "AUA: tumor markers before treatment; Doppler helps, but absent flow does not exclude tumor." ] }, { "status": "yellow", "celulas": [ "Typical extratesticular lesion", "Epididymal cyst, spermatocele, appendage, lipoma or adenomatoid tumor may be benign.", "Describe origin and relationship to epididymis, cord and tunics." ] }, { "status": "yellow", "celulas": [ "Solid extratesticular mass", "More often benign than intratesticular, but not automatically benign.", "Consider MRI/referral if indeterminate." ] }, { "status": "green", "celulas": [ "Isolated microlithiasis", "No mass and no risk factors: no routine follow-up required.", "AUA/ESUR guidance." ] }, { "status": "yellow", "celulas": [ "Microlithiasis with risk factor", "Cryptorchidism/orchidopexy, personal/family history of germ-cell tumor, atrophy or infertility.", "Individualized follow-up." ] } ] }, { "id": "escroto.c4", "grupo": "escroto", "nome": "Main differentials", "nota": null, "fonte": "AIUM-ACR-SPR-SRU / ACR acute scrotum / AUA / ESUR", "colunas": [ "Condition", "Useful findings", "Pitfall" ], "linhas": [ { "status": "red", "celulas": [ "Testicular torsion", "Reduced/absent flow, cord whirlpool, high-riding or horizontal testis, reactive edema.", "Residual flow may persist in partial torsion." ] }, { "status": "yellow", "celulas": [ "Torsion of testicular appendage", "Small avascular nodule near upper pole, peripheral reactive hyperemia.", "May mimic epididymitis." ] }, { "status": "yellow", "celulas": [ "Epididymitis/orchitis", "Enlarged epididymis, hyperemia, reactive hydrocele and skin thickening.", "Infarction/abscess makes it red." ] }, { "status": "red", "celulas": [ "Testicular tumor", "Solid intratesticular mass, usually hypoechoic and vascular; calcification/scar may indicate burned-out tumor.", "Do not routinely biopsy through the scrotum." ] }, { "status": "yellow", "celulas": [ "Hydrocele, hematocele or pyocele", "Simple fluid, internal echoes, septa, debris, clots or gas depending on etiology.", "Complex pyocele/hematocele with symptoms changes urgency." ] }, { "status": "red", "celulas": [ "Inguinoscrotal hernia", "Fat or bowel content, peristalsis, Valsalva and reducibility.", "Nonreducible bowel or ischemia is urgent." ] } ] } ] }, { "metodo": "US", "chave": "penis", "slug": "penis", "url": "https://sonoaireport.com/en/referencias-ultrassom/penis", "nome": "Penis / penile Doppler", "temPaginaPublica": true, "medidas": [ { "id": "penis.0", "grupo": "penis", "ruleId": null, "rotulo": "Minimum anatomic protocol", "valor": "high-frequency linear transducer; transverse and longitudinal planes", "unidade": null, "nota": "Assess corpora cavernosa, corpus spongiosum, glans, penile urethra when relevant, tunica albuginea, deep fascia, cavernosal arteries, dorsal arteries, and superficial/deep dorsal veins according to the clinical question.", "fonte": "RadioGraphics 2024 / University of Washington penile ultrasound protocol / Radiologia Brasileira", "faixas": [] }, { "id": "penis.1", "grupo": "penis", "ruleId": null, "rotulo": "Normal B-mode anatomy", "valor": "two dorsolateral corpora cavernosa + ventral corpus spongiosum", "unidade": null, "nota": "The tunica albuginea appears as a thin echogenic line around the erectile bodies; the cavernosal artery is usually seen in the center of each corpus cavernosum.", "fonte": "Translational Andrology and Urology / RadioGraphics", "faixas": [] }, { "id": "penis.2", "grupo": "penis", "ruleId": null, "rotulo": "Penile fracture", "valor": "tunica albuginea discontinuity + hematoma", "unidade": null, "nota": "A snap, sudden pain, detumescence, and bruising make the clinical diagnosis likely; ultrasound localizes the tear and measures hematoma. Hematuria, urinary retention, or air in the erectile bodies suggest urethral injury and change urgency.", "fonte": "Radiologia Brasileira 2019 / Translational Andrology and Urology 2017", "faixas": [ { "status": "green", "rotulo": "continuous tunica", "valor": "no deep hematoma", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "hematoma with intact tunica", "valor": "fracture mimic differential", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely fracture", "valor": "tunical defect", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "penis.3", "grupo": "penis", "ruleId": null, "rotulo": "Peyronie disease — plaque", "valor": "focal tunical thickening, fibrosis, or calcification", "unidade": null, "nota": "Report location, side, length, thickness, calcification/acoustic shadowing, relationship to septum and neurovascular bundle, curvature during induced erection when performed, and Doppler flow around the plaque if active phase is suspected.", "fonte": "AUA Peyronie guideline / RadioGraphics 2024 / Frontiers Pharmacol 2019", "faixas": [ { "status": "yellow", "rotulo": "noncalcified plaque", "valor": "may be active phase", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "calcification", "valor": "affects treatment planning", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "mass or atypical erosion", "valor": "do not assume Peyronie", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "penis.4", "grupo": "penis", "ruleId": null, "rotulo": "Ischemic priapism", "valor": "markedly reduced or absent cavernosal flow", "unidade": null, "nota": "This is a urologic emergency, especially with a painful erection lasting more than 4 hours. Doppler should be performed before aspiration when possible, because intervention may create reactive hyperemia and confuse interpretation.", "fonte": "EAU Priapism guideline / AUA-SMSNA Priapism guideline / Radiologia Brasileira", "faixas": [ { "status": "red", "rotulo": "emergency", "valor": "pain + rigidity + little/no flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate", "valor": "correlate with corporal blood gas", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "penis.5", "grupo": "penis", "ruleId": null, "rotulo": "Nonischemic / high-flow priapism", "valor": "high/turbulent flow, fistula, or pseudoaneurysm", "unidade": null, "nota": "Often follows perineal/penile trauma and is less painful. It is not the same emergency as ischemic priapism, but it is abnormal and Doppler localizes the fistula for guided compression, follow-up, or embolization.", "fonte": "EAU Priapism guideline / Radiologia Brasileira", "faixas": [] }, { "id": "penis.6", "grupo": "penis", "ruleId": null, "rotulo": "Superficial dorsal vein thrombosis", "valor": "noncompressible vein + echogenic thrombus + absent flow", "unidade": null, "nota": "Also called penile Mondor disease. It is usually benign/self-limited, but Doppler helps distinguish it from Peyronie disease, sclerosing lymphangitis, mass, and hematoma.", "fonte": "Radiologia Brasileira / Korean J Radiol / case literature", "faixas": [ { "status": "yellow", "rotulo": "usually self-limited abnormality", "valor": "confirm compressibility and flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "systemic signs or mass", "valor": "look for another cause", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "penis.7", "grupo": "penis", "ruleId": null, "rotulo": "Dynamic Doppler — technique", "valor": "measure cavernosal arteries at the base every 5 min up to 20-30 min", "unidade": null, "nota": "Record drug and dose, injection side, time, rigidity grade, peak systolic velocity, end-diastolic velocity, resistive index, and side-to-side difference. Doppler angle should be kept below 60 degrees.", "fonte": "EAU Erectile Dysfunction guideline / RadioGraphics 2024 / EPOS ECR 2024", "faixas": [] }, { "id": "penis.8", "grupo": "penis", "ruleId": null, "rotulo": "Post-stimulation peak systolic velocity", "valor": "strong green >35; divergent 30-35; abnormal <25", "unidade": "cm/s", "nota": "European guidance considers above 30 cm/s usually normal; radiology reviews use above 35 cm/s to exclude significant stenosis. Between 25 and 35 cm/s, interpret as a gray zone with rigidity, dose, anxiety, and timing.", "fonte": "EAU / Scientific Reports 2022 / RadioGraphics 2024", "faixas": [ { "status": "green", "rotulo": "strong normality", "valor": ">35 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "normal in some sources", "valor": "30–35 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate", "valor": "25–29 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely arterial insufficiency", "valor": "<25 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "penis.9", "grupo": "penis", "ruleId": null, "rotulo": "End-diastolic velocity", "valor": "<3 by European guidance; >5 suggests venous leak if arterial inflow is adequate", "unidade": "cm/s", "nota": "Veno-occlusive interpretation is reliable only when arterial response and rigidity are sufficient; anxiety and low dose may mimic venous leak.", "fonte": "EAU / RadioGraphics / EPOS ECR 2024", "faixas": [ { "status": "green", "rotulo": "strict normal", "valor": "<3 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "3–5 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely venous leak", "valor": ">5 cm/s com boa resposta arterial", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "penis.10", "grupo": "penis", "ruleId": null, "rotulo": "Resistive index", "valor": ">0.8 usually normal", "unidade": null, "nota": "Below 0.8 together with elevated end-diastolic velocity suggests veno-occlusive dysfunction; use cautiously if arterial response was poor.", "fonte": "EAU / RadioGraphics / EPOS ECR 2024", "faixas": [ { "status": "green", "rotulo": "normal", "valor": ">0,8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "0,75–0,80", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious", "valor": "<0,75 ou <0,8 com diástole elevada", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "penis.c0", "grupo": "penis", "nome": "Interactive assistant — penis and penile Doppler", "nota": "This tool is educational: it does not replace urologic evaluation, corporal blood gas in priapism, or treatment decisions. In prolonged painful priapism or penile fracture, communication should be immediate.", "fonte": "EAU / AUA-SMSNA / RadioGraphics / Radiologia Brasileira", "colunas": [], "linhas": [ { "status": "green", "celulas": [ "Green", "Peak systolic velocity above 35 cm/s on both sides, low end-diastolic velocity, resistive index above 0.8, adequate rigidity, and no critical anatomic findings." ] }, { "status": "yellow", "celulas": [ "Yellow", "Peak systolic velocity 25-35 cm/s, diastole 3-5 cm/s, incomplete rigidity, technique without vasoactive injection, plaque/calcification, superficial dorsal thrombosis, or nonischemic priapism." ] }, { "status": "red", "celulas": [ "Red", "Peak systolic velocity below 25 cm/s, diastole above 5 cm/s with good arterial inflow, low resistive index, ischemic priapism, high-flow fistula, fracture, suspicious mass, abscess, gas, or urethral sign." ] } ] }, { "id": "penis.c1", "grupo": "penis", "nome": "Dynamic Doppler — hemodynamic reading", "nota": null, "fonte": "EAU Erectile Dysfunction / RadioGraphics 2024 / EPOS ECR 2024", "colunas": [ "Parameter", "Green", "Yellow", "Red" ], "linhas": [ { "status": "green", "celulas": [ "Peak systolic velocity", ">35 cm/s", "25–35 cm/s", "<25 cm/s" ] }, { "status": "yellow", "celulas": [ "Cavernosal artery side difference", "<10 cm/s", ">10 cm/s with preserved velocities", ">10 cm/s with lower side <25 cm/s" ] }, { "status": "yellow", "celulas": [ "End-diastolic velocity", "<3 cm/s", "3–5 cm/s", ">5 cm/s persistent if arterial inflow is adequate" ] }, { "status": "yellow", "celulas": [ "Resistive index", ">0,8", "0,75–0,8", "<0.75 or <0.8 with elevated diastole" ] }, { "status": "yellow", "celulas": [ "Rigidity", "complete or sufficient rigidity", "tumescence or partial rigidity", "no response despite adequate technique" ] } ] }, { "id": "penis.c2", "grupo": "penis", "nome": "Emergencies and differentials", "nota": null, "fonte": "Radiologia Brasileira / RadioGraphics / AUA / EAU", "colunas": [ "Condition", "Ultrasound findings", "Practical message" ], "linhas": [ { "status": "red", "celulas": [ "Penile fracture", "Focal tunica albuginea defect, adjacent hematoma, sometimes urethra/corpus spongiosum involved.", "Surgical emergency in most cases; localize the tear." ] }, { "status": "red", "celulas": [ "Ischemic priapism", "Absent or high-resistance cavernosal flow, rigid and painful corpora cavernosa.", "Emergency; do not delay treatment." ] }, { "status": "red", "celulas": [ "High-flow nonischemic priapism", "Arteriocavernosal fistula, pseudoaneurysm, turbulence and low-resistance flow.", "Usually not ischemic, but abnormal and may need embolization." ] }, { "status": "yellow", "celulas": [ "Penile Mondor disease", "Noncompressible superficial dorsal vein with thrombus and absent flow.", "Usually self-limited; distinguish from plaque, mass, and lymphangitis." ] }, { "status": "yellow", "celulas": [ "Peyronie disease", "Tunica albuginea plaque, thickening, fibrosis, calcification, or acoustic shadowing.", "Measure and map; Doppler helps if erectile dysfunction is also present." ] }, { "status": "red", "celulas": [ "Deep infection or abscess", "Collection, hyperemia, gas, skin/fascial thickening, or perineal extension.", "May be an emergency, especially with gas or suspected Fournier disease." ] }, { "status": "red", "celulas": [ "Suspicious mass", "Irregular solid lesion, glans/foreskin, local invasion, vascularity, or suspicious nodes.", "Do not label as plaque; refer for workup." ] } ] }, { "id": "penis.c3", "grupo": "penis", "nome": "Structured report checklist", "nota": null, "fonte": "EAU / AUA-SMSNA / RadioGraphics", "colunas": [ "Block", "What to report", "Why it matters" ], "linhas": [ { "status": "green", "celulas": [ "Technique", "Transducer, planes, ventral/dorsal approach, color/spectral Doppler and Doppler angle.", "Avoids wrong measurements from angle or sampling." ] }, { "status": "yellow", "celulas": [ "Dynamic Doppler", "Drug, dose, injection side, timing of measurements and rigidity grade.", "Without this, velocity and venous leak can be false." ] }, { "status": "yellow", "celulas": [ "Plaques/fibrosis", "Location by surface/third, size, calcification, shadowing and septal relationship.", "Helps urology plan treatment." ] }, { "status": "red", "celulas": [ "Trauma", "Tunica integrity, hematoma, corpus spongiosum, urethra and cavernosal vascularity.", "Defines urgency and surgical map." ] }, { "status": "red", "celulas": [ "Priapism", "Ischemic versus nonischemic, cavernosal flow, fistula/pseudoaneurysm and whether it was before aspiration.", "Completely changes management." ] } ] } ] }, { "metodo": "US", "chave": "obstetrico_1tri", "slug": "obstetrico-1tri", "url": "https://sonoaireport.com/en/referencias-ultrassom/obstetrico-1tri", "nome": "Obstetric — 1st trimester", "temPaginaPublica": true, "medidas": [ { "id": "obstetrico_1tri.0", "grupo": "obstetrico_1tri", "ruleId": null, "rotulo": "Gestational sac visible (TV)", "valor": "≈ 5,0", "unidade": "wk", "nota": "2–3 mm sac", "fonte": "GLOWM / Ultrasoundpaedia", "faixas": [] }, { "id": "obstetrico_1tri.1", "grupo": "obstetrico_1tri", "ruleId": null, "rotulo": "Yolk sac visible", "valor": "MSD ≤ 10 mm", "unidade": null, "nota": "≈ 5.5–6 wk", "fonte": "GLOWM", "faixas": [] }, { "id": "obstetrico_1tri.2", "grupo": "obstetrico_1tri", "ruleId": null, "rotulo": "Embryo with heartbeat", "valor": "≈ 6", "unidade": "wk", "nota": "usually by MSD 25 mm", "fonte": "Radiology Key", "faixas": [] }, { "id": "obstetrico_1tri.3", "grupo": "obstetrico_1tri", "ruleId": null, "rotulo": "Embryonic HR — poor prognosis", "valor": "< 90", "unidade": "bpm", "nota": "in embryo < 8 wk", "fonte": "Medscape", "faixas": [] } ], "classificacoes": [ { "id": "obstetrico_1tri.c0", "grupo": "obstetrico_1tri", "nome": "Calculator — nuchal translucency (11–13+6 wk)", "nota": "Only measure in the CRL 45–84 mm window, mid-sagittal plane, neutral fetus, adequate magnification. Secondary markers: absent nasal bone, tricuspid regurgitation, ductus venosus reversed a-wave.", "fonte": "Fetal Medicine Foundation (FMF) / ISUOG guidelines", "colunas": [ "NT", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "< 3.0 mm (CRL 45–84 mm)", "Within expected; integrate into combined risk." ] }, { "status": "yellow", "celulas": [ "3,0–3,4 mm", "Above the 95th percentile for most CRLs; weigh in risk." ] }, { "status": "red", "celulas": [ "≥ 3,5 mm", "Increased risk (aneuploidy, cardiac, syndromes): counseling + diagnostic testing + fetal echo." ] } ] }, { "id": "obstetrico_1tri.c1", "grupo": "obstetrico_1tri", "nome": "Criteria for NONVIABLE pregnancy (2012 consensus)", "nota": "Diagnostic (definitive) criteria from the 2012 SRU consensus. \"Suspicious\" findings warrant a follow-up scan.", "fonte": "SRU Consensus 2012 (Doubilet et al.)", "colunas": [ "Finding", "Conclusion" ], "linhas": [ { "status": null, "celulas": [ "CRL ≥ 7 mm with NO heartbeat", "Nonviable" ] }, { "status": null, "celulas": [ "MSD ≥ 25 mm with NO embryo", "Nonviable" ] }, { "status": null, "celulas": [ "No embryo w/ HB ≥ 2 wk after sac without yolk sac", "Nonviable" ] }, { "status": null, "celulas": [ "No embryo w/ HB ≥ 11 days after sac with yolk sac", "Nonviable" ] } ] } ] }, { "metodo": "US", "chave": "carotida_cmi", "slug": "carotida-cmi", "url": "https://sonoaireport.com/en/referencias-ultrassom/carotida-cmi", "nome": "Carotid arteries — Doppler / plaque", "temPaginaPublica": true, "medidas": [ { "id": "carotida_cmi.0", "grupo": "carotida_cmi", "ruleId": null, "rotulo": "Peak systolic velocity — internal carotid artery", "valor": "<140 in the Brazilian standard for <50%", "unidade": "cm/s", "nota": "IAC 2023 uses <180 cm/s for normal or <50%; 140–179 cm/s is a yellow zone if other parameters do not confirm stenosis.", "fonte": "DIC/SBC-CBR-SBACV 2023 / IAC 2023 / SRU 2003", "faixas": [ { "status": "green", "rotulo": "Green — no plaque and low velocity", "valor": "<125–140 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow — SRU/Brazil/IAC divergence", "valor": "125–179 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — likely hemodynamic stenosis", "valor": "≥180 cm/s com placa/razão elevada; >230 cm/s alto grau", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "carotida_cmi.1", "grupo": "carotida_cmi", "ruleId": null, "rotulo": "End-diastolic velocity — internal carotid artery", "valor": "<40", "unidade": "cm/s", "nota": "Helps confirm the stenosis range when systolic velocity is not representative.", "fonte": "DIC/SBC-CBR-SBACV 2023 / SRU 2003", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "<40 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — 50% or more", "valor": "≥40 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — high grade", "valor": ">100 cm/s; >140 cm/s sugere 80–89% no padrão brasileiro", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "carotida_cmi.2", "grupo": "carotida_cmi", "ruleId": null, "rotulo": "Internal carotid / common carotid systolic ratio", "valor": "<2,0", "unidade": null, "nota": "Use the highest internal carotid systolic velocity at the stenosis and the common carotid systolic velocity in a representative segment away from plaque.", "fonte": "DIC/SBC-CBR-SBACV 2023 / IAC 2023 / SRU 2003", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "<2,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — 50–69%", "valor": "2,0–4,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — 70% or more", "valor": ">4,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "carotida_cmi.3", "grupo": "carotida_cmi", "ruleId": null, "rotulo": "Intima-media thickness", "valor": "≤0,9", "unidade": "mm", "nota": "Operational cutoff; the Brazilian recommendation prefers age-, sex- and ethnicity-specific percentiles when available and does not recommend routine measurement in the general population.", "fonte": "DIC/SBC-CBR-SBACV 2023 / SBC vascular ultrasound 2019 / Mannheim", "faixas": [ { "status": "green", "rotulo": "Green — usual", "valor": "≤0,9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow — thickened", "valor": ">0,9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — plaque by thickness", "valor": ">1,5 mm se focal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "carotida_cmi.4", "grupo": "carotida_cmi", "ruleId": null, "rotulo": "Carotid plaque — definition", "valor": "protrusion ≥0.5 mm or >50% of adjacent wall or >1.5 mm", "unidade": null, "nota": "Any one criterion is enough; plaque should not be called only intima-media thickening.", "fonte": "DIC/SBC-CBR-SBACV 2023 / Mannheim / Plaque-RADS 2024", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "no focal protrusion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "smooth/calcified plaque without relevant stenosis", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "ulcerated, predominantly echolucent plaque or stenosis ≥50%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "carotida_cmi.5", "grupo": "carotida_cmi", "ruleId": null, "rotulo": "Doppler angle for velocities", "valor": "≤60", "unidade": "degrees", "nota": "The angle should be corrected and no greater than 60 degrees whenever velocity is measured.", "fonte": "CBR technical ultrasound guideline / ACR-AIUM-SPR-SRU cerebrovascular parameter", "faixas": [] } ], "classificacoes": [ { "id": "carotida_cmi.c0", "grupo": "carotida_cmi", "nome": "Quick calculator — carotid stenosis by Doppler", "nota": "The calculator cross-checks DIC/SBC-CBR-SBACV 2023, IAC 2023 and SRU 2003. The final result must consider technique, Doppler angle, arrhythmia, tandem stenoses, contralateral occlusion and clinical correlation.", "fonte": "DIC/SBC-CBR-SBACV 2023 / IAC 2023 / SRU 2003", "colunas": [ "Color", "Result", "How to interpret" ], "linhas": [ { "status": "green", "celulas": [ "Green", "No hemodynamically significant stenosis", "Low velocities, internal/common ratio <2.0 and no relevant plaque." ] }, { "status": "yellow", "celulas": [ "Yellow", "Borderline or divergent zone", "Plaque without relevant stenosis, intima-media thickening, or velocity 125–179 cm/s without confirmation by ratio/plaque." ] }, { "status": "red", "celulas": [ "Red", "Abnormal stenosis or high risk", "Stenosis of 50% or more, near occlusion, occlusion, ulcerated plaque or predominantly echolucent plaque." ] } ] }, { "id": "carotida_cmi.c1", "grupo": "carotida_cmi", "nome": "Plaque-RADS — carotid plaque morphology classification", "nota": "Plaque-RADS complements, but does not replace, stenosis percentage. When multiple plaques are present, record the highest category and describe the dominant plaque.", "fonte": "Saba et al., JACC Cardiovascular Imaging 2024 / QIMS 2026 ultrasound validation", "colunas": [ "Category", "Main criterion", "Subtype / detail", "Color reading" ], "linhas": [ { "status": "green", "celulas": [ "1", "No atherosclerotic plaque.", "Wall without detectable plaque.", "Green — consensus morphologic normality." ] }, { "status": "yellow", "celulas": [ "2", "Plaque present with maximum wall thickness <3 mm.", "No intraplaque hemorrhage, cap rupture or intraluminal thrombus.", "Yellow — low-risk plaque, but not a normal wall." ] }, { "status": "yellow", "celulas": [ "3a", "Maximum wall or plaque thickness ≥3 mm.", "Thick/intact fibrous cap; no complicated feature.", "Yellow — intermediate risk." ] }, { "status": "yellow", "celulas": [ "3b", "Maximum thickness ≥3 mm with suspected thin fibrous cap.", "Ultrasound may suggest it; MRI better assesses a thin cap.", "Yellow — possible vulnerability; confirm in context." ] }, { "status": "red", "celulas": [ "3c", "Ulcerated plaque.", "Cavity/ulcerated surface communicating with the lumen.", "Red — abnormal risk morphology." ] }, { "status": "red", "celulas": [ "4a", "Intraplaque hemorrhage.", "Complicated feature; ultrasound may be limited.", "Red — complicated plaque." ] }, { "status": "red", "celulas": [ "4b", "Fibrous cap rupture.", "Complicated feature.", "Red — complicated plaque." ] }, { "status": "red", "celulas": [ "4c", "Intraluminal thrombus.", "Complicated feature.", "Red — complicated plaque." ] } ] }, { "id": "carotida_cmi.c2", "grupo": "carotida_cmi", "nome": "Internal carotid stenosis — Brazil 2023 (NASCET)", "nota": "Use the NASCET method for the reported percentage. Systolic velocity is the primary criterion; diastolic velocity and ratios confirm when velocity is affected by hemodynamic factors.", "fonte": "DIC/SBC + CBR + SBACV 2023", "colunas": [ "Stenosis", "Internal systolic velocity", "Internal diastolic velocity", "Internal/common systolic ratio", "Comment" ], "linhas": [ { "status": "yellow", "celulas": [ "<50%", "<140", "<40", "<2,0", "Not hemodynamically significant; if plaque is present, describe morphology." ] }, { "status": "yellow", "celulas": [ "50–59%", "140–230", "40–69", "2,0–3,1", "Range where there is divergence from IAC 2023 when systolic velocity is below 180 cm/s." ] }, { "status": "red", "celulas": [ "60–69%", "no own cutoff", "70–100", "3,2–4,0", "Use diastolic velocity and ratio as confirmation." ] }, { "status": "red", "celulas": [ "70–79%", ">230", ">100", ">4,0", "High-grade stenosis; differentiate from near occlusion." ] }, { "status": "red", "celulas": [ "80–89%", "no own cutoff", ">140", "no own cutoff", "Very high diastolic velocity supports high grade." ] }, { "status": "red", "celulas": [ ">90%", ">400", "no own cutoff", ">5,0", "Velocity may paradoxically fall if near occlusion is present." ] }, { "status": "red", "celulas": [ "Near occlusion", "variable — threadlike flow", "variable", "variable", "Diagnosis is morphologic/color Doppler-based; it does not depend on a fixed cutoff." ] }, { "status": "red", "celulas": [ "Occlusion", "absence of flow", "absence of flow", "not applicable", "No detectable patent lumen." ] } ] }, { "id": "carotida_cmi.c3", "grupo": "carotida_cmi", "nome": "IAC 2023 — modified internal carotid criteria", "nota": "IAC recognizes that 125–180 cm/s with ratio ≥2.0, significant plaque and post-stenotic turbulence may also be 50–69%.", "fonte": "IAC Vascular Testing Communication 2023", "colunas": [ "Category", "Internal systolic velocity", "Plaque estimate", "Internal/common systolic ratio", "Internal diastolic velocity" ], "linhas": [ { "status": "green", "celulas": [ "Normal", "<180", "none", "<2,0", "<40" ] }, { "status": "yellow", "celulas": [ "<50%", "<180", "<50%", "<2,0", "<40" ] }, { "status": "red", "celulas": [ "50–69%", "180–230", ">50%", "2,0–4,0", "40–100" ] }, { "status": "red", "celulas": [ ">70% up to before near occlusion", ">230", ">50%", ">4,0", ">100" ] }, { "status": "red", "celulas": [ "Near occlusion", "high, low or undetectable", "visible", "variable", "variable" ] }, { "status": "red", "celulas": [ "Total occlusion", "undetectable", "visible, no detectable lumen", "not applicable", "not applicable" ] } ] }, { "id": "carotida_cmi.c4", "grupo": "carotida_cmi", "nome": "SRU 2003 — classic criterion still found in services", "nota": "Kept for historical comparison; when used, state the standard adopted by the service.", "fonte": "SRU Consensus Conference 2003", "colunas": [ "Category", "Internal systolic velocity", "Internal diastolic velocity", "Internal/common systolic ratio" ], "linhas": [ { "status": "green", "celulas": [ "Normal", "<125", "<40", "<2,0" ] }, { "status": "yellow", "celulas": [ "<50%", "<125", "<40", "<2,0" ] }, { "status": "yellow", "celulas": [ "50–69%", "125–230", "40–100", "2,0–4,0" ] }, { "status": "red", "celulas": [ "70% or more up to near occlusion", ">230", ">100", ">4,0" ] }, { "status": "red", "celulas": [ "Near occlusion", "variable", "variable", "variable" ] }, { "status": "red", "celulas": [ "Occlusion", "no flow", "no flow", "not applicable" ] } ] }, { "id": "carotida_cmi.c5", "grupo": "carotida_cmi", "nome": "Plaque morphology and surface", "nota": "Plaque-RADS 2024 reinforces that plaque morphology/composition complements stenosis percentage, but does not yet replace hemodynamic grading.", "fonte": "DIC/SBC-CBR-SBACV 2023 / Plaque-RADS 2024", "colunas": [ "Item", "Finding", "Color reading" ], "linhas": [ { "status": "green", "celulas": [ "No plaque", "No focal protrusion and no focal thickening >1.5 mm.", "Green if velocities are normal." ] }, { "status": "yellow", "celulas": [ "Echogenic or calcified plaque", "Type III–V; calcification may cast shadow and limit measurement.", "Yellow if no stenosis ≥50%; red if it limits assessment or accompanies stenosis." ] }, { "status": "red", "celulas": [ "Predominantly echolucent plaque", "Type I–II; associated with greater vulnerability in several classifications.", "Red for morphologic risk." ] }, { "status": "yellow", "celulas": [ "Irregular surface", "Irregularity 0.4 to 2.0 mm deep.", "Yellow; describe in the report." ] }, { "status": "red", "celulas": [ "Ulceration", "Concavity/extension >2.0 mm by the de Bray criterion.", "Red; high morphologic risk." ] } ] }, { "id": "carotida_cmi.c6", "grupo": "carotida_cmi", "nome": "Technical checklist — carotid and vertebral arteries", "nota": "Avoid abbreviations in teaching text: write internal carotid, common carotid, systolic velocity, diastolic velocity and internal/common ratio.", "fonte": "CBR technical ultrasound guideline / ACR-AIUM-SPR-SRU extracranial cerebrovascular parameter", "colunas": [ "Step", "Record", "Reason" ], "linhas": [ { "status": "green", "celulas": [ "Longitudinal B-mode", "Intima-media thickness when indicated and plaque at bulb/bifurcation.", "Defines plaque and anatomic limitations." ] }, { "status": "green", "celulas": [ "Color or power Doppler", "Bulb, bifurcation, internal and external carotid arteries.", "Locates turbulence, near occlusion and residual flow." ] }, { "status": "green", "celulas": [ "Spectral Doppler", "Common carotid systolic velocity; internal carotid systolic and diastolic velocities.", "Allows ratio and NASCET grading." ] }, { "status": "yellow", "celulas": [ "Doppler angle", "Correct and keep at or below 60 degrees.", "Above this, velocity loses reliability." ] }, { "status": "yellow", "celulas": [ "Vertebral arteries", "Flow direction, spectral pattern and asymmetry; no universal numeric cutoffs in the Brazilian document.", "Assessment is qualitative and contextual." ] } ] } ] }, { "metodo": "US", "chave": "msk", "slug": "msk", "url": "https://sonoaireport.com/en/referencias-ultrassom/msk", "nome": "Musculoskeletal / soft tissue", "temPaginaPublica": true, "medidas": [ { "id": "msk.0", "grupo": "msk", "ruleId": null, "rotulo": "Soft-tissue mass — minimum documentation", "valor": "three measurements, layer, fascia, margins, composition and Doppler", "unidade": null, "nota": "include history, growth, pain, trauma, anticoagulation, punctum/discharge, reducibility and comparison when useful", "fonte": "BMUS 2024 / ESSR 2015 / SRU 2022", "faixas": [ { "status": "green", "rotulo": "complete", "valor": "two projections, three planes and Doppler", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "incomplete", "valor": "no layer, no fascia or no Doppler", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "unsafe", "valor": "calling benign without typical criteria", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "msk.1", "grupo": "msk", "ruleId": null, "rotulo": "Mass size", "valor": "<5 versus ≥5", "unidade": "cm", "nota": "5 cm is a classic trigger for MRI/specialist assessment, but smaller masses may still be malignant if deep, growing or atypical", "fonte": "ESSR 2015 / sarcoma guidelines / BMUS 2024", "faixas": [ { "status": "green", "rotulo": "small typical", "valor": "<5 cm and typical benignity", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "not decisive", "valor": "<5 cm but solid/indeterminate", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "alert", "valor": "≥5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "msk.2", "grupo": "msk", "ruleId": null, "rotulo": "Relationship to fascia and depth", "valor": "superficial, contacts fascia, crosses fascia or intramuscular/deep", "unidade": null, "nota": "below superficial fascia, intramuscular or not fully accessible by ultrasound favors MRI", "fonte": "ESSR 2015 / BMUS 2024", "faixas": [ { "status": "green", "rotulo": "typical superficial", "valor": "entirely subcutaneous and fully seen", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "fascial contact", "valor": "broad base or difficult deep margin", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "deep", "valor": "crosses fascia, intramuscular or not fully seen", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "msk.3", "grupo": "msk", "ruleId": null, "rotulo": "Typical cyst, ganglion or bursa", "valor": "anechoic, thin-walled, posterior enhancement, no solid component and no internal vascularity", "unidade": null, "nota": "if there are internal echoes, thick wall, nodularity or vascularity, it becomes indeterminate", "fonte": "ESSR 2015 / BMUS 2024 / SRU 2022", "faixas": [ { "status": "green", "rotulo": "typical", "valor": "pure avascular cystic", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "complex", "valor": "debris, thin septa or inflammatory context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "solid/nodular", "valor": "vascularized component", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "msk.4", "grupo": "msk", "ruleId": null, "rotulo": "Typical superficial lipoma", "valor": "oval/elliptic, well-defined, compressible, parallel to skin, echogenic or striated, without relevant vascularity", "unidade": null, "nota": "deep, large, heterogeneous, painful or growing lipoma should not be treated as simple", "fonte": "SRU 2022 / ESSR 2015 / BMUS 2024", "faixas": [ { "status": "green", "rotulo": "typical", "valor": "superficial and stable", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "atypical", "valor": "heterogeneous or symptomatic", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "not simple", "valor": "deep, ≥5 cm or rapid growth", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "msk.5", "grupo": "msk", "ruleId": null, "rotulo": "Collection, hematoma or abscess", "valor": "context + compressibility + internal echoes + peripheral Doppler", "unidade": null, "nota": "hematoma should decrease on follow-up; abscess often has pain, redness, fever or peripheral hyperemia", "fonte": "BMUS 2024 / Radiol Clin North Am 2019", "faixas": [ { "status": "green", "rotulo": "clear trauma", "valor": "regressing hematoma", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "complex collection", "valor": "follow-up or drainage by clinical context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "infection/expansion", "valor": "fever, gas, severe pain or growth", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "msk.6", "grupo": "msk", "ruleId": null, "rotulo": "Median nerve — wrist cross-sectional area", "valor": "<9–10", "unidade": "mm²", "nota": "≥10 mm² suggests carpal tunnel; interpret with symptoms and proximal/distal comparison", "fonte": "J Ultrasound Med / MSK ultrasound reviews", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "<9–10 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "10–12 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "enlarged", "valor": ">12 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "msk.7", "grupo": "msk", "ruleId": null, "rotulo": "Achilles tendon — thickness", "valor": "4–6", "unidade": "mm", "nota": ">7 mm suggests tendinopathy when associated with fibrillar-pattern loss, pain or hyperemia", "fonte": "IJSPT / AJR", "faixas": [] } ], "classificacoes": [ { "id": "msk.c0", "grupo": "msk", "nome": "Interactive assistant — soft tissue, differential and next steps", "nota": "Use as educational triage. The result lists possibilities, not a definitive diagnosis.", "fonte": "SRU Radiology 2022 / BMUS 2024 / ESSR 2015 / ACR 2022", "colunas": [ "Input", "How the app interprets it", "Limitation" ], "linhas": [ { "status": "green", "celulas": [ "Typical benign", "Simple cyst/ganglion, typical superficial lipoma, foreign body with compatible history or clear dynamic hernia.", "Use only if all typical criteria are present." ] }, { "status": "yellow", "celulas": [ "Indeterminate", "Nonlipomatous solid, complex collection, small but atypical mass, vascularity or nonconclusive anatomic relationship.", "Ultrasound should not close the diagnosis when there is overlap." ] }, { "status": "red", "celulas": [ "Suspicious or urgent", "Deep, larger than 5 cm, growing, fixed, invasive margins, disorganized vascularity, recurrence after excision or severe infectious signs.", "MRI/specialist referral according to local pathway." ] } ] }, { "id": "msk.c1", "grupo": "msk", "nome": "Differential by ultrasound pattern", "nota": null, "fonte": "SRU 2022 / BMUS 2024 / ESSR 2015", "colunas": [ "Pattern", "Common possibilities", "Sign that changes management" ], "linhas": [ { "status": "green", "celulas": [ "Pure avascular cystic", "Simple cyst, ganglion, distended bursa, synovial cyst.", "Solid component, mural nodule or internal vascularity." ] }, { "status": "green", "celulas": [ "Typical superficial fatty", "Superficial lipoma.", "Deep, ≥5 cm, heterogeneous, painful or growing." ] }, { "status": "yellow", "celulas": [ "Nonlipomatous solid", "Fibroma, nerve sheath tumor, giant cell tumor of tendon sheath, lymph node, scar endometriosis, fibromatosis.", "Infiltrative margins, growth or disorganized vascularity." ] }, { "status": "yellow", "celulas": [ "Complex collection", "Hematoma, seroma, abscess, Morel-Lavallée, complicated bursitis.", "Fever, redness, gas, severe pain, expansion or no regression." ] }, { "status": "yellow", "celulas": [ "Vascular or compressible", "Venous/lymphatic malformation, varix, pseudoaneurysm, hemangioma.", "Pulsatile arterial flow, fistula, thrombus or high flow." ] }, { "status": "yellow", "celulas": [ "Dynamic with Valsalva", "Hernia, muscle herniation, expansile varix.", "Entrapment, marked pain, nonreducible or compromised bowel loop." ] }, { "status": "yellow", "celulas": [ "Echogenic with shadow or foreign body", "Foreign body, granuloma, calcification, myositis ossificans, tophus.", "Intramuscular calcification or associated mass: radiography/MRI depending on context." ] }, { "status": "red", "celulas": [ "Deep or invasive mass", "Sarcoma and other aggressive tumors enter the differential until proven otherwise.", "MRI and oncology/sarcoma referral pathway." ] } ] }, { "id": "msk.c2", "grupo": "msk", "nome": "Warning signs — when not to close as benign", "nota": null, "fonte": "ESSR 2015 / BMUS 2024 / ACR 2022", "colunas": [ "Sign", "Why it matters", "Color" ], "linhas": [ { "status": "red", "celulas": [ "Larger than 5 cm", "Classic trigger for additional workup, especially if solid.", "Red" ] }, { "status": "red", "celulas": [ "Deep, intramuscular or crosses fascia", "Ultrasound may not see full extent; MRI is preferred.", "Red" ] }, { "status": "red", "celulas": [ "Rapid growth or post-excision recurrence", "Increases suspicion and changes biopsy/referral pathway.", "Red" ] }, { "status": "red", "celulas": [ "Invasive margins or disorganized vascularity", "Morphologic sign of aggressiveness, although not specific alone.", "Red" ] }, { "status": "yellow", "celulas": [ "Isolated pain", "May be inflammatory/traumatic, but is also a clinical warning sign if associated with a solid mass.", "Yellow" ] }, { "status": "yellow", "celulas": [ "Calcification", "Occurs in benign and malignant lesions; if in an extremity or within muscle, radiography helps.", "Yellow" ] } ] }, { "id": "msk.c3", "grupo": "msk", "nome": "Technical checklist — soft-tissue ultrasound", "nota": null, "fonte": "BMUS 2024 / ESSR 2015 / SRU 2022", "colunas": [ "Step", "Report", "Reason" ], "linhas": [ { "status": "green", "celulas": [ "Targeted history", "Duration, growth, pain, trauma, anticoagulation, fever/redness, punctum/discharge, reducibility and prior surgery/cancer.", "Changes the differential." ] }, { "status": "green", "celulas": [ "Anatomic location", "Side, exact point, layer: skin, subcutaneous, fascia, muscle, tendon, joint, vessel or nerve.", "Avoids a generic report." ] }, { "status": "green", "celulas": [ "Images and measurements", "Two orthogonal projections, three measurements, depth, image of deep margin and contralateral comparison if useful.", "Enables follow-up." ] }, { "status": "green", "celulas": [ "B-mode and Doppler", "Composition, echogenicity, margins, enhancement/shadowing, calcification, compressibility, peripheral/internal flow.", "Separates cystic, solid, inflammatory and vascular." ] }, { "status": "yellow", "celulas": [ "Dynamic maneuvers", "Compression, tendon/muscle motion, Valsalva, standing position when hernia/varix is a hypothesis.", "Shows functional relationship." ] }, { "status": "red", "celulas": [ "Safe conclusion", "Typical benign, indeterminate or suspicious; if indeterminate, clearly state that correlation/additional imaging is needed.", "Protects patient and physician." ] } ] } ] }, { "metodo": "US", "chave": "punho", "slug": "punho", "url": "https://sonoaireport.com/en/referencias-ultrassom/punho", "nome": "Wrist / hand (with and without Doppler)", "temPaginaPublica": true, "medidas": [ { "id": "punho.0", "grupo": "punho", "ruleId": null, "rotulo": "Minimum protocol without Doppler", "valor": "dorsal + volar + dynamic", "unidade": null, "nota": "Assess tendons in short and long axis, retinacula, radiocarpal/intercarpal joints, carpal tunnel, Guyon canal and painful point.", "fonte": "ESSR wrist guideline / AIUM MSK parameter", "faixas": [] }, { "id": "punho.1", "grupo": "punho", "ruleId": null, "rotulo": "Protocol with Doppler", "valor": "low scale and high gain without artifact", "unidade": null, "nota": "Use for synovitis, tenosynovitis, inflammatory arthritis, peritendinous hyperemia, vascular mass and infection; avoid excessive compression.", "fonte": "AIUM / OMERACT-EULAR", "faixas": [] }, { "id": "punho.2", "grupo": "punho", "ruleId": null, "rotulo": "Median nerve — cross-sectional area at the carpal tunnel", "valor": "<10", "unidade": "mm²", "nota": "Fixed cutoffs vary; 10–12 mm² is a gray zone and >12 mm² is more consistent with compressive neuropathy when symptoms match.", "fonte": "J Ultrasound Med / Frontiers Neurology / CTS reviews", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "<10 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "10–12 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "enlarged", "valor": ">12 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "punho.3", "grupo": "punho", "ruleId": null, "rotulo": "Median nerve — wrist/forearm ratio", "valor": "<1,4", "unidade": null, "nota": "Ratio ≥1.4 increases suspicion and reduces body-habitus variation; use wrist area divided by proximal forearm area.", "fonte": "Hobson-Webb / J Ultrasound Med", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "<1,4", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious", "valor": "≥1,4", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "punho.4", "grupo": "punho", "ruleId": null, "rotulo": "Median nerve — wrist-circumference adjusted limit", "valor": "0.88 × circumference − 4", "unidade": "mm²", "nota": "Alternative described to adjust the upper normal limit by wrist circumference in centimeters.", "fonte": "Frontiers Neurology 2021", "faixas": [] }, { "id": "punho.5", "grupo": "punho", "ruleId": null, "rotulo": "Ulnar nerve in Guyon canal", "valor": "no universal cutoff", "unidade": null, "nota": "Compare caliber, fascicles, compression, mass/cyst, ulnar artery, bifurcation into superficial sensory branch and deep motor branch.", "fonte": "ESSR wrist guideline / AIUM peripheral nerve", "faixas": [] }, { "id": "punho.6", "grupo": "punho", "ruleId": null, "rotulo": "Synovitis — OMERACT/EULAR scale", "valor": "0–3", "unidade": "B-mode and Doppler", "nota": "B-mode measures synovial hypertrophy; Doppler measures active vascularity. Interpret separately and with clinical context.", "fonte": "EULAR-OMERACT / SONAR RA recommendations", "faixas": [] } ], "classificacoes": [ { "id": "punho.c0", "grupo": "punho", "nome": "Interactive assistant — wrist, nerves and synovitis", "nota": "Use as educational triage. The final impression must integrate symptoms, physical exam, symptom distribution and clinical hypothesis.", "fonte": "ESSR / AIUM / EULAR-OMERACT / Frontiers Neurology", "colunas": [ "Input", "How to interpret", "Limitation" ], "linhas": [ { "status": "green", "celulas": [ "No synovitis and usual median nerve", "Nerve area <10 mm², no synovial Doppler, no tenosynovitis and no erosion.", "Correlate with symptoms; ultrasound does not exclude every neuropathy." ] }, { "status": "yellow", "celulas": [ "Gray zone", "Nerve 10–12 mm², isolated ratio ≥1.4, grade 1 synovitis, mild Doppler or tenosynovitis without aggressive signs.", "Needs clinical correlation, contralateral comparison and sometimes nerve conduction or rheumatology." ] }, { "status": "red", "celulas": [ "Relevant abnormal", "Nerve >12 mm² with high ratio/symptoms, Doppler grade 2–3, B-mode synovitis grade 2–3, erosion, tendon rupture or motor deficit.", "Do not close as incidental." ] } ] }, { "id": "punho.c1", "grupo": "punho", "nome": "Wrist extensor compartments — anatomic map", "nota": null, "fonte": "ESSR wrist technical guideline / Radiopaedia anatomy", "colunas": [ "Compartment", "Tendons", "Tips and common pathology" ], "linhas": [ { "status": "yellow", "celulas": [ "1", "Abductor pollicis longus + extensor pollicis brevis.", "De Quervain tenosynovitis; look for vertical septum and accessory tendons." ] }, { "status": "green", "celulas": [ "2", "Extensor carpi radialis longus + extensor carpi radialis brevis.", "Crossing point with the first compartment in the distal forearm: intersection syndrome." ] }, { "status": "yellow", "celulas": [ "3", "Extensor pollicis longus.", "Use Lister tubercle as landmark; rupture risk in rheumatoid arthritis or attrition." ] }, { "status": "yellow", "celulas": [ "4", "Extensor digitorum + extensor indicis proprius.", "Inflammatory tenosynovitis is common; dynamic maneuver separates tendons." ] }, { "status": "yellow", "celulas": [ "5", "Extensor digiti minimi.", "Small and ulnar; assess tenosynovitis and rupture in inflammatory arthritis." ] }, { "status": "yellow", "celulas": [ "6", "Extensor carpi ulnaris.", "Assess dynamic subluxation, tendinopathy, tenosynovitis and gout/crystal deposition." ] } ] }, { "id": "punho.c2", "grupo": "punho", "nome": "Volar side — carpal tunnel and Guyon canal", "nota": null, "fonte": "ESSR wrist technical guideline / AIUM MSK parameter", "colunas": [ "Structure", "Content / landmark", "What to look for" ], "linhas": [ { "status": "green", "celulas": [ "Proximal carpal tunnel", "Radial scaphoid and ulnar pisiform; median nerve superficial to flexor tendons.", "Median nerve area, fascicular edema, retinaculum, persistent median artery and bifid nerve." ] }, { "status": "green", "celulas": [ "Distal carpal tunnel", "Radial trapezium and ulnar hook of hamate.", "Flattening, retinacular bowing, cysts, flexor tenosynovitis and masses." ] }, { "status": "yellow", "celulas": [ "Flexor tendons inside the tunnel", "Four flexor digitorum superficialis, four flexor digitorum profundus and flexor pollicis longus.", "Flexor tenosynovitis, adhesion, partial tear and inflammatory trigger." ] }, { "status": "yellow", "celulas": [ "Guyon canal", "Ulnar artery radial to ulnar nerve; divide into superficial sensory and deep motor branches.", "Cyst/ganglion, ulnar artery thrombosis/aneurysm, compression at hamate hook and deep motor branch lesion." ] }, { "status": "yellow", "celulas": [ "Flexor carpi radialis tendon", "Radial, over scaphoid/trapezium, outside the main carpal tunnel.", "Tenosynovitis, tendinopathy and volar radial pain." ] }, { "status": "yellow", "celulas": [ "Flexor carpi ulnaris tendon", "Inserts on pisiform; reference for Guyon canal.", "Enthesopathy, calcification, crystal deposition and ulnar pain." ] } ] }, { "id": "punho.c3", "grupo": "punho", "nome": "Synovitis and rheumatoid arthritis — OMERACT/EULAR teaching scale", "nota": "In rheumatoid arthritis, report scanned joints, B-mode grade, Doppler grade, erosions, tenosynovitis and tendon rupture. Persistent Doppler may indicate activity even when clinical disease seems controlled.", "fonte": "EULAR-OMERACT / SONAR recommendations / AIUM", "colunas": [ "Grade", "B-mode: synovial hypertrophy", "Doppler: vascularity" ], "linhas": [ { "status": "green", "celulas": [ "0", "Absent: no synovial hypertrophy.", "Absent: no Doppler signal." ] }, { "status": "yellow", "celulas": [ "1", "Minimal: mild thickening without major bulging.", "Minimal: up to a few isolated spots/signals." ] }, { "status": "red", "celulas": [ "2", "Moderate: hypertrophy bulges beyond the bone line with flat or concave surface.", "Moderate: vascular signals in less than half of the synovial area." ] }, { "status": "red", "celulas": [ "3", "Severe: marked hypertrophy with convex surface.", "Severe: vascular signals in half or more of the synovial area." ] } ] }, { "id": "punho.c4", "grupo": "punho", "nome": "Main wrist differentials", "nota": null, "fonte": "ESSR / AIUM / EULAR-OMERACT / MSK reviews", "colunas": [ "Condition", "Useful ultrasound findings", "Comment" ], "linhas": [ { "status": "yellow", "celulas": [ "Carpal tunnel syndrome", "Enlarged median nerve, high wrist/forearm ratio, fascicular edema, distal flattening, retinacular bowing, intraneural hypervascularity.", "Correlate with sensory territory and nerve conduction when needed." ] }, { "status": "yellow", "celulas": [ "De Quervain tenosynovitis", "First-compartment sheath thickening, fluid, hyperemia and pain on dynamic compression.", "Look for septum between abductor pollicis longus and extensor pollicis brevis." ] }, { "status": "yellow", "celulas": [ "Intersection syndrome", "Friction/tenosynovitis where first-compartment tendons cross radial extensors in distal forearm.", "Pain is usually more proximal than De Quervain." ] }, { "status": "yellow", "celulas": [ "Ganglion/synovial cyst", "Cystic lesion with posterior enhancement, sometimes visible articular stalk, no internal flow.", "If complex, vascularized or solid, reclassify as indeterminate." ] }, { "status": "red", "celulas": [ "Inflammatory arthritis / rheumatoid arthritis", "B-mode synovitis, synovial Doppler, marginal erosions, flexor/extensor tenosynovitis and possible ruptures.", "Doppler and erosion make suspicion more relevant; integrate with serology and rheumatology." ] }, { "status": "yellow", "celulas": [ "Gout or crystal disease", "Heterogeneous tophi, shadowing, erosions, double contour on cartilage when visible, crystal tenosynovitis.", "May mimic infection or inflammatory arthritis." ] }, { "status": "red", "celulas": [ "Infection", "Collection, intense hyperemia, suspected purulent tenosynovitis, gas, cellulitis and marked pain.", "Clinical urgency; ultrasound helps locate collection and guide aspiration." ] }, { "status": "yellow", "celulas": [ "Ligament injury/triangular fibrocartilage complex", "Ultrasound partially assesses dorsal scapholunate ligament and ulnar triangular complex; use maneuvers and compare.", "MRI/MR arthrography may be needed." ] } ] } ] }, { "metodo": "US", "chave": "tornozelo_pe", "slug": "tornozelo-pe", "url": "https://sonoaireport.com/en/referencias-ultrassom/tornozelo-pe", "nome": "Ankle and foot", "temPaginaPublica": true, "medidas": [ { "id": "tornozelo_pe.0", "grupo": "tornozelo_pe", "ruleId": null, "rotulo": "Regional protocol", "valor": "anterior + medial + lateral + posterior + plantar + forefoot", "unidade": null, "nota": "Use a high-frequency linear transducer; assess long and short axis, painful point, dynamic maneuvers, contralateral comparison and Doppler when inflammatory pain, mass, tenosynovitis or infection is suspected.", "fonte": "AIUM Practice Parameter for Musculoskeletal Ultrasound; ESSR ankle and foot technical guideline", "faixas": [] }, { "id": "tornozelo_pe.1", "grupo": "tornozelo_pe", "ruleId": null, "rotulo": "Achilles tendon — anteroposterior thickness", "valor": "up to about 6", "unidade": "mm", "nota": "The limit varies by sex, age, sports load and measurement site. Thickness alone does not diagnose tendinopathy; values above 6 mm, hypoechogenicity, fibrillar loss, Doppler or focal pain increase suspicion.", "fonte": "Scientific Reports 2021 Achilles normative data; AIUM MSK parameter", "faixas": [ { "status": "green", "rotulo": "usual if echotexture is normal", "valor": "≤6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline/contextual", "valor": ">6–8 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely abnormal if symptomatic", "valor": ">8 mm ou defeito", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tornozelo_pe.2", "grupo": "tornozelo_pe", "ruleId": null, "rotulo": "Plantar fascia — thickness at calcaneal origin", "valor": "<4", "unidade": "mm", "nota": "Below 4 mm favors normality. Many studies use 4 mm as a sensitive cutoff; others find higher specificity with 4.5 to 5 mm. For safety, 4 to 4.9 mm is yellow and 5 mm or more is red when typical pain is present.", "fonte": "Musculoskeletal ultrasound plantar fasciitis reviews; IJGM 2024; POCUS/ACEP heel pain teaching", "faixas": [ { "status": "green", "rotulo": "strong normality", "valor": "<4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "4–4,9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "thickened if pain matches", "valor": "≥5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tornozelo_pe.3", "grupo": "tornozelo_pe", "ruleId": null, "rotulo": "Morton interdigital neuroma — largest axis", "valor": "size alone does not decide", "unidade": "mm", "nota": "Lesions larger than 5 mm are more likely clinically relevant, but small symptomatic neuromas and asymptomatic lesions exist. Pain, Mulder click, dynamic compression and relation to intermetatarsal bursa matter more than size alone.", "fonte": "Foot and ankle ultrasound reviews; Morton neuroma imaging studies", "faixas": [ { "status": "green", "rotulo": "less specific if isolated", "valor": "<4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "correlate with pain", "valor": "4–5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "probably relevant if symptomatic", "valor": ">5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tornozelo_pe.4", "grupo": "tornozelo_pe", "ruleId": null, "rotulo": "Synovitis and tenosynovitis — Doppler", "valor": "0–3", "unidade": "B-mode and Doppler", "nota": "Use low scale, high gain without artifact and minimal compression. Grade 1 may be contextual; Doppler or synovial hypertrophy grades 2-3 are abnormal in inflammatory context.", "fonte": "EULAR-OMERACT synovitis scoring; AIUM MSK parameter", "faixas": [ { "status": "green", "rotulo": "absent", "valor": "0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "mild/contextual", "valor": "1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "active/abnormal", "valor": "2–3", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tornozelo_pe.5", "grupo": "tornozelo_pe", "ruleId": null, "rotulo": "When ultrasound is not enough", "valor": "focal bone pain, inability to bear weight, occult fracture, osteomyelitis or surgical planning", "unidade": null, "nota": "Radiography, CT or MRI may be needed depending on trauma, diabetic foot, bone concern, surgical plantar plate concern or complex tear.", "fonte": "ACR Appropriateness Criteria chronic ankle pain / acute foot trauma; AIUM MSK parameter", "faixas": [] } ], "classificacoes": [ { "id": "tornozelo_pe.c0", "grupo": "tornozelo_pe", "nome": "Interactive assistant — ankle and foot", "nota": "The calculator is educational. It helps organize findings, but the final impression depends on the clinical question, physical examination, technique and contralateral comparison.", "fonte": "AIUM / ESSR / ACR Appropriateness Criteria / EULAR-OMERACT", "colunas": [ "Input", "How to use", "Limitation" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Achilles up to 6 mm, plantar fascia <4 mm, no defect, no synovial Doppler and no warning sign.", "Only valid if technique and clinical context agree." ] }, { "status": "yellow", "celulas": [ "Yellow", "Achilles >6-8 mm, fascia 4-4.9 mm, neuroma 4-5 mm, partial sprain, tenosynovitis or grade 1 synovitis.", "Compare, test dynamically and correlate with the painful point." ] }, { "status": "red", "celulas": [ "Red", "Tendon tear, dynamic instability, fascia ≥5 mm with typical pain, symptomatic neuroma >5 mm, synovitis/Doppler grade 2-3, infection, complicated diabetic foot or neurovascular compression.", "Do not close as a variant; describe extent and guide correlation/referral." ] } ] }, { "id": "tornozelo_pe.c1", "grupo": "tornozelo_pe", "nome": "Anatomic map by compartments", "nota": null, "fonte": "ESSR ankle and foot technical guideline / AIUM MSK parameter", "colunas": [ "Region", "Main structures", "Do not forget" ], "linhas": [ { "status": "green", "celulas": [ "Anterior", "Tibialis anterior, extensor hallucis longus, extensor digitorum longus, deep peroneal nerve and dorsalis pedis artery.", "Retinacula, tenosynovitis, dorsal ganglion and anterior impingement." ] }, { "status": "yellow", "celulas": [ "Medial", "Posterior tibial tendon, flexor digitorum longus, posterior tibial vessels, tibial nerve and flexor hallucis longus.", "Tarsal tunnel, posterior tibial tendinopathy, tenosynovitis and deltoid ligament." ] }, { "status": "yellow", "celulas": [ "Lateral", "Anterior talofibular ligament, calcaneofibular ligament, peroneus brevis and longus tendons.", "Sprain, tear, dynamic instability, peroneal subluxation and retinacular injury." ] }, { "status": "yellow", "celulas": [ "Posterior", "Achilles tendon, paratenon, retrocalcaneal bursa, subcutaneous bursa and calcaneal insertion.", "Insertional/non-insertional tendinopathy, partial/complete tear, bursitis and enthesopathy." ] }, { "status": "yellow", "celulas": [ "Plantar", "Plantar fascia, fat pad, aponeurosis, plantar muscles and superficial foreign body.", "Measure at the calcaneal origin; look for fibroma, tear, perifascial edema and spur without overvaluing it alone." ] }, { "status": "yellow", "celulas": [ "Forefoot and intermetatarsal spaces", "Plantar plates, bursae, interdigital neuroma, flexor/extensor tendons and metatarsophalangeal joints.", "Dynamic compression, Mulder sign, plantar plate and synovitis are essential." ] } ] }, { "id": "tornozelo_pe.c2", "grupo": "tornozelo_pe", "nome": "Tendon and ligament injury — color reading", "nota": null, "fonte": "AIUM MSK parameter / ESSR ankle-foot guideline / foot and ankle ultrasound reviews", "colunas": [ "Finding", "Interpretation", "Report action" ], "linhas": [ { "status": "green", "celulas": [ "Continuous fibers, preserved echotexture and no dynamic pain", "Usual pattern.", "Report assessed structures and limitation if present." ] }, { "status": "yellow", "celulas": [ "Thickening or hypoechogenicity without defect", "Tendinopathy/sprain; depends on pain, sport activity and comparison.", "Localize, measure and mention Doppler if present." ] }, { "status": "yellow", "celulas": [ "Tenosynovitis", "Fluid and/or synovial thickening of the sheath; Doppler weighs toward activity.", "State which tendon and extent of involved sheath." ] }, { "status": "red", "celulas": [ "Partial defect", "Partial tear or split; residual fibers still present.", "Measure length, thickness, estimated percentage and dynamic function." ] }, { "status": "red", "celulas": [ "Complete discontinuity or gap", "Complete tear until proven otherwise.", "Measure gap/retraction and communicate if acute or functionally relevant." ] }, { "status": "red", "celulas": [ "Dynamic subluxation of peroneal tendons", "Suggests superior retinaculum injury or lateral instability.", "Report position, maneuver and involved tendons." ] } ] }, { "id": "tornozelo_pe.c3", "grupo": "tornozelo_pe", "nome": "Heel and forefoot pain — useful differentials", "nota": null, "fonte": "Plantar fasciitis ultrasound reviews / AIUM / ACR foot trauma", "colunas": [ "Condition", "Ultrasound findings", "Watch for" ], "linhas": [ { "status": "green", "celulas": [ "Normal plantar fascia", "Thickness <4 mm, preserved fibrillar pattern, no marked perifascial edema.", "Green if pain and technique agree." ] }, { "status": "yellow", "celulas": [ "Early plantar fasciopathy", "4-4.9 mm, mild hypoechogenicity, focal pain or perifascial edema.", "Compare with the opposite side." ] }, { "status": "red", "celulas": [ "Typical plantar fasciopathy or tear", "≥5 mm at origin with typical pain, or focal defect/hematoma/retraction.", "Measure and describe extent." ] }, { "status": "yellow", "celulas": [ "Morton interdigital neuroma", "Fusiform hypoechoic nodule in the intermetatarsal space, moves with compression and may reproduce pain/click.", "Size alone is not enough." ] }, { "status": "red", "celulas": [ "Plantar plate tear", "Hypoechoic defect, dynamic instability, phalangeal subluxation or joint fluid.", "MRI may help if surgical planning is considered." ] }, { "status": "red", "celulas": [ "Diabetic foot or infected foreign body", "Collection, gas, sinus tract, foreign body, infectious tenosynovitis or bone contact.", "Prioritized communication." ] } ] }, { "id": "tornozelo_pe.c4", "grupo": "tornozelo_pe", "nome": "Report checklist — ankle and foot", "nota": null, "fonte": "AIUM / ESSR / ACR Appropriateness Criteria", "colunas": [ "Item", "How to report", "Why it matters" ], "linhas": [ { "status": "green", "celulas": [ "Clinical question", "Focal pain, trauma, instability, mass, metatarsalgia, fasciopathy, tendon or arthritis.", "Defines protocol and dynamic maneuver." ] }, { "status": "green", "celulas": [ "Precise location", "Side, region, structure, distance from landmark and relation to joint/tendon/nerve/vessel.", "Avoids a generic report." ] }, { "status": "green", "celulas": [ "Measurements and comparison", "Measure thickness, largest axis, gap, retraction, collection and compare with opposite side when useful.", "Enables follow-up and treatment decision." ] }, { "status": "yellow", "celulas": [ "Dynamic assessment", "Dorsiflexion, plantar flexion, eversion, inversion, interdigital compression, weight-bearing or directed maneuver according to hypothesis.", "Shows instability and reproduces pain." ] }, { "status": "yellow", "celulas": [ "Doppler", "Low scale, high gain without artifact, little compression and recording of hyperemia when present.", "Changes synovitis, tenosynovitis and infection reading." ] }, { "status": "red", "celulas": [ "Limitations and referral", "State when bone, occult fracture, osteomyelitis, complex injury or surgical planning requires another modality.", "Protects patient and physician." ] } ] } ] }, { "metodo": "US", "chave": "pelve_pediatrica", "slug": "pelve-pediatrica", "url": "https://sonoaireport.com/en/referencias-ultrassom/pelve-pediatrica", "nome": "Pediatric female pelvis", "temPaginaPublica": true, "medidas": [ { "id": "pelve_pediatrica.0", "grupo": "pelve_pediatrica", "ruleId": null, "rotulo": "Neonate (<3 months) — estrogenized uterus", "valor": "length ~2.5–3.5 cm; body/cervix ratio ~1:2; visible endometrium", "unidade": "cm", "nota": "maternal estrogen effect; involutes over the first weeks/months. A visible endometrium and small ovarian cysts are physiologic at this stage.", "fonte": "Radiologia Brasileira 2009 / StatPearls 2025 / Pediatric Radiology 2019", "faixas": [ { "status": "green", "rotulo": "neonatal pattern", "valor": "cervix-dominant, visible endometrium, expected involution", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "persistent", "valor": "prominent uterus not involuting on follow-up", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "mass/obstruction", "valor": "hydrometrocolpos, complicated or large ovarian cyst", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelve_pediatrica.1", "grupo": "pelve_pediatrica", "ruleId": "pelvic_ped.uterine_length", "rotulo": "Uterus — length by age", "valor": "prepubertal ≤4 cm; pubertal 5–8 cm", "unidade": "cm", "nota": "grows slowly until ~7–8 years and accelerates at puberty (Dixit: ~2.6 cm at 5y → 4.0 cm at 10y → 6.9 cm at 15–16y). Length >4–4.5 cm or a pubertal shape under age 8 favors early estrogenization.", "fonte": "Dixit 2021 / Gilligan (Pediatric Radiology 2019) / Herter (AJR 2002) / Kelsey 2016", "faixas": [ { "status": "green", "rotulo": "prepubertal", "valor": "≤4 cm and thickness <1 cm (tubular)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } }, { "status": "yellow", "rotulo": "borderline", "valor": "4–4.5 cm or thickness 1–1.5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } }, { "status": "green", "rotulo": "adolescent (pubertal)", "valor": "5–8 cm with fundal dominance", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMin": 8 } }, { "status": "red", "rotulo": "pubertal under 8 years", "valor": ">4.5 cm or thickness >1.5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } } ] }, { "id": "pelve_pediatrica.2", "grupo": "pelve_pediatrica", "ruleId": null, "rotulo": "Body/cervix ratio (fundus/cervix)", "valor": "neonate ~1:2; childhood ~1:1; pubertal 2:1–3:1", "unidade": null, "nota": "estrogenization marker: the fundus becomes dominant over the cervix with puberty. The ratio alone overlaps — combine with length, ovary and endometrium.", "fonte": "Dixit 2021 (FCR) / Radiologia Brasileira 2009 / StatPearls 2025", "faixas": [ { "status": "green", "rotulo": "tubular prepubertal", "valor": "≤1.2 (~1:1)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } }, { "status": "yellow", "rotulo": "transition", "valor": "1,2–1,4", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } }, { "status": "green", "rotulo": "adolescent (pubertal)", "valor": ">1.4 (2:1–3:1)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMin": 8 } }, { "status": "red", "rotulo": "fundal dominance under 8 years", "valor": ">1.4 (2:1–3:1)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } } ] }, { "id": "pelve_pediatrica.3", "grupo": "pelve_pediatrica", "ruleId": "pelvic_ped.ovary_volume", "rotulo": "Ovary — volume by age", "valor": "prepubertal <1–2 cm³; pubertal >3.5–4 cm³", "unidade": "cm³", "nota": "volume = 0.523 × L × W × D. Kelsey model: ~0.7 cm³ at age 2 → ~2.5 cm³ at 10 → ~7.7 cm³ at 20. There is substantial overlap between prepubertal and early pubertal.", "fonte": "Kelsey (PLoS ONE 2013) / Dixit 2021 / Gilligan 2019 / Herter (AJR 2002)", "faixas": [ { "status": "green", "rotulo": "prepubertal", "valor": "<1–2 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } }, { "status": "yellow", "rotulo": "divergent", "valor": ">2–3,5 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } }, { "status": "green", "rotulo": "adolescent (pubertal)", "valor": ">3.5–4 cm³ (up to ~20 cm³)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMin": 8 } }, { "status": "red", "rotulo": "pubertal under 8 years", "valor": ">3,5–4 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": { "ageMax": 8 } }, { "status": "red", "rotulo": "investigate mass/cyst", "valor": ">20 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelve_pediatrica.4", "grupo": "pelve_pediatrica", "ruleId": null, "rotulo": "Pediatric endometrium", "valor": "prepubertal: not visible; pubertal: visible/cyclic", "unidade": null, "nota": "a visible endometrium is a specific estrogenization marker (~100% specificity, lower sensitivity). Visible in the neonate and at puberty is normal; under age 8 outside the neonatal period it is a warning sign.", "fonte": "Radiologia Brasileira 2009 / Gilligan 2019 / StatPearls 2025", "faixas": [ { "status": "green", "rotulo": "prepubertal", "valor": "not visible", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "thin line", "valor": "early transition — correlate", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "green", "rotulo": "pubertal/neonate", "valor": "visible/cyclic expected", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "visible under 8 years", "valor": "cyclic/thickened outside the neonatal period", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pelve_pediatrica.5", "grupo": "pelve_pediatrica", "ruleId": null, "rotulo": "Ovarian follicles and cysts", "valor": "small follicles/microcysts are physiologic at any pediatric age", "unidade": "mm", "nota": "small follicles do not indicate puberty; a dominant unilateral cyst changes interpretation and may be functional.", "fonte": "Gilligan 2019 / StatPearls 2025", "faixas": [ { "status": "green", "rotulo": "usual childhood", "valor": "<9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual macrocystic", "valor": "9–20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "dominant/complex", "valor": ">20 mm or complex content/torsion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "pelve_pediatrica.c0", "grupo": "pelve_pediatrica", "nome": "Calculator — pediatric female pelvis by age", "nota": "The calculator reads each structure by age and flags early estrogenization when a pubertal finding appears under age 8. No single criterion is diagnostic — correlate with Tanner stage, growth curve and bone age, coordinating with pediatric endocrinology.", "fonte": "Gilligan (Pediatric Radiology 2019) / Dixit 2021 / Kelsey 2013/2016 / Herter (AJR 2002) / Radiologia Brasileira 2009", "colunas": [ "Structure", "Green (normal for age)", "Red (alert)" ], "linhas": [ { "status": "green", "celulas": [ "Uterine length", "≤4 cm prepubertal; grows with age up to 5–8 cm in adolescence (see table)", ">4.5 cm or pubertal shape under 8 years" ] }, { "status": "green", "celulas": [ "Body/cervix ratio", "~1:1 in childhood; 2:1–3:1 at puberty", ">1.4 (fundal dominance) under 8 years" ] }, { "status": "green", "celulas": [ "Ovarian volume", "<1–2 cm³ prepubertal; rises with age to >3.5 cm³ in adolescence (see table)", ">3.5–4 cm³ under 8 years; >20 cm³ investigate" ] }, { "status": "green", "celulas": [ "Endometrium", "not visible in childhood; visible at puberty/neonate", "visible/cyclic under 8 years (outside neonate)" ] } ] }, { "id": "pelve_pediatrica.c1", "grupo": "pelve_pediatrica", "nome": "Normal by age — uterus, ovary and body/cervix ratio", "nota": "Mean values (backbone Dixit 2021, cohort 5–16 years; neonate and 1–4 years from Radiologia Brasileira/Kelsey). These are means — use the green/yellow/red bands above and the clinical context; there is substantial overlap at early puberty.", "fonte": "Dixit (Pediatr Endocrinol Diabetes Metab 2021) / Kelsey (PLoS ONE 2013) / Radiologia Brasileira 2009", "colunas": [ "Age", "Uterine length (cm)", "Mean ovarian volume (cm³)", "Body/cervix ratio" ], "linhas": [ { "status": "green", "celulas": [ "Neonate", "2,5–3,5", "~1,0", "~1:2" ] }, { "status": "green", "celulas": [ "1–4 years", "<3,0", "~0,7–1,0", "~1:1" ] }, { "status": "green", "celulas": [ "5–6", "2,6", "0,5", "0,9" ] }, { "status": "green", "celulas": [ "6–7", "3,1", "0,6", "1,0" ] }, { "status": "green", "celulas": [ "7–8", "3,3", "0,8", "1,1" ] }, { "status": "green", "celulas": [ "8–9", "3,5", "1,3", "1,3" ] }, { "status": "green", "celulas": [ "9–10", "3,8", "1,8", "1,3" ] }, { "status": "green", "celulas": [ "10–11", "4,0", "2,0", "1,3" ] }, { "status": "green", "celulas": [ "11–12", "4,6", "2,1", "1,3" ] }, { "status": "green", "celulas": [ "12–13", "5,5", "3,0", "1,5" ] }, { "status": "green", "celulas": [ "13–14", "6,1", "3,5", "1,5" ] }, { "status": "green", "celulas": [ "14–15", "6,5", "4,4", "1,7" ] }, { "status": "green", "celulas": [ "15–16", "6,9", "4,6", "1,8" ] } ] } ] }, { "metodo": "US", "chave": "pediatrico", "slug": "pediatrico", "url": "https://sonoaireport.com/en/referencias-ultrassom/pediatrico", "nome": "Pediatric", "temPaginaPublica": true, "medidas": [ { "id": "pediatrico.0", "grupo": "pediatrico", "ruleId": null, "rotulo": "Pylorus — muscle thickness (HPS)", "valor": "> 3", "unidade": "mm", "nota": "small infants may have HPS with lower values", "fonte": "Medscape / Permanente J", "faixas": [] }, { "id": "pediatrico.1", "grupo": "pediatrico", "ruleId": null, "rotulo": "Pylorus — canal length (HPS)", "valor": "≥ 14–16", "unidade": "mm", "nota": null, "fonte": "Medscape", "faixas": [] }, { "id": "pediatrico.2", "grupo": "pediatrico", "ruleId": null, "rotulo": "Pylorus — diameter (HPS)", "valor": "> 12", "unidade": "mm", "nota": null, "fonte": "Medscape", "faixas": [] }, { "id": "pediatrico.3", "grupo": "pediatrico", "ruleId": "appendix.diameter", "rotulo": "Appendix — outer diameter", "valor": "≤ 6", "unidade": "mm", "nota": "≥ 6 mm and non-compressible = appendicitis (peds ~≥ 6.5 mm)", "fonte": "Radiology / StatPearls", "faixas": [] } ], "classificacoes": [ { "id": "pediatrico.c0", "grupo": "pediatrico", "nome": "Calculator — hypertrophic pyloric stenosis", "nota": "Correlate with non-bilious projectile vomiting and hypochloremic alkalosis. Borderline measurements → reassess in real time and repeat.", "fonte": "Hernanz-Schulman (Radiology) / ACR-SPR practice parameter", "colunas": [ "Measure", "Cutoff", "Reading" ], "linhas": [ { "status": "red", "celulas": [ "Muscle thickness", "≥ 3 mm", "Main criterion (≥2.5 mm in preterm/<3 weeks)." ] }, { "status": "red", "celulas": [ "Channel length", "≥ 15–17 mm", "Supports the diagnosis." ] }, { "status": "yellow", "celulas": [ "Pyloric diameter", "≥ 13 mm", "Supportive finding." ] }, { "status": "yellow", "celulas": [ "Functional", "No relaxation", "Observe 10–20 min in real time." ] } ] }, { "id": "pediatrico.c1", "grupo": "pediatrico", "nome": "Calculator — intussusception", "nota": "Reduction (hydrostatic/pneumatic enema) if the child is stable and without perforation/peritonitis; otherwise surgery. A pathologic lead point warrants workup.", "fonte": "ACR-SPR / Applegate (RadioGraphics)", "colunas": [ "Finding", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "Target <20 mm", "Probably transient ileo-ileal; observe." ] }, { "status": "yellow", "celulas": [ "Target 20–25 mm", "Indeterminate — reassess." ] }, { "status": "red", "celulas": [ "Target ≥25 mm (ileocolic)", "Usually requires enema reduction." ] }, { "status": "red", "celulas": [ "No flow / trapped fluid / lead point", "Ischemia or lower reduction success; caution." ] } ] }, { "id": "pediatrico.c2", "grupo": "pediatrico", "nome": "Graf — hip dysplasia (infant)", "nota": "Also assess the beta angle and femoral head coverage.", "fonte": "Graf method / Radiology Assistant", "colunas": [ "Type", "Alpha angle", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "I", "≥ 60°", "Normal/mature" ] }, { "status": null, "celulas": [ "IIa", "50–59°", "Physiologically immature (< 3 months)" ] }, { "status": null, "celulas": [ "IIb", "50–59°", "Delayed ossification (> 3 months)" ] }, { "status": null, "celulas": [ "IIc", "43–49°", "Dysplastic" ] }, { "status": null, "celulas": [ "III–IV", "< 43°", "Eccentric / dislocated" ] } ] } ] }, { "metodo": "US", "chave": "quadril_infantil", "slug": "quadril-infantil", "url": "https://sonoaireport.com/en/referencias-ultrassom/quadril-infantil", "nome": "Infant hip", "temPaginaPublica": true, "medidas": [ { "id": "quadril_infantil.0", "grupo": "quadril_infantil", "ruleId": null, "rotulo": "Ideal age and modality choice", "valor": "6 weeks to 4 months is usually the most useful window", "unidade": null, "nota": "Before 6 weeks physiologic laxity increases false positives unless the physical examination is abnormal. When femoral head ossification limits visualization of the relationship with the triradiate cartilage, pelvic radiography becomes preferred.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter 2023 / ACR Appropriateness Criteria", "faixas": [] }, { "id": "quadril_infantil.1", "grupo": "quadril_infantil", "ruleId": null, "rotulo": "Main indications", "valor": "Abnormal or equivocal physical examination, breech presentation, family history, neuromuscular condition, or treatment follow-up", "unidade": null, "nota": "Oligohydramnios, intrauterine postural molding, asymmetric thigh creases, and leg-length discrepancy are relative indications.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter 2023 / AAOS", "faixas": [] }, { "id": "quadril_infantil.2", "grupo": "quadril_infantil", "ruleId": null, "rotulo": "Standard coronal plane", "valor": "Straight iliac line + labrum + ilium/triradiate cartilage transition", "unidade": null, "nota": "The plane is reliable only when it shows a straight ilium, the labral tip, and the transition from ilium to triradiate cartilage; the acetabulum should be shown at its deepest point.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter 2023", "faixas": [] }, { "id": "quadril_infantil.3", "grupo": "quadril_infantil", "ruleId": null, "rotulo": "Alpha angle — bony roof", "valor": "Normal: >= 60°", "unidade": null, "nota": "It is the angle between the iliac baseline and the acetabular bony roof line. It measures bony roof depth/ossification and is the main angle for Graf classification.", "fonte": "Graf method / ACR-AIUM-SPR-SRU / International Hip Dysplasia Institute", "faixas": [ { "status": "green", "rotulo": "mature", "valor": "≥60°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "immature/age-dependent", "valor": "50–59° antes de 13 semanas", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "dysplastic", "valor": "<50° ou 50–59° após 13 semanas", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "quadril_infantil.4", "grupo": "quadril_infantil", "ruleId": null, "rotulo": "Beta angle — cartilaginous roof/labrum", "valor": "Helps separate Ia/Ib and IIc/D", "unidade": null, "nota": "It is the angle between the iliac baseline and the cartilaginous roof line, drawn from the acetabular bony rim to the labrum. Beta greater than 77° with alpha from 43° to 49° suggests decentering type D.", "fonte": "Graf method / Radiology Assistant", "faixas": [ { "status": "green", "rotulo": "Ia when alpha is normal", "valor": "<55°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Ib if alpha is normal", "valor": "≥55°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "type D if alpha 43–49°", "valor": ">77°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "quadril_infantil.5", "grupo": "quadril_infantil", "ruleId": null, "rotulo": "Femoral head coverage", "valor": "Practical consensus: >= 50% well covered", "unidade": null, "nota": "Some management criteria consider 45% or higher normal; therefore 45–49% is yellow. Less than 35% is dysplastic in appropriate-use criteria.", "fonte": "International Hip Dysplasia Institute / AAOS Appropriate Use Criteria / ACR references", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "≥50%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "normal in some sources / borderline", "valor": "35–49%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "dysplastic", "valor": "<35%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "quadril_infantil.6", "grupo": "quadril_infantil", "ruleId": null, "rotulo": "Dynamic stability", "valor": "Femoral head centered at rest and under gentle stress", "unidade": null, "nota": "In the transverse flexion view, assess ultrasound Barlow/Ortolani. More than 50% of the head should remain covered; below 45% suggests instability.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter / International Hip Dysplasia Institute", "faixas": [] } ], "classificacoes": [ { "id": "quadril_infantil.c0", "grupo": "quadril_infantil", "nome": "Teaching calculator — infant hip", "nota": null, "fonte": "Graf method / ACR-AIUM-SPR-SRU / AAOS AUC / IHDI", "colunas": [], "linhas": [ { "status": "green", "celulas": [ "Green", "Alpha >=60°, centered head, coverage >=50%, stable, and adequate standard plane." ] }, { "status": "yellow", "celulas": [ "Yellow", "Alpha 50–59° before 13 weeks, coverage 35–49%, borderline beta, transient neonatal instability, or incomplete technique." ] }, { "status": "red", "celulas": [ "Red", "Alpha <50°, alpha 50–59° after 13 weeks, coverage <35%, decentering/dislocation, persistent instability, or inadequate plane for conclusion." ] } ] }, { "id": "quadril_infantil.c1", "grupo": "quadril_infantil", "nome": "Graf classification — complete reading", "nota": null, "fonte": "Graf / Radiology Assistant / ACR Appropriateness Criteria", "colunas": [ "Type", "Criterion", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "I", "Alpha >=60°. Ia if beta <55°; Ib if beta >=55°.", "Mature hip; no imaging follow-up if clinical examination and context agree." ] }, { "status": "yellow", "celulas": [ "IIa", "Alpha 50–59° before 13 weeks.", "Physiologic immaturity. Follow local protocol; IIa− or worsening requires attention." ] }, { "status": "red", "celulas": [ "IIb", "Alpha 50–59° at 13 weeks or older.", "Dysplasia due to delayed maturation; coordinate with pediatric orthopedics according to protocol." ] }, { "status": "red", "celulas": [ "IIc", "Alpha 43–49° and beta <=77°, head still centered.", "Critical dysplasia even if centered; do not treat as simple immaturity." ] }, { "status": "red", "celulas": [ "D", "Alpha 43–49° and beta >77° or signs of decentering.", "Decentering hip; alert for treatment/referral." ] }, { "status": "red", "celulas": [ "III–IV", "Alpha <43° with eccentric or dislocated head; labrum displaced or interposed.", "Severe dislocation/subluxation. Priority communication." ] } ] }, { "id": "quadril_infantil.c2", "grupo": "quadril_infantil", "nome": "How to draw the angles", "nota": null, "fonte": "ACR-AIUM-SPR-SRU Practice Parameter / Graf method", "colunas": [ "Element", "How to draw it", "Common error" ], "linhas": [ { "status": "green", "celulas": [ "Iliac baseline", "Straight line tangential to the lateral iliac cortex in the standard coronal plane.", "Using an oblique image or curved ilium; this distorts alpha and beta." ] }, { "status": "green", "celulas": [ "Bony roof line", "Line from the acetabular bony rim to the inferior bony roof point, forming the alpha angle with the iliac line.", "Choosing the wrong rounded rim or measuring away from the deepest acetabulum." ] }, { "status": "yellow", "celulas": [ "Cartilaginous roof line", "Line from the acetabular bony rim to the functional center/tip of the labrum, forming the beta angle.", "Drawing from the bony roof instead of the bony rim; beta becomes artificial." ] }, { "status": "red", "celulas": [ "Inadequate plane", "If the labrum, straight ilium, or triradiate cartilage is not shown, classification should be withheld.", "Classifying despite no standard plane; this creates false normal or false dysplastic results." ] } ] }, { "id": "quadril_infantil.c3", "grupo": "quadril_infantil", "nome": "Coverage and dynamic stability", "nota": null, "fonte": "IHDI / AAOS AUC / ACR-AIUM-SPR-SRU", "colunas": [ "Finding", "Color", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Coverage >=50%", "Green", "Well covered by the international practical rule." ] }, { "status": "yellow", "celulas": [ "Coverage 45–49%", "Yellow", "Normal in some management criteria, but below the classic 50% cutoff." ] }, { "status": "yellow", "celulas": [ "Coverage 35–44%", "Yellow", "Borderline range in appropriate-use criteria; integrate with alpha and stability." ] }, { "status": "red", "celulas": [ "Coverage <35%", "Red", "Dysplastic in AAOS appropriate-use criteria." ] }, { "status": "red", "celulas": [ "Subluxable, dislocatable, or dislocated", "Red", "Stability weighs as much as morphology; communicate and correlate with physical examination." ] } ] }, { "id": "quadril_infantil.c4", "grupo": "quadril_infantil", "nome": "Minimum technical protocol", "nota": null, "fonte": "ACR-AIUM-SPR-SRU Practice Parameter 2023", "colunas": [ "Step", "What to record", "Color if absent" ], "linhas": [ { "status": "red", "celulas": [ "Both hips", "Right and left, even when the concern is unilateral.", "Red if only one side was assessed without justification." ] }, { "status": "red", "celulas": [ "Standard coronal neutral", "Morphology, femoral head position, and alpha angle.", "Red: do not assign Graf classification." ] }, { "status": "yellow", "celulas": [ "Transverse flexion view", "Femoral head on the ischium, position at rest and with gentle stress.", "Yellow/red according to clinical concern." ] }, { "status": "yellow", "celulas": [ "Dynamic maneuver", "Ultrasound Barlow; Ortolani if the head is subluxated/dislocated to assess reducibility.", "Yellow if omitted; acceptable to omit in Pavlik/splint." ] }, { "status": "green", "celulas": [ "Documentation", "Side, orientation, age, whether stress was applied, alpha, beta/coverage when used, stability, and limitations.", "Yellow if incomplete." ] } ] }, { "id": "quadril_infantil.c5", "grupo": "quadril_infantil", "nome": "Teaching pitfalls", "nota": null, "fonte": "ACR-AIUM-SPR-SRU / Radiology Assistant / Children’s Colorado", "colunas": [ "Situation", "Risk", "Practical action" ], "linhas": [ { "status": "yellow", "celulas": [ "Younger than 6 weeks", "Physiologic laxity can mimic instability.", "If physical examination is normal, follow local screening policy; if abnormal, scan and describe context." ] }, { "status": "yellow", "celulas": [ "Stable Graf IIa", "Many mature spontaneously, but some are IIa− or have low coverage.", "Do not call fully normal; recommend follow-up according to age/protocol." ] }, { "status": "red", "celulas": [ "Normal alpha with instability", "Mature morphology does not exclude dynamic subluxability.", "Report instability and correlate with orthopedics/physical examination." ] }, { "status": "red", "celulas": [ "Nonstandard plane", "Can change alpha and beta by several degrees.", "Repeat acquisition; if still limited, report as limited." ] }, { "status": "yellow", "celulas": [ "Using Pavlik harness or splint", "Stress should not be routinely applied.", "Document femoral head position in the device and omit stress." ] } ] } ] }, { "metodo": "US", "chave": "quadril_adulto", "slug": "quadril-adulto", "url": "https://sonoaireport.com/en/referencias-ultrassom/quadril-adulto", "nome": "Adult hip", "temPaginaPublica": true, "medidas": [ { "id": "quadril_adulto.0", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Minimum adult hip protocol", "valor": "anterior, lateral, medial, posterior and dynamic when indicated", "unidade": null, "nota": "Anteriorly, align the transducer with the femoral neck for the anterior recess and iliopsoas. Laterally, assess the greater trochanter, gluteus medius, gluteus minimus, fascia lata and bursae. Medially, assess adductors/distal iliopsoas. Posteriorly, assess proximal hamstrings and sciatic nerve.", "fonte": "AIUM-ACR-SPR-SRU musculoskeletal ultrasound parameter / ESSR hip technical guideline", "faixas": [] }, { "id": "quadril_adulto.1", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Transducer and depth", "valor": "highest frequency that penetrates adequately", "unidade": null, "nota": "Deep hip, obesity and arthroplasty may require a curvilinear or lower-frequency transducer. Use low-scale Doppler and light compression when the question is synovitis, infection or collection.", "fonte": "AIUM-ACR-SPR-SRU musculoskeletal ultrasound parameter", "faixas": [] }, { "id": "quadril_adulto.2", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Hip effusion — anterior capsule/femoral neck distance", "valor": "5–7", "unidade": "mm", "nota": "There is divergence: practical protocols use >5 mm or a 2 mm side difference; classic musculoskeletal literature uses 7 mm or more, and some osteoarthritis studies use 8 mm. Measure along the femoral neck axis and compare with the opposite side when possible.", "fonte": "Ann Rheum Dis 2000 / Emory Emergency Ultrasound / AJR 2003 / Scientific Reports 2020", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "<5 mm and no relevant asymmetry", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "5-6.9 mm or 1-1.9 mm side difference", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": ">=7 mm or >=2 mm side difference; urgency depends on fever, trauma, prosthesis or complex fluid", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "quadril_adulto.3", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Iliopsoas bursa", "valor": "normally collapsed/not visible", "unidade": null, "nota": "When visible, look for communication with the joint, pelvic extension, relation to femoral vessels and femoral nerve compression.", "fonte": "ESSR hip guideline / International Journal of Sports Physical Therapy 2024", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "not visible", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "simple distention or associated tendinopathy", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "complex, bulky, infected, hemorrhagic or with neural/vascular compression", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "quadril_adulto.4", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Peritrochanteric bursae", "valor": "normally not visible", "unidade": null, "nota": "Lateral hip pain is rarely just bursitis; greater trochanteric pain syndrome often involves gluteus medius or minimus tendinopathy, with or without bursa.", "fonte": "ESSR hip guideline / Br J Gen Pract 2017 review", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "bursa not visible and tendons preserved", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "simple bursa, tendinopathy or calcifications", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "complete tear, retraction, complex collection or possible infection", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "quadril_adulto.5", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Gluteus medius and minimus tendons", "valor": "fibrillar and continuous", "unidade": null, "nota": "Assess at the greater trochanter in long- and short-axis. Describe which tendon/facet is involved, thickening, hypoechogenicity, calcification, cleft, gap, retraction and Doppler.", "fonte": "AIUM-ACR-SPR-SRU / ESSR hip guideline / GTPS review", "faixas": [] }, { "id": "quadril_adulto.6", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Snapping hip — dynamic maneuver", "valor": "reproduce the movement causing the snap", "unidade": null, "nota": "Internal snapping usually involves iliopsoas over the iliopectineal/femoral prominence; external snapping involves fascia lata or gluteus maximus over the trochanter. If labral/intra-articular snapping is suspected, ultrasound is limited.", "fonte": "AIUM-ACR-SPR-SRU / IJSPT iliopsoas review / AJR dynamic snapping hip", "faixas": [] }, { "id": "quadril_adulto.7", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Osteoarthritis — ultrasound-accessible signs", "valor": "osteophytes, superficial deformity and effusion/synovitis", "unidade": null, "nota": "Ultrasound can show anterior osteophytes and deformity, but it does not replace radiography for osteoarthritis grading or MRI when cartilage/labrum are the question.", "fonte": "Scientific Reports 2020 / BMJ Open hip osteoarthritis ultrasound", "faixas": [] }, { "id": "quadril_adulto.8", "grupo": "quadril_adulto", "ruleId": null, "rotulo": "Painful hip arthroplasty", "valor": "effusion, collection, mass, pseudotumor and tendons", "unidade": null, "nota": "Ultrasound helps detect collections and guide aspiration when periprosthetic infection is suspected, but an isolated finding does not replace laboratory, radiographic and orthopedic correlation.", "fonte": "AIUM-ACR-SPR-SRU / AJR prosthetic hip infection sonography", "faixas": [] } ], "classificacoes": [ { "id": "quadril_adulto.c0", "grupo": "quadril_adulto", "nome": "Interactive assistant — adult hip ultrasound", "nota": "Fill measurements, fluid quality, Doppler, iliopsoas, lateral tendons, bursa, visible bone, posterior region, arthroplasty and alerts to generate a color reading.", "fonte": "AIUM-ACR-SPR-SRU / ESSR / Ann Rheum Dis / AJR / GTPS review", "colunas": [ "Input", "Output", "How to use" ], "linhas": [ { "status": "green", "celulas": [ "Normal measurements, nonvisible bursae, continuous tendons and no alert", "Green", "Use when the question is soft tissue/effusion and the regional protocol was documented." ] }, { "status": "yellow", "celulas": [ "5-6.9 mm recess, mild asymmetry, tendinopathy, simple bursitis or reproduced snapping", "Yellow", "Describe as contextual, compare with the opposite side and suggest complementary imaging if the question is deep." ] }, { "status": "red", "celulas": [ ">=7 mm, >=2 mm difference, complex fluid, arthroplasty collection, complete tear, fracture, deep mass or possible infection", "Red", "Communicate the relevant finding and route to guided aspiration, radiograph, CT, MRI or specialist assessment according to context." ] } ] }, { "id": "quadril_adulto.c1", "grupo": "quadril_adulto", "nome": "Anatomic roadmap by region", "nota": null, "fonte": "AIUM-ACR-SPR-SRU / ESSR hip technical guideline", "colunas": [ "Region", "What to assess", "Pitfalls" ], "linhas": [ { "status": "green", "celulas": [ "Anterior", "Hip recess, capsule, visible anterior labrum, iliopsoas, iliopsoas bursa, femoral vessels and femoral nerve when indicated.", "Do not call capsular thickness synovitis without seeing fluid/synovium; compare sides." ] }, { "status": "yellow", "celulas": [ "Lateral", "Greater trochanter, gluteus medius, gluteus minimus, fascia lata, gluteus maximus and bursae.", "Lateral pain is often gluteal tendinopathy with or without bursa, not just “bursitis”." ] }, { "status": "yellow", "celulas": [ "Medial", "Adductors, pubis, distal iliopsoas, pectineus and groin structures when the complaint allows.", "Hernia and athletic pubalgia may mimic hip-joint pain." ] }, { "status": "yellow", "celulas": [ "Posterior", "Proximal hamstrings, ischial tuberosity, gluteus maximus, sciatic nerve and deep masses.", "Deep window may be limited; do not exclude neural compression from an incomplete exam." ] }, { "status": "yellow", "celulas": [ "Dynamic", "Reproduce the movement causing snapping/pain: flexion, extension, rotation, abduction or adduction according to complaint.", "If the snap is intra-articular, labrum and loose bodies are better assessed by MRI." ] } ] }, { "id": "quadril_adulto.c2", "grupo": "quadril_adulto", "nome": "Hip effusion and synovitis — color reading", "nota": "In adults, ultrasound detects distention and guides aspiration, but small effusion may be difficult and etiology is not defined by ultrasound alone.", "fonte": "Ann Rheum Dis 2000 / AJR 2003 / Emory Emergency Ultrasound", "colunas": [ "Finding", "Green", "Yellow", "Red" ], "linhas": [ { "status": "yellow", "celulas": [ "Capsule/femoral neck distance", "<5 mm", "5-6.9 mm", ">=7 mm; some studies use 8 mm" ] }, { "status": "yellow", "celulas": [ "Contralateral comparison", "<1 mm difference", "1-1.9 mm", ">=2 mm in practical protocols; >=1 mm in some studies" ] }, { "status": "red", "celulas": [ "Fluid quality", "no fluid or simple trace", "simple effusion", "debris, septa, gas, pus, blood or suspicious postoperative setting" ] }, { "status": "yellow", "celulas": [ "Synovial Doppler", "no flow", "mild/moderate", "intense with fever, prosthesis, wound or disabling pain" ] } ] }, { "id": "quadril_adulto.c3", "grupo": "quadril_adulto", "nome": "Lateral hip pain — greater trochanteric pain syndrome", "nota": "Clinical review emphasizes that lateral trochanteric pain should not be reduced to “bursitis”; gluteal tendinopathy is common.", "fonte": "Br J Gen Pract 2017 / ESSR / AIUM", "colunas": [ "Structure", "Normal/low risk", "Caution", "High risk" ], "linhas": [ { "status": "yellow", "celulas": [ "Gluteus medius/minimus", "fibrillar and continuous", "thickening, hypoechogenicity, calcification or partial cleft", "complete tear, retraction or important atrophy" ] }, { "status": "yellow", "celulas": [ "Trochanteric bursa", "not visible", "small simple distention", "complex, hyperemic or possible infection" ] }, { "status": "yellow", "celulas": [ "Fascia lata/gluteus maximus", "smooth gliding", "reproduced external snapping", "disabling pain, associated tear or mass" ] } ] }, { "id": "quadril_adulto.c4", "grupo": "quadril_adulto", "nome": "Anterior pain, iliopsoas and snapping", "nota": null, "fonte": "ESSR / IJSPT iliopsoas review / AJR dynamic snapping hip", "colunas": [ "Pattern", "Ultrasound clue", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "Normal iliopsoas", "striated muscle, echogenic tendon and nonvisible bursa", "Green if pain is not reproduced and no collection is present." ] }, { "status": "yellow", "celulas": [ "Iliopsoas tendinopathy", "thickening, hypoechogenicity, focal pain or Doppler", "Describe along the course and relation with bursa." ] }, { "status": "yellow", "celulas": [ "Internal snapping", "iliopsoas tendon snaps dynamically during the maneuver", "Record movement used and whether it reproduced pain." ] }, { "status": "red", "celulas": [ "Complex/bulky bursa", "deep collection between iliopsoas and capsule, possibly extending to pelvis", "Assess infection, bleeding, joint communication and femoral compression." ] } ] }, { "id": "quadril_adulto.c5", "grupo": "quadril_adulto", "nome": "Painful arthroplasty and priority-changing findings", "nota": null, "fonte": "AIUM-ACR-SPR-SRU / AJR prosthetic hip infection sonography", "colunas": [ "Scenario", "Ultrasound finding", "Teaching action" ], "linhas": [ { "status": "red", "celulas": [ "Possible infection", "effusion/collection, complex fluid, hyperemia, wound or fever", "Communicate and consider guided aspiration according to local protocol." ] }, { "status": "red", "celulas": [ "Mass or pseudotumor", "periprosthetic mass, deep extension or neurovascular relation", "Measure, map extent and suggest complementary imaging." ] }, { "status": "red", "celulas": [ "Trauma or fracture", "cortical step, avulsion, deep hematoma or inability to bear weight", "Radiograph/CT or orthopedic assessment according to scenario." ] }, { "status": "yellow", "celulas": [ "Arthroplasty limitation", "artifact, shadowing, depth or pain prevents complete assessment", "Do not exclude deep complication; record limitation." ] } ] }, { "id": "quadril_adulto.c6", "grupo": "quadril_adulto", "nome": "Useful adult hip differential diagnoses", "nota": null, "fonte": "AIUM / ESSR / Ann Rheum Dis / GTPS review", "colunas": [ "Complaint", "Ultrasound possibilities", "When to remember another modality" ], "linhas": [ { "status": "yellow", "celulas": [ "Anterior/groin pain", "effusion, synovitis, iliopsoas, bursa, adductors, hernia or lymph node", "Labrum, cartilage, impingement and avascular necrosis require MRI/radiograph." ] }, { "status": "yellow", "celulas": [ "Lateral pain", "gluteal tendinopathy, bursa, external snapping, calcification or mass", "Lumbar/radicular pain may mimic trochanteric pain." ] }, { "status": "red", "celulas": [ "Posterior pain", "proximal hamstrings, sciatic nerve, hematoma or deep mass", "Neurologic deficit, deep mass or avulsion requires complementary imaging." ] }, { "status": "red", "celulas": [ "Fever or inability to bear weight", "effusion, synovitis, collection, abscess or complicated prosthesis", "Do not delay aspiration/urgent assessment when clinical concern is strong." ] } ] }, { "id": "quadril_adulto.c7", "grupo": "quadril_adulto", "nome": "Adult hip report checklist", "nota": null, "fonte": "Best-practice synthesis from AIUM / ESSR / AJR / clinical reviews", "colunas": [ "Item", "Question the report should answer" ], "linhas": [ { "status": "green", "celulas": [ "Technique", "Were side, transducer, assessed region, position, contralateral comparison and dynamic maneuver when indicated described?" ] }, { "status": "green", "celulas": [ "Measurements", "Were anterior recess, asymmetry, bursa, collection, mass or tendon gap measured when present?" ] }, { "status": "yellow", "celulas": [ "Limitations", "Does the report state that labrum, deep cartilage, impingement and deep bone are not well excluded by ultrasound?" ] }, { "status": "red", "celulas": [ "Alert", "Is there communication for possible infection, arthroplasty collection, complete tear, fracture, deep mass or neural compression?" ] } ] } ] }, { "metodo": "US", "chave": "arterial_mmii", "slug": "arterial-mmii", "url": "https://sonoaireport.com/en/referencias-ultrassom/arterial-mmii", "nome": "Arterial Doppler — limbs and arteriovenous fistula", "temPaginaPublica": true, "medidas": [ { "id": "arterial_mmii.0", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Abdominal aorta — diameter", "valor": "< 3", "unidade": "cm", "nota": "≥ 3 cm = aneurysm", "fonte": "Merck / USPSTF", "faixas": [] }, { "id": "arterial_mmii.1", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Common iliac artery — diameter", "valor": "≈ 8–10", "unidade": "mm", "nota": null, "fonte": "J Vasc Surg 1993", "faixas": [] }, { "id": "arterial_mmii.2", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Common femoral artery — diameter", "valor": "≈ 5–9", "unidade": "mm", "nota": null, "fonte": "Doppler US (ResearchGate)", "faixas": [] }, { "id": "arterial_mmii.3", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Lower-limb arterial protocol", "valor": "aorta, iliac, femoral, popliteal, tibial and dorsalis pedis arteries", "unidade": null, "nota": "Document peak systolic velocity, spectral waveform, color/aliasing and comparison with a normal proximal segment. When there is a focal jet, calculate the velocity ratio.", "fonte": "IAC Vascular Testing / StatPearls / SVU-SVM waveform consensus", "faixas": [] }, { "id": "arterial_mmii.4", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Upper-limb arterial protocol", "valor": "subclavian, axillary, brachial, radial, ulnar and palmar arch when indicated", "unidade": null, "nota": "For arteriovenous fistula planning, assess dominance, patency, calcification, diameter, reactive hyperemia and radial-ulnar/palmar communication according to local protocol.", "fonte": "ACR-AIUM-SRU vessel mapping / AIUM preoperative dialysis access", "faixas": [] }, { "id": "arterial_mmii.5", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Pre-fistula mapping — donor artery", "valor": "> 2,0", "unidade": "mm", "nota": "Arterial diameter above 2.0 mm is a common target for native arteriovenous fistula; below that, decisions depend on pulse, calcification, reactive hyperemia and surgical strategy.", "fonte": "KDOQI 2019 review / ACR-AIUM-SRU / AIUM", "faixas": [ { "status": "green", "rotulo": "good candidate", "valor": ">2.0 mm and no limiting calcification", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "1,5–2,0 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high technical risk", "valor": "<1.5 mm, occlusion or marked calcification", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "arterial_mmii.6", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Pre-fistula mapping — superficial vein", "valor": "> 2,5", "unidade": "mm", "nota": "Vein above 2.5 mm is a common target for arteriovenous fistula; for grafts, many protocols use vein above 4.0 mm. Compressibility, continuity and depth are as important as diameter.", "fonte": "KDOQI 2019 review / AIUM / ACR-AIUM-SRU", "faixas": [ { "status": "green", "rotulo": "favorable for fistula", "valor": ">2.5 mm, compressible and continuous", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "2,0–2,5 mm ou profundidade > 6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "unfavorable", "valor": "<2.0 mm, thrombosis or noncompressible", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "arterial_mmii.7", "grupo": "arterial_mmii", "ruleId": null, "rotulo": "Working arteriovenous fistula — access flow", "valor": "interpret with trend and clinical context", "unidade": "mL/min", "nota": "Older practical rules use 600 mL/min as a maturation target, but modern guidance emphasizes physical examination, dialysis performance, flow trend and focal stenosis findings.", "fonte": "KDOQI 2019 / AIUM postoperative hemodialysis access", "faixas": [] } ], "classificacoes": [ { "id": "arterial_mmii.c0", "grupo": "arterial_mmii", "nome": "Interactive assistant — stenosis, waveform and arteriovenous fistula", "nota": "Fill the cells below to obtain velocity ratio, likely stenosis grade, waveform reading, tardus-parvus suspicion and arteriovenous fistula triage.", "fonte": "StatPearls/NCBI / Society for Vascular Medicine / SVU-SVM / KDOQI", "colunas": [ "Input", "Output", "How to use" ], "linhas": [ { "status": "green", "celulas": [ "Velocity ratio <1.5 and multiphasic waveform", "Green", "Favors no hemodynamically relevant stenosis in the analyzed segment." ] }, { "status": "yellow", "celulas": [ "Ratio 1.5-1.99 or isolated biphasic/monophasic waveform", "Yellow", "Borderline zone: confirm angle, sampling at the jet, proximal reference segment and contralateral comparison." ] }, { "status": "red", "celulas": [ "Ratio >=2, distal tardus-parvus waveform, absent flow or thrombosis", "Red", "Treat as abnormal until proven otherwise; document location, highest velocity, ratio and distal waveform." ] } ] }, { "id": "arterial_mmii.c1", "grupo": "arterial_mmii", "nome": "Peripheral arterial stenosis by velocity ratio", "nota": "Ratio = peak systolic velocity at the jet or suspicious point divided by peak systolic velocity in the normal proximal segment. Specific segments, stents and grafts may require their own criteria.", "fonte": "StatPearls/NCBI Bookshelf / Society for Vascular Medicine / IAC", "colunas": [ "Interpretation", "Velocity ratio", "Note" ], "linhas": [ { "status": "green", "celulas": [ "No relevant stenosis", "< 1,5", "Multiphasic waveform and no focal aliasing favor normality in the segment." ] }, { "status": "yellow", "celulas": [ "Likely mild stenosis", "1,5–1,99", "Often estimated as 30-49%; confirm technique and avoid overcalling in isolation." ] }, { "status": "red", "celulas": [ "Hemodynamically significant stenosis", "2,0–4,0", "Compatible with at least 50% stenosis in many protocols; look for focal jet, turbulence and distal change." ] }, { "status": "red", "celulas": [ "Severe stenosis", "> 4,0", "Suggests greater than 75-80% stenosis when sampling is correct and morphology agrees." ] }, { "status": "red", "celulas": [ "Occlusion", "no demonstrable flow", "Confirm gain, scale, angle and collaterals before concluding; distal waveform may be reconstituted by collaterals." ] } ] }, { "id": "arterial_mmii.c2", "grupo": "arterial_mmii", "nome": "Peripheral arterial waveform patterns", "nota": null, "fonte": "SVU-SVM peripheral arterial waveform consensus / IAC", "colunas": [ "Pattern", "Color", "Practical meaning" ], "linhas": [ { "status": "green", "celulas": [ "Multiphasic with rapid systolic upstroke", "Green", "Expected pattern in healthy peripheral arteries, especially at rest." ] }, { "status": "yellow", "celulas": [ "Biphasic with preserved amplitude", "Yellow", "May be acceptable in some older patients or after vasodilation, but deserves comparison and context." ] }, { "status": "yellow", "celulas": [ "Low-resistance monophasic with still rapid upstroke", "Yellow", "May occur distally after exercise, inflammation, hyperemia or fistula; it is not always proximal stenosis." ] }, { "status": "red", "celulas": [ "Damped monophasic or tardus-parvus", "Red", "Slow upstroke, rounded peak and low amplitude suggest inflow disease or proximal stenosis." ] }, { "status": "red", "celulas": [ "Absent flow where flow should be present", "Red", "Consider occlusion, thrombosis, severe spasm or technical error; confirm with color, power Doppler and spectral Doppler." ] } ] }, { "id": "arterial_mmii.c3", "grupo": "arterial_mmii", "nome": "Arteriovenous fistula — pre-creation and follow-up", "nota": "Intervention decisions in hemodialysis access should not depend on a single velocity: integrate physical examination, cannulation difficulty, dialysis venous pressure, flow decline, arm swelling and access history.", "fonte": "KDOQI 2019 / AIUM postoperative hemodialysis access / ACR-AIUM-SRU", "colunas": [ "Scenario", "Green", "Yellow", "Red" ], "linhas": [ { "status": "green", "celulas": [ "Donor artery", ">2.0 mm, patent, adequate pulse and no limiting calcification", "1.5-2.0 mm or weak reactive hyperemia", "<1.5 mm, occlusion, severe calcification or relevant steal" ] }, { "status": "green", "celulas": [ "Candidate superficial vein", ">2.5 mm, compressible, continuous and favorable depth", "2.0-2.5 mm, depth >6 mm or short segment", "<2.0 mm, thrombosis, sclerosis or noncompressible" ] }, { "status": "yellow", "celulas": [ "Working fistula — access flow", "Functional, stable trend and usually >600 mL/min", "400-600 mL/min, progressive drop or very high flow without symptoms", "<400-500 mL/min with dysfunction, thrombosis, nonmaturation or very high flow with cardiac impact" ] }, { "status": "red", "celulas": [ "Fistula stenosis", "No focal jet, no critical turbulence and favorable physical examination", "Focal jet with ratio 2-3 or isolated finding without flow drop", "Ratio >3, marked jet, post-stenotic change, thrombus, aneurysm/pseudoaneurysm or clinical change" ] } ] } ] }, { "metodo": "US", "chave": "salivares", "slug": "salivares", "url": "https://sonoaireport.com/en/referencias-ultrassom/salivares", "nome": "Salivary glands", "temPaginaPublica": true, "medidas": [ { "id": "salivares.0", "grupo": "salivares", "ruleId": null, "rotulo": "Minimum protocol", "valor": "high-frequency linear transducer; transverse, longitudinal and anteroposterior planes; bilateral comparison; color/power Doppler in lesions", "unidade": null, "nota": "Assess parenchyma, echogenicity, ducts, stone, collection, mass, cervical lymph nodes and relationship with skin, masseter, mandible, oral floor and vessels. Every focal lesion should be measured in three axes.", "fonte": "ACR-AIUM-SPR-SRU Head and Neck 2022 / AIUM Head and Neck", "faixas": [] }, { "id": "salivares.1", "grupo": "salivares", "ruleId": null, "rotulo": "Parotid — approximate cut-surface area", "valor": "≈ 3–4", "unidade": "cm²", "nota": "Teaching value, not universal. Comparison with the opposite side, atrophy, post-treatment change, inflammation and body habitus matter more than an isolated cutoff.", "fonte": "Iowa Head and Neck Protocols", "faixas": [ { "status": "green", "rotulo": "teaching range", "valor": "3–4 cm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual", "valor": "outside range or asymmetry", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "salivares.2", "grupo": "salivares", "ruleId": null, "rotulo": "Submandibular — approximate cut-surface area", "valor": "≈ 1–2", "unidade": "cm²", "nota": "Teaching value. A small/atrophic gland may occur with age, chronic obstruction, Sjögren, radioiodine or radiation therapy; enlargement may be inflammatory/obstructive.", "fonte": "Iowa Head and Neck Protocols", "faixas": [ { "status": "green", "rotulo": "teaching range", "valor": "1–2 cm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "contextual", "valor": "outside range or asymmetry", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "salivares.3", "grupo": "salivares", "ruleId": null, "rotulo": "Main salivary duct", "valor": "normally not visible", "unidade": null, "nota": "A visible, dilated duct or transition point suggests obstruction/stenosis when associated with meal-related pain, stone, gland swelling or purulent secretion.", "fonte": "Iowa Head and Neck Protocols / AIUM Head and Neck", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "duct not visible and no obstructive symptoms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "isolated visible duct or suspected stenosis without stone", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "abnormal", "valor": "dilated duct with stone, meal pain, pus or collection", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "salivares.4", "grupo": "salivares", "ruleId": null, "rotulo": "Sialolithiasis", "valor": "intraductal echogenic focus with shadow/twinkle + proximal dilatation", "unidade": null, "nota": "Ultrasound sensitivity varies with stone size/location and ductal dilatation; a small stone without a dilated duct can be false negative. Calcification outside the duct may be a calcified node, phlebolith or vascular calcification.", "fonte": "AJR 2013 / PMC salivary calculi review / Radiopaedia", "faixas": [ { "status": "yellow", "rotulo": "suspicious", "valor": "calcification without clear ductal continuity", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "consensus abnormal", "valor": "intraductal stone with shadow/twinkle and dilated duct", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "salivares.5", "grupo": "salivares", "ruleId": null, "rotulo": "Focal salivary lesion", "valor": "measure three axes + Doppler + lymph nodes", "unidade": null, "nota": "Size alone does not define benignity. Irregularity, infiltration, extraglandular extension, facial palsy, suspicious nodes, rapid growth or progressive pain increase risk.", "fonte": "ACR-AIUM-SPR-SRU Head and Neck / salivary tumor imaging reviews", "faixas": [ { "status": "yellow", "rotulo": "indeterminate", "valor": "solid/cystic mass without aggressive signs", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high risk", "valor": "infiltrative margins, extension, facial nerve or suspicious nodes", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "salivares.c0", "grupo": "salivares", "nome": "Interactive assistant — salivary glands", "nota": null, "fonte": "ACR-AIUM-SPR-SRU Head and Neck / Iowa / OMERACT / AJR", "colunas": [], "linhas": [ { "status": "green", "celulas": [ "Green", "Homogeneous parenchyma, contralateral comparison without relevant asymmetry, duct not visible, no stone, mass, collection, suspicious node or clinical alert." ] }, { "status": "yellow", "celulas": [ "Yellow", "Isolated visible duct, mild/asymmetric change, mass without aggressive signs, cyst/ranula, OMERACT grade 1-2 without concordant clinical picture, post-treatment or technical limitation." ] }, { "status": "red", "celulas": [ "Red", "Intraductal stone with shadow/twinkle and dilatation, abscess/gas, complicated sialadenitis, infiltrative margins, extraglandular extension, facial palsy, suspicious nodes, rapid growth or high OMERACT in sicca/autoimmune context." ] } ] }, { "id": "salivares.c1", "grupo": "salivares", "nome": "Sjögren — OMERACT 0-3 per gland", "nota": "OMERACT is a structural per-gland scale. Recent studies explore 0-12 sum and 0-6 ordinal scores; high thresholds have higher specificity, but ultrasound does not replace clinical criteria, serology, sialometry or biopsy when needed.", "fonte": "OMERACT / RMD Open 2021 / Arthritis Res Ther 2026", "colunas": [ "Grade", "Finding", "Teaching color" ], "linhas": [ { "status": "green", "celulas": [ "0", "Normal/homogeneous parenchyma", "Green" ] }, { "status": "yellow", "celulas": [ "1", "Mild inhomogeneity without defined hypoechoic/anechoic areas", "Yellow" ] }, { "status": "yellow", "celulas": [ "2", "Moderate change with focal hypoechoic/anechoic areas surrounded by preserved parenchyma", "Yellow/Red by context" ] }, { "status": "red", "celulas": [ "3", "Severe change: diffuse hypo/anechoic areas involving the gland, fibrosis or fatty replacement", "Red when concordant with clinical/serologic context" ] } ] }, { "id": "salivares.c2", "grupo": "salivares", "nome": "Salivary obstruction — color reading", "nota": "Absence of a stone on ultrasound does not exclude treatable duct stenosis; duct dilatation has high predictive value for stenosis in sialendoscopy series.", "fonte": "Iowa Head and Neck Protocols / AJR 2013", "colunas": [ "Finding", "Green", "Yellow", "Red" ], "linhas": [ { "status": "green", "celulas": [ "Duct", "not visible", "isolated visibility or salivary stimulation changes caliber", "dilated with transition point, stone, pus or collection" ] }, { "status": "red", "celulas": [ "Stone", "absent", "calcification without clear ductal continuity", "intraductal focus with shadow/twinkle and proximal dilatation" ] }, { "status": "red", "celulas": [ "Infection", "no hyperemia/collection", "painful/hypervascular gland without collection", "abscess, gas, cellulitis, fever or purulent secretion" ] } ] }, { "id": "salivares.c3", "grupo": "salivares", "nome": "Salivary mass — differential and risk signs", "nota": null, "fonte": "ACR-AIUM-SPR-SRU Head and Neck / StatPearls / salivary tumor imaging reviews", "colunas": [ "Pattern", "Useful differentials", "What changes priority" ], "linhas": [ { "status": "yellow", "celulas": [ "Well-defined solid", "pleomorphic adenoma, Warthin tumor, intraparotid lymph node, oncocytoma", "measure 3 axes, Doppler and nodes; sampling according to local protocol" ] }, { "status": "yellow", "celulas": [ "Cystic", "ranula, sialocele, lymphoepithelial cyst, cystic node, abscess, cystic tumor", "complex content, hyperemia, gas or fever increase urgency" ] }, { "status": "red", "celulas": [ "Infiltrative/aggressive", "primary malignancy, metastasis, lymphoma, carcinoma ex pleomorphic adenoma", "irregular margins, extraglandular extension, facial palsy, rapid growth or suspicious nodes" ] }, { "status": "yellow", "celulas": [ "Bilateral/multifocal", "Warthin, Sjögren, HIV, IgG4-related disease, sarcoidosis, lymphoma", "integrate age, smoking, sicca, serology, HIV and distribution" ] } ] }, { "id": "salivares.c4", "grupo": "salivares", "nome": "Teaching report checklist", "nota": null, "fonte": "SonoAI synthesis from cited sources", "colunas": [ "Item", "Safety question" ], "linhas": [ { "status": "green", "celulas": [ "Coverage", "Which gland and side were assessed? Was contralateral comparison performed?" ] }, { "status": "yellow", "celulas": [ "Duct/stone", "Was the duct seen? Is there dilatation, transition point, stone with shadow/twinkle or meal-related pain?" ] }, { "status": "yellow", "celulas": [ "Focal lesion", "Was the lesion measured in three axes, with margins, content, Doppler, deep plane and nodes?" ] }, { "status": "yellow", "celulas": [ "Sjögren", "Were the four major glands scored when the question is sicca/Sjögren?" ] }, { "status": "red", "celulas": [ "Communication", "Were abscess/gas, facial palsy, extraglandular extension, suspicious nodes or infiltrative mass highlighted?" ] } ] } ] }, { "metodo": "US", "chave": "ombro", "slug": "ombro", "url": "https://sonoaireport.com/en/referencias-ultrassom/ombro", "nome": "Shoulder / rotator cuff", "temPaginaPublica": true, "medidas": [ { "id": "ombro.0", "grupo": "ombro", "ruleId": null, "rotulo": "Minimum shoulder protocol", "valor": "biceps, subscapularis, supraspinatus, infraspinatus, teres minor, bursa, acromioclavicular joint, posterior recess and dynamic maneuvers when indicated", "unidade": null, "nota": "Examine seated when possible, adapt to pain and range of motion, document in short and long axis and measure abnormalities in two orthogonal planes.", "fonte": "AIUM-ACR-SPR-SRU MSK ultrasound parameter / ESSR shoulder guideline", "faixas": [] }, { "id": "ombro.1", "grupo": "ombro", "ruleId": null, "rotulo": "Technique and positioning", "valor": "high-frequency linear transducer; forearm supinated for biceps; external rotation for subscapularis; hand in back pocket for supraspinatus; posterior sweep for infraspinatus and teres minor", "unidade": null, "nota": "Avoid anisotropy and remember that forced internal rotation may overestimate supraspinatus tear size.", "fonte": "ESSR shoulder technical guideline", "faixas": [] }, { "id": "ombro.2", "grupo": "ombro", "ruleId": null, "rotulo": "Subacromial-subdeltoid bursa — thickness/fluid", "valor": "<2", "unidade": "mm", "nota": "Normal fluid is rarely thicker than 2 mm and tends to be posterior; greater than 3 mm, fluid medial to the acromioclavicular joint or anterior to the humerus is abnormal.", "fonte": "White et al., J Comput Assist Tomogr 2006 / PubMed PMID 16628056", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "up to 2 mm, posterior, without hyperemia and without focal pain", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": ">2 to 3 mm or small context-dependent fluid", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": ">3 mm, anterior/medial fluid, complex content or hyperemia with inflammatory/infectious concern", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ombro.3", "grupo": "ombro", "ruleId": null, "rotulo": "Partial rotator cuff tear — Ellman depth", "valor": "<3 / 3–6 / >6", "unidade": "mm", "nota": "Also classify as articular-sided, bursal-sided or intrasubstance; measure depth and extent. Greater than 6 mm usually represents more than half tendon thickness.", "fonte": "Ellman 1990 / Shoulderdoc classification summary", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "no focal defect and continuous fibers", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "Ellman I <3 mm or Ellman II 3-6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "Ellman III >6 mm or more than 50% thickness", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ombro.4", "grupo": "ombro", "ruleId": null, "rotulo": "Full-thickness tear — essential measurements", "valor": "width in short axis + retraction in long axis", "unidade": null, "nota": "Describe involved tendons, communication with the bursa, retraction, width, muscle bulk and fatty infiltration when visible; compare with the opposite side when useful.", "fonte": "AIUM-ACR-SPR-SRU MSK ultrasound parameter", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "no tendon discontinuity", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "full-thickness defect, retraction or large/massive tear", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ombro.5", "grupo": "ombro", "ruleId": null, "rotulo": "Long head of biceps", "valor": "centered in the groove, fibrillar, without relevant sheath distention", "unidade": null, "nota": "Assess in short and long axis. Fluid, synovitis or hyperemia suggest tenosynovitis; subluxation/dislocation should raise concern for subscapularis or rotator interval injury.", "fonte": "AIUM-ACR-SPR-SRU MSK ultrasound parameter / ESSR", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "centered, fibrillar, without hyperemia", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "tenosynovitis, tendinopathy or mild fluid", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "subluxation, dislocation or tear", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ombro.6", "grupo": "ombro", "ruleId": null, "rotulo": "Shoulder Doppler", "valor": "bursa, biceps sheath, joint synovium and painful tendon", "unidade": null, "nota": "Color or power Doppler helps detect hyperemia in bursitis, tenosynovitis, synovitis, calcific crisis, postoperative repair or infection.", "fonte": "AIUM-ACR-SPR-SRU MSK ultrasound parameter", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "no hyperemia in the right context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "mild or moderate hyperemia without systemic signs", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "intense hyperemia with fever, wound, postoperative status, complex bursa or collection", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ombro.7", "grupo": "ombro", "ruleId": null, "rotulo": "Important limitations", "valor": "deep labrum, cartilage, bone marrow, complex instability and occult fracture", "unidade": null, "nota": "When the clinical question is deep or osseous, ultrasound should guide but not replace radiographs, MRI or CT according to context.", "fonte": "AIUM-ACR-SPR-SRU / ESSR", "faixas": [] } ], "classificacoes": [ { "id": "ombro.c0", "grupo": "ombro", "nome": "Interactive assistant — shoulder ultrasound", "nota": "Fill measurements and structures in the panel to generate color, critical points and next step. The assistant does not replace medical judgment or integration with radiographs/MRI.", "fonte": "AIUM-ACR-SPR-SRU / ESSR / PubMed / Ellman", "colunas": [ "Color", "How to interpret" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Thin bursa, continuous tendons, centered biceps, no effusion, no hyperemia and no critical limitation in completed fields." ] }, { "status": "yellow", "celulas": [ "Yellow", "Gray zone: tendinopathy, superficial/intermediate partial tear, small bursa, hyperemia without systemic signs, dynamic impingement or deep labral question." ] }, { "status": "red", "celulas": [ "Red", "Consensus abnormal or high-impact finding: bursa above 3 mm, full-thickness tear, Ellman III, biceps dislocation, muscle atrophy, pseudoparalysis, fever/infection, suspected fracture/dislocation." ] } ] }, { "id": "ombro.c1", "grupo": "ombro", "nome": "Anatomic structure-by-structure checklist", "nota": null, "fonte": "AIUM-ACR-SPR-SRU / ESSR shoulder guideline", "colunas": [ "Structure", "How to examine", "Do not forget" ], "linhas": [ { "status": "green", "celulas": [ "Long head of biceps", "Forearm supinated; short axis in the bicipital groove and long axis to the myotendinous junction.", "Confirm position in the groove, sheath fluid, hyperemia, subluxation, dislocation or tear." ] }, { "status": "green", "celulas": [ "Subscapularis", "Elbow at the side, external rotation; sweep from myotendinous junction to lesser tuberosity insertion.", "Dynamic maneuver helps detect biceps instability and subcoracoid impingement." ] }, { "status": "green", "celulas": [ "Supraspinatus", "Hand in back pocket or modified position according to pain; assess long and short axis while keeping the beam perpendicular.", "Compress the tendon to reveal a nonretracted tear; measure depth, extent and retraction when a defect is present." ] }, { "status": "green", "celulas": [ "Infraspinatus and teres minor", "Posterior sweep below the scapular spine, with internal and external rotation when useful.", "Look for atrophy, fatty infiltration, posterior tear and paralabral cyst at the spinoglenoid notch." ] }, { "status": "yellow", "celulas": [ "Bursa and dynamic impingement", "Assess the bursa at rest and during abduction in internal rotation if symptoms suggest impingement.", "Pain with bursal/tendon bunching is contextual; bursa above 3 mm is abnormal." ] }, { "status": "yellow", "celulas": [ "Acromioclavicular joint and posterior recess", "Transducer at the shoulder apex for the acromioclavicular joint; posterior transverse plane at the glenohumeral joint space.", "Describe osteoarthritis, synovitis, trauma, posterior effusion, paralabral cyst and indirect labral signs." ] } ] }, { "id": "ombro.c2", "grupo": "ombro", "nome": "Rotator cuff — color reading", "nota": null, "fonte": "AIUM-ACR-SPR-SRU / Ellman", "colunas": [ "Finding", "Green", "Yellow", "Red" ], "linhas": [ { "status": "green", "celulas": [ "Tendon and echotexture", "continuous fibers, compatible thickness/echotexture, no focal pain", "tendinopathy, calcification, hypoechogenicity or compression pain", "complete discontinuity, retraction or large defect" ] }, { "status": "yellow", "celulas": [ "Partial tear", "no focal defect", "Ellman I <3 mm or Ellman II 3-6 mm; state articular, bursal or intrasubstance side", "Ellman III >6 mm or more than 50% thickness" ] }, { "status": "red", "celulas": [ "Full-thickness tear", "not present", "suspicion limited by pain, anisotropy or incomplete window", "defect crossing full thickness, communication with bursa, retraction or massive tear" ] }, { "status": "red", "celulas": [ "Rotator cuff muscles", "preserved and symmetric bulk", "mild atrophy or difficult comparison", "evident atrophy/fatty infiltration, especially with tear" ] } ] }, { "id": "ombro.c3", "grupo": "ombro", "nome": "Bursa, biceps and Doppler — practical interpretation", "nota": null, "fonte": "PubMed PMID 16628056 / AIUM-ACR-SPR-SRU", "colunas": [ "Structure", "Green", "Yellow", "Red" ], "linhas": [ { "status": "red", "celulas": [ "Subacromial-subdeltoid bursa", "up to 2 mm, posterior, without hyperemia", ">2-3 mm or small context-dependent fluid", ">3 mm, anterior/medial fluid, complex content or marked hyperemia" ] }, { "status": "yellow", "celulas": [ "Long head of biceps", "centered, fibrillar, without relevant fluid", "tenosynovitis, tendinopathy or mild fluid", "subluxation, dislocation or tear" ] }, { "status": "yellow", "celulas": [ "Doppler", "no hyperemia in the right context", "mild/moderate hyperemia without systemic signs", "intense hyperemia with fever, wound, postoperative status, complex bursa or collection" ] }, { "status": "yellow", "celulas": [ "Acromioclavicular joint", "no focal pain or distention", "osteoarthritis, osteophytes or capsulitis/synovitis", "suspected separation/dislocation or infection" ] } ] }, { "id": "ombro.c4", "grupo": "ombro", "nome": "Useful shoulder differential diagnoses", "nota": null, "fonte": "AIUM-ACR-SPR-SRU / ESSR / MSK ultrasound reviews", "colunas": [ "Presentation", "Consider", "Role of ultrasound" ], "linhas": [ { "status": "yellow", "celulas": [ "Lateral pain and painful arc", "supraspinatus tendinopathy, bursitis, subacromial impingement, calcific tendinopathy", "assess cuff, bursa and dynamic maneuver; Doppler helps in active phase" ] }, { "status": "yellow", "celulas": [ "Anterior pain", "biceps, subscapularis, rotator interval, acromioclavicular joint", "confirm biceps in groove, fluid, hyperemia, subluxation and subscapularis tendon" ] }, { "status": "yellow", "celulas": [ "Global stiffness", "adhesive capsulitis, arthropathy, pain limitation, postoperative state", "ultrasound may show synovitis/bursa, but diagnosis is clinical and may require MRI" ] }, { "status": "red", "celulas": [ "Acute trauma or sudden strength loss", "complete tear, avulsion, occult fracture, dislocation, biceps injury", "measure tear and retraction; radiographs/MRI according to bone or surgical concern" ] }, { "status": "red", "celulas": [ "Neurologic weakness or atrophy", "suprascapular nerve compression, paralabral cyst, neuropathy, chronic tear", "look for cyst at the suprascapular/spinoglenoid notch and compare muscles" ] }, { "status": "red", "celulas": [ "Fever, wound or painful postoperative state", "infection, abscess, septic bursa, collection, retear", "Doppler, complex content and guided aspiration may change management" ] } ] }, { "id": "ombro.c5", "grupo": "ombro", "nome": "Teaching checklist for the shoulder report", "nota": null, "fonte": "AIUM-ACR-SPR-SRU / ESSR", "colunas": [ "Item", "Safety question" ], "linhas": [ { "status": "green", "celulas": [ "Structure-based protocol", "Were biceps, subscapularis, supraspinatus, infraspinatus/teres minor, bursa, acromioclavicular joint and posterior recess documented?" ] }, { "status": "yellow", "celulas": [ "Measurements", "Does a partial tear have depth and side? Does a full-thickness tear have width and retraction?" ] }, { "status": "yellow", "celulas": [ "Doppler and dynamics", "Was hyperemia documented when there was pain, bursa, fluid, postoperative state or inflammatory concern? Was impingement tested when indicated?" ] }, { "status": "red", "celulas": [ "Priority-changing findings", "Were full-thickness tear, Ellman III, bursa above 3 mm, biceps dislocation, fever, collection, pseudoparalysis or suspected fracture/dislocation highlighted?" ] }, { "status": "yellow", "celulas": [ "Limitations", "Was it stated when labrum, cartilage, deep bone, pain or mobility limited the examination?" ] } ] } ] }, { "metodo": "US", "chave": "joelho", "slug": "joelho", "url": "https://sonoaireport.com/en/referencias-ultrassom/joelho", "nome": "Knee", "temPaginaPublica": true, "medidas": [ { "id": "joelho.0", "grupo": "joelho", "ruleId": null, "rotulo": "Minimum knee protocol", "valor": "anterior, medial, lateral, posterior and dynamic", "unidade": null, "nota": "Document the suprapatellar recess, patellar and quadriceps tendons, collateral ligaments, accessible menisci, bursae, Baker cyst, popliteal fossa and dynamic comparison when useful.", "fonte": "ESSR knee technical guidelines / RadioGraphics knee US", "faixas": [] }, { "id": "joelho.1", "grupo": "joelho", "ruleId": null, "rotulo": "Effusion — suprapatellar recess", "valor": "3,6–6,0", "unidade": "mm", "nota": "There is no single cutoff: 3.6 mm increases sensitivity, 6 mm increases specificity; some services use 4 mm. Prefer longitudinal measurement with the knee around 30 degrees flexed.", "fonte": "J Diagn Med Sonogr 2020 / Arthritis Care & Research 2012", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "<2 mm without inflammatory context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "2-5.9 mm or cutoff disagreement", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "≥6 mm with fever, trauma, postoperative status or complex fluid", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "joelho.2", "grupo": "joelho", "ruleId": null, "rotulo": "Patellar tendon — thickness", "valor": "4–5", "unidade": "mm", "nota": "Thickness alone does not diagnose tendinopathy; correlate with hypoechogenicity, fibrillar loss, Doppler, enthesis and focal pain.", "fonte": "AJR 2001", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "4-5 mm with preserved echotexture", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": ">5 mm or focal thickening", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "joelho.3", "grupo": "joelho", "ruleId": null, "rotulo": "Quadriceps tendon — thickness", "valor": "no universal cutoff", "unidade": null, "nota": "Measurements vary with technique, sex, activity and measurement point. Use the calculator as a contextual alert, not as a standalone diagnosis.", "fonte": "Radiographics knee US / MSK ultrasound reviews", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "continuous fibers and no focal pain", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "thickening, hypoechogenicity or Doppler", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "complete discontinuity or retraction", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "joelho.4", "grupo": "joelho", "ruleId": null, "rotulo": "Meniscal extrusion", "valor": "3", "unidade": "mm", "nota": "Three millimeters is a practical but not absolute cutoff; loading, age, osteoarthritis, technique and MRI change interpretation.", "fonte": "Orthopedic Reviews 2023 / AJR meniscal extrusion / BLOKS", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "<2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "2-4.9 mm or degenerative context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "≥5 mm, especially with root-tear concern or advanced osteoarthritis", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "joelho.5", "grupo": "joelho", "ruleId": null, "rotulo": "Medial collateral ligament — thickness", "valor": "3,3–5,6", "unidade": "mm", "nota": "Range described at the femoral attachment. Thickening is more meaningful with edema, focal pain, fibrillar loss or instability.", "fonte": "Skeletal Radiology 1996", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "up to 5.6 mm at the femoral point with preserved fibers", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": ">5.6 mm or edema without tear", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "complete discontinuity or avulsion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "joelho.6", "grupo": "joelho", "ruleId": null, "rotulo": "Iliotibial band — thickness", "valor": "~1,1", "unidade": "mm", "nota": "Values above 2-3 mm, with edema or deep fluid near the lateral femoral condyle, favor iliotibial band syndrome.", "fonte": "Skeletal Radiology 2010 / RadioGraphics knee US", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "≤2 mm without edema", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": ">2-3 mm or dynamic lateral pain", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": ">3 mm with typical deep edema/fluid", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "joelho.7", "grupo": "joelho", "ruleId": null, "rotulo": "Baker's cyst", "valor": "neck between semimembranosus and medial gastrocnemius", "unidade": null, "nota": "A posterior cyst may drain knee fluid; absence of suprapatellar fluid does not exclude effusion when a Baker cyst is present.", "fonte": "ESSR knee guideline / RadioGraphics knee US / J Diagn Med Sonogr 2020", "faixas": [ { "status": "yellow", "rotulo": "Yellow", "valor": "simple or septated, without rupture signs", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "ruptured, dissecting into calf or mimicking thrombosis", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "joelho.8", "grupo": "joelho", "ruleId": null, "rotulo": "Prepatellar and pes anserine bursae", "valor": "normally not visible", "unidade": null, "nota": "Simple distension is usually contextual; complex content, gas, intense hyperemia or wound raises priority.", "fonte": "RadioGraphics knee US / MSK ultrasound reviews", "faixas": [] } ], "classificacoes": [ { "id": "joelho.c0", "grupo": "joelho", "nome": "Interactive assistant — knee ultrasound", "nota": "Fill measurements, synovium, tendons, menisci, ligaments, Baker cyst, posterior region and warning signs to generate a color reading.", "fonte": "ESSR / EULAR-OMERACT / J Diagn Med Sonogr / RadioGraphics", "colunas": [ "Input", "Output", "How to use" ], "linhas": [ { "status": "green", "celulas": [ "Measurements in range and no clinical alert", "Green", "Use when the minimum protocol was documented and a deep structure is not the main question." ] }, { "status": "yellow", "celulas": [ "Small effusion, mild synovitis, tendinopathy, simple bursitis or borderline meniscal extrusion", "Yellow", "Describe as contextual, compare with the opposite side when useful and suggest clinical correlation or MRI if the question is internal." ] }, { "status": "red", "celulas": [ "Possible infection, complete tear, fracture/avulsion, thrombosis/aneurysm, ruptured cyst or significant effusion in a risk context", "Red", "Communicate priority and route to orthopedics, rheumatology, vascular care or emergency according to the dominant pattern." ] } ] }, { "id": "joelho.c1", "grupo": "joelho", "nome": "Anatomic roadmap by compartment", "nota": null, "fonte": "ESSR knee technical guidelines / RadioGraphics", "colunas": [ "Compartment", "What to assess", "Pitfalls" ], "linhas": [ { "status": "green", "celulas": [ "Anterior", "Suprapatellar recess, quadriceps tendon, patellar tendon, Hoffa fat pad and prepatellar bursa.", "Fluid redistributes with flexion; also scan medial and lateral to the quadriceps tendon." ] }, { "status": "yellow", "celulas": [ "Medial", "Medial collateral ligament, peripheral medial meniscus, pes anserine region and osteophytes.", "Meniscal extrusion depends on loading, osteoarthritis and technique; do not diagnose root tear by ultrasound alone." ] }, { "status": "yellow", "celulas": [ "Lateral", "Iliotibial band, lateral complex, peripheral lateral meniscus, fibular head and common peroneal nerve.", "Anisotropy may mimic ligament injury; use long- and short-axis views." ] }, { "status": "yellow", "celulas": [ "Posterior", "Baker cyst, popliteal fossa, artery, vein, tibial nerve and common peroneal nerve.", "Ruptured cyst may mimic thrombosis; with calf swelling, perform compression venous assessment." ] } ] }, { "id": "joelho.c2", "grupo": "joelho", "nome": "Effusion and synovitis — color reading", "nota": "Effusion and synovitis are not synonyms: fluid may be mechanical/traumatic; synovial hypertrophy with Doppler suggests inflammatory activity.", "fonte": "J Diagn Med Sonogr 2020 / EULAR-OMERACT", "colunas": [ "Finding", "Green", "Yellow", "Red" ], "linhas": [ { "status": "yellow", "celulas": [ "Suprapatellar recess", "<2 mm and no synovitis", "2-5.9 mm or divergent cutoff", "≥6 mm with fever, trauma, postoperative status or complex fluid" ] }, { "status": "yellow", "celulas": [ "Greyscale synovium", "no hypertrophy", "grade 1-2", "grade 3 or exuberant synovial mass" ] }, { "status": "yellow", "celulas": [ "Synovial Doppler", "no flow", "few signals or moderate flow", "intense flow or associated infection concern" ] } ] }, { "id": "joelho.c3", "grupo": "joelho", "nome": "Simplified EULAR-OMERACT synovitis score", "nota": null, "fonte": "EULAR-OMERACT / RMD Open", "colunas": [ "Grade", "Greyscale", "Doppler", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "0", "no synovial hypertrophy", "no Doppler signal", "no active synovitis by score" ] }, { "status": "yellow", "celulas": [ "1", "minimal hypertrophy", "few punctate signals", "mild or early activity" ] }, { "status": "yellow", "celulas": [ "2", "moderate hypertrophy", "confluent flow in less than half of synovium", "probable inflammatory activity" ] }, { "status": "red", "celulas": [ "3", "marked hypertrophy", "flow in more than half of synovium", "important activity; correlate with inflammatory arthritis or infection according to context" ] } ] }, { "id": "joelho.c4", "grupo": "joelho", "nome": "Extensor mechanism and tendons", "nota": null, "fonte": "RadioGraphics knee US / AJR patellar tendon", "colunas": [ "Structure", "Normal/low risk", "Caution", "High risk" ], "linhas": [ { "status": "yellow", "celulas": [ "Patellar tendon", "4-5 mm, fibrillar and no Doppler", ">5 mm, hypoechogenicity, enthesopathy or Doppler", "complete tear or avulsion" ] }, { "status": "yellow", "celulas": [ "Quadriceps tendon", "continuous fibers", "thickening or partial tear", "complete discontinuity, retraction or extension inability" ] }, { "status": "yellow", "celulas": [ "Hoffa fat pad and prepatellar bursa", "no distension or hyperemia", "edema, simple bursitis or anterior impingement", "complex content, gas, wound or possible infection" ] } ] }, { "id": "joelho.c5", "grupo": "joelho", "nome": "Menisci, collateral ligaments and iliotibial band", "nota": null, "fonte": "Orthopedic Reviews / Skeletal Radiology / RadioGraphics", "colunas": [ "Structure", "Green", "Yellow", "Red" ], "linhas": [ { "status": "yellow", "celulas": [ "Meniscal extrusion", "<2 mm", "2-4.9 mm; 3 mm is practical, not absolute", "≥5 mm or root-tear/advanced osteoarthritis concern" ] }, { "status": "yellow", "celulas": [ "Medial collateral ligament", "continuous fibers; up to 5.6 mm at the described femoral point", "thickening, edema or partial tear", "complete tear or avulsion" ] }, { "status": "yellow", "celulas": [ "Lateral complex", "continuous fibers and no focal pain", "sprain, thickening or partial tear", "complete tear, avulsion or posterolateral instability" ] }, { "status": "yellow", "celulas": [ "Iliotibial band", "≤2 mm without deep edema", ">2-3 mm or dynamic pain", ">3 mm with typical deep edema/fluid" ] } ] }, { "id": "joelho.c6", "grupo": "joelho", "nome": "Posterior knee and differential diagnoses", "nota": null, "fonte": "ESSR / RadioGraphics knee US", "colunas": [ "Finding", "Ultrasound clue", "Teaching action" ], "linhas": [ { "status": "yellow", "celulas": [ "Baker's cyst", "typical neck between semimembranosus and medial gastrocnemius", "measure, describe simple/complex and look for effusion/synovitis" ] }, { "status": "red", "celulas": [ "Ruptured Baker's cyst", "fluid dissecting into calf", "differentiate from thrombosis, hematoma and cellulitis" ] }, { "status": "red", "celulas": [ "Popliteal thrombosis", "noncompressible vein or thrombus", "activate venous protocol; do not treat as isolated cyst" ] }, { "status": "red", "celulas": [ "Aneurysm or pseudoaneurysm", "pulsatile mass, yin-yang flow or arterial neck", "use Doppler and communicate vascular finding" ] }, { "status": "yellow", "celulas": [ "Ganglion or intraneural cyst", "relationship with common peroneal or tibial nerve", "document neural course and relation to fibular head" ] } ] }, { "id": "joelho.c7", "grupo": "joelho", "nome": "Knee report checklist", "nota": null, "fonte": "Best-practice synthesis from ESSR / EULAR-OMERACT / RadioGraphics", "colunas": [ "Item", "Question the report should answer" ], "linhas": [ { "status": "green", "celulas": [ "Technique", "Were transducer, compartments assessed, position/flexion and dynamic maneuvers described?" ] }, { "status": "green", "celulas": [ "Measurements", "Were effusion, tendons, meniscal extrusion, ligament thickening or cyst measured when present?" ] }, { "status": "yellow", "celulas": [ "Limitation", "Does the conclusion avoid excluding central meniscus, deep cartilage and cruciate ligaments when not assessable?" ] }, { "status": "red", "celulas": [ "Alert", "Is there a communication phrase for possible infection, complete tear, thrombosis/aneurysm or fracture/avulsion?" ] } ] } ] }, { "metodo": "US", "chave": "hernias", "slug": "hernias", "url": "https://sonoaireport.com/en/referencias-ultrassom/hernias", "nome": "Abdominal wall / hernias", "temPaginaPublica": true, "medidas": [ { "id": "hernias.0", "grupo": "hernias", "ruleId": null, "rotulo": "Technique — dynamic maneuver", "valor": "—", "unidade": null, "nota": "Valsalva / standing increase sensitivity (detect occult hernia)", "fonte": "AJR / ECR poster", "faixas": [] }, { "id": "hernias.1", "grupo": "hernias", "ruleId": null, "rotulo": "Transducer", "valor": "7,5–10", "unidade": "MHz", "nota": "linear; sens. 86–96%, spec. 77–96% (inguinal)", "fonte": "PMC", "faixas": [] } ], "classificacoes": [ { "id": "hernias.c0", "grupo": "hernias", "nome": "Hernia types — US location", "nota": "Diagnosis = contents (fat/bowel) crossing the fascial defect; measure the defect.", "fonte": "AJR 2006", "colunas": [ "Type", "Finding" ], "linhas": [ { "status": null, "celulas": [ "Indirect inguinal", "Antero-lateral to the spermatic cord" ] }, { "status": null, "celulas": [ "Direct inguinal", "Medial/posterior to the cord; conjoint tendon bulge on Valsalva" ] }, { "status": null, "celulas": [ "Femoral", "Medial to the femoral vein" ] }, { "status": null, "celulas": [ "Umbilical / epigastric / incisional", "Midline / scar defect, with sac and contents" ] } ] } ] }, { "metodo": "US", "chave": "regioes_inguinais", "slug": "regioes-inguinais", "url": "https://sonoaireport.com/en/referencias-ultrassom/regioes-inguinais", "nome": "Inguinal regions", "temPaginaPublica": true, "medidas": [ { "id": "regioes_inguinais.0", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Minimum groin protocol", "valor": "high-frequency linear + rest + dynamic maneuver", "unidade": null, "nota": "Use a high-frequency linear transducer and scan the painful point, inguinal canal, femoral region, femoral vessels and contralateral side when the finding is equivocal. Valsalva, coughing and upright scanning increase sensitivity for occult hernia.", "fonte": "ACR-AIUM-SPR-SRU abdomen parameter / RadioGraphics 2016 / HerniaSurge 2018", "faixas": [] }, { "id": "regioes_inguinais.1", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Mandatory anatomic landmarks", "valor": "inferior epigastric vessels, inguinal ligament, femoral vein", "unidade": null, "nota": "Avoid abbreviations in teaching reports: write inferior epigastric vessels, inguinal canal, Hesselbach triangle, inguinal ligament, femoral vein and deep inguinal ring.", "fonte": "RadioGraphics 2016 / EPOS ECR 2023", "faixas": [] }, { "id": "regioes_inguinais.2", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Indirect inguinal hernia", "valor": "lateral to the inferior epigastric vessels", "unidade": null, "nota": "The neck is usually at the deep inguinal ring and the contents may course through the inguinal canal toward the scrotum or labia majora.", "fonte": "RadioGraphics 2016 / AJR 2006", "faixas": [] }, { "id": "regioes_inguinais.3", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Direct inguinal hernia", "valor": "medial to the inferior epigastric vessels", "unidade": null, "nota": "Occurs in Hesselbach triangle, above the inguinal ligament; posterior-wall bulging with Valsalva may precede an evident direct hernia.", "fonte": "RadioGraphics 2016 / EPOS ECR 2019", "faixas": [] }, { "id": "regioes_inguinais.4", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Femoral hernia", "valor": "inferior to the inguinal ligament and medial to the femoral vein", "unidade": null, "nota": "It has a higher complication risk than inguinal hernia; bowel, pain, nonreducibility, sac fluid or obstruction signs should be communicated with priority.", "fonte": "HerniaSurge 2018 / Safer Care Victoria / EPOS ECR 2019", "faixas": [ { "status": "yellow", "rotulo": "Small reducible fat", "valor": "real finding, but management depends on symptoms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Bowel, pain or nonreducible", "valor": "risk of incarceration/strangulation", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "regioes_inguinais.5", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Hernia defect or neck", "valor": "measure in millimeters", "unidade": null, "nota": "There is no universal normal cutoff: measure neck/defect, sac, contents, reducibility and behavior at rest/Valsalva/upright position. A small ultrasound-only hernia may not indicate surgery if minimal or asymptomatic.", "fonte": "HerniaSurge 2018 / Insights Imaging 2022 / Safer Care Victoria", "faixas": [] }, { "id": "regioes_inguinais.6", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Inguinal lymph node — short axis", "valor": "<10 usual; up to 15 may be contextual", "unidade": "mm", "nota": "CT in asymptomatic patients found a mean of 5.4 mm and two standard deviations at 8.8 mm; Node-RADS accepts up to 15 mm for the inguinal region. On ultrasound, morphology matters more than size alone.", "fonte": "Bontumasi AJR 2014 / Node-RADS / VITA-GLOWM", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "≤8.8 mm, oval, fatty hilum, thin cortex", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "9-15 mm with preserved morphology", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": ">15 mm or suspicious morphology", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "regioes_inguinais.7", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Inguinal lymph node — benign morphology", "valor": "oval, central hilum, cortex <4 mm", "unidade": null, "nota": "Useful criteria: long-axis/short-axis ratio greater than 2, preserved fatty hilum, homogeneous cortex smaller than 4 mm and hilar or absent flow.", "fonte": "EPOS ECR 2023 inguinal nodes / superficial lymph node ultrasound reviews", "faixas": [] }, { "id": "regioes_inguinais.8", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Femoral pseudoaneurysm", "valor": "arterial neck + bidirectional flow", "unidade": null, "nota": "The yin-yang color Doppler sign helps, but the more specific finding is to-and-fro flow in the neck communicating with the artery.", "fonte": "SRU vascular case / World Journal of Radiology", "faixas": [ { "status": "red", "rotulo": "Red", "valor": "neck with to-and-fro flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "regioes_inguinais.9", "grupo": "regioes_inguinais", "ruleId": null, "rotulo": "Canal of Nuck / female hydrocele", "valor": "anechoic cyst in the female inguinal canal", "unidade": null, "nota": "May mimic hernia or lymph node. A cystic avascular lesion with posterior enhancement and no bowel continuity favors canal of Nuck hydrocele; look for peritoneal communication and complication.", "fonte": "J Ultrason 2024 / JSCR 2022", "faixas": [] } ], "classificacoes": [ { "id": "regioes_inguinais.c0", "grupo": "regioes_inguinais", "nome": "Interactive assistant — inguinal region", "nota": "Fill in the fields below to generate color reading, differentials and a next-step phrase.", "fonte": "HerniaSurge 2018/2023 / RadioGraphics 2016 / ACR-AIUM-SPR-SRU", "colunas": [ "Input", "Output", "How to use" ], "linhas": [ { "status": "green", "celulas": [ "Complete dynamic exam without finding", "Green", "Use only when rest, Valsalva/cough and, when needed, upright scanning were documented." ] }, { "status": "yellow", "celulas": [ "Small, fat-only or equivocal hernia", "Yellow", "Describe as real/possible finding, measure the neck and correlate symptoms; management may vary." ] }, { "status": "red", "celulas": [ "Femoral hernia, nonreducible bowel or compromise signs", "Red", "Communicate clinical priority: risk of incarceration, strangulation or obstruction." ] } ] }, { "id": "regioes_inguinais.c1", "grupo": "regioes_inguinais", "nome": "Anatomic map of groin hernia", "nota": null, "fonte": "RadioGraphics 2016 / EPOS ECR 2023 / AJR 2006", "colunas": [ "Type", "Ultrasound location", "Points to report" ], "linhas": [ { "status": "yellow", "celulas": [ "Indirect inguinal", "Lateral to the inferior epigastric vessels; enters through the deep inguinal ring and follows the canal.", "Side, neck, content, reducibility, extension to scrotum/labia majora." ] }, { "status": "yellow", "celulas": [ "Direct inguinal", "Medial to the inferior epigastric vessels, in Hesselbach triangle, above the inguinal ligament.", "Posterior-wall bulge, neck, content and whether it appears only with strain." ] }, { "status": "red", "celulas": [ "Femoral", "Inferior to the inguinal ligament, usually medial to the femoral vein.", "Prioritize if pain, bowel, nonreducibility or sac fluid is present." ] }, { "status": "yellow", "celulas": [ "Recurrent / postoperative", "Scan mesh margins and the inferomedial region with dynamic maneuver.", "Differentiate recurrence from seroma, hematoma, fibrosis, plug/mesh and lymph node." ] } ] }, { "id": "regioes_inguinais.c2", "grupo": "regioes_inguinais", "nome": "Inguinal lymph node — color reading", "nota": "The inguinal region accepts larger nodes than other territories; therefore morphology and bilateral comparison are decisive.", "fonte": "Bontumasi AJR 2014 / VITA consensus / EPOS ECR 2023", "colunas": [ "Color", "Finding", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Short axis up to 8.8 mm, oval, long-axis/short-axis ratio >2, fatty hilum, homogeneous cortex <4 mm.", "Compatible with reactive/benign node if clinical context matches." ] }, { "status": "yellow", "celulas": [ "Yellow", "Short axis 9-15 mm with preserved hilum, diffuse cortical thickening or inflammatory context.", "Common groin gray zone; size alone does not establish malignancy." ] }, { "status": "red", "celulas": [ "Red", "Short axis >15 mm, round, absent hilum, eccentric cortex, necrosis/cystic change, interrupted capsule or peripheral/disorganized flow.", "Suspicious, especially in skin, vulvar, penile, anal-canal cancer, melanoma, lymphoma or soft-tissue mass." ] } ] }, { "id": "regioes_inguinais.c3", "grupo": "regioes_inguinais", "nome": "Practical differential diagnosis of a groin mass", "nota": null, "fonte": "JSCR 2022 / RadioGraphics 2016 / superficial lymph node ultrasound reviews", "colunas": [ "Pattern", "Possibilities", "Alert" ], "linhas": [ { "status": "yellow", "celulas": [ "Increases with Valsalva or standing", "Hernia, round-ligament varices, spermatic-cord varicocele, postoperative recurrence.", "Confirm trajectory and relation to vessels/inguinal ligament." ] }, { "status": "green", "celulas": [ "Simple avascular cystic", "Canal of Nuck hydrocele, spermatic-cord cyst, simple seroma.", "Yellow if septated, painful, infected or with uncertain communication." ] }, { "status": "yellow", "celulas": [ "Solid oval with hilum", "Reactive node, lower-limb dermatopathy, genital/perineal inflammation.", "Do not use size alone; follow morphology." ] }, { "status": "red", "celulas": [ "Pulsatile vascular", "Femoral pseudoaneurysm, arteriovenous fistula, thrombosed varix.", "Spectral Doppler is mandatory before puncture." ] }, { "status": "red", "celulas": [ "Irregular or deep solid", "Metastasis, lymphoma, sarcoma, inguinal-canal endometriosis, nerve-sheath tumor.", "Consider additional imaging and local oncology pathway." ] } ] }, { "id": "regioes_inguinais.c4", "grupo": "regioes_inguinais", "nome": "Report checklist — inguinal region", "nota": null, "fonte": "ACR-AIUM-SPR-SRU / HerniaSurge / RadioGraphics", "colunas": [ "Item", "Why it matters" ], "linhas": [ { "status": "green", "celulas": [ "Side and pain point", "Avoids a generic report when the finding is focal or contralateral." ] }, { "status": "green", "celulas": [ "Rest, Valsalva/cough and upright position when needed", "Without dynamic maneuver, an occult hernia may be missed." ] }, { "status": "green", "celulas": [ "Relation to inferior epigastric vessels and femoral vein", "Classifies direct, indirect or femoral without difficult abbreviations." ] }, { "status": "yellow", "celulas": [ "Content and reducibility", "Reducible fat, bowel, bladder/ovary, fluid and pain change priority." ] }, { "status": "red", "celulas": [ "Complication", "Nonreducible content, thickened bowel, fluid, absent peristalsis, pseudoaneurysm, thrombosis or infection require explicit conclusion." ] } ] } ] }, { "metodo": "US", "chave": "regiao_cervical", "slug": "regiao-cervical", "url": "https://sonoaireport.com/en/referencias-ultrassom/regiao-cervical", "nome": "Cervical region", "temPaginaPublica": true, "medidas": [ { "id": "regiao_cervical.0", "grupo": "regiao_cervical", "ruleId": null, "rotulo": "Cervical lymph node — short axis", "valor": "≤8–10 with benign morphology", "unidade": "mm", "nota": "Size alone is weak: use together with shape, fatty hilum, cortex, necrosis, calcifications, vascularity and clinical context.", "fonte": "Ahuja & Ying AJR 2005 / ATA 2015 / AIUM head and neck", "faixas": [ { "status": "green", "rotulo": "Green — practical benign consensus", "valor": "≤8 mm, oval, preserved hilum, no suspicious signs", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow — borderline or divergent", "valor": "8–10 mm or >10 mm with reactive morphology", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — abnormal/suspicious", "valor": ">15 mm or any size with necrosis, calcifications, associated absent hilum, peripheral vascularity or growth", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "regiao_cervical.1", "grupo": "regiao_cervical", "ruleId": null, "rotulo": "Short-axis / long-axis ratio", "valor": "<0,5", "unidade": null, "nota": "An oval node favors benignity; rounding increases suspicion, especially when combined with loss of hilum or peripheral vascularity.", "fonte": "Ahuja & Ying AJR 2005 / thyroid cancer neck ultrasound reviews", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "<0.5 and preserved hilum", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "≈0.5 in isolation", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": ">0.5 with suspicious signs", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "regiao_cervical.2", "grupo": "regiao_cervical", "ruleId": null, "rotulo": "Suspicious node in thyroid cancer context", "valor": "≥8–10", "unidade": "mm in the smallest axis", "nota": "The American Thyroid Association recommends fine-needle aspiration of a suspicious lymph node from 8–10 mm in the smallest axis when the result changes management.", "fonte": "ATA 2015 Recommendation 32", "faixas": [ { "status": "yellow", "rotulo": "Yellow — smaller than 8 mm", "valor": "may be follow-up if it does not change management", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red — suspicious ≥8–10 mm", "valor": "consider fine-needle aspiration if clinically relevant", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "regiao_cervical.3", "grupo": "regiao_cervical", "ruleId": null, "rotulo": "Normal parathyroid gland", "valor": "usually not visible", "unidade": null, "nota": "When an enlarged parathyroid gland is seen, document location, three measurements, relationship with the thyroid and Doppler if requested.", "fonte": "AIUM head and neck practice parameter", "faixas": [ { "status": "green", "rotulo": "Green", "valor": "not identified and no focal lesion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Yellow", "valor": "compatible hypoechoic lesion, but without laboratory context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Red", "valor": "compatible lesion in hyperparathyroidism or documented growth", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "regiao_cervical.4", "grupo": "regiao_cervical", "ruleId": null, "rotulo": "Focal cervical mass", "valor": "measure in three axes", "unidade": null, "nota": "Describe compartment, side, relationship to skin, muscle, thyroid, salivary glands and vessels; Doppler only when indicated/requested.", "fonte": "ACR-AIUM-SPR-SRU head and neck / ACR Appropriateness Criteria", "faixas": [] } ], "classificacoes": [ { "id": "regiao_cervical.c0", "grupo": "regiao_cervical", "nome": "Quick calculator — cervical lymph node", "nota": "The calculator is assistive. Painful/inflammatory node, age, known cancer, previous thyroidectomy and laterality change the weight of findings.", "fonte": "Ahuja & Ying AJR 2005 / ATA 2015 / AIUM head and neck", "colunas": [ "Color", "Interpretation", "Practical criteria" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Benign morphology", "Short axis ≤8 mm, oval, preserved fatty hilum, thin cortex and hilar or absent vascularity." ] }, { "status": "yellow", "celulas": [ "Yellow", "Gray zone", "Short axis 8–10 mm, isolated rounding, poorly seen hilum, reactive enlargement or disagreement between size and morphology." ] }, { "status": "red", "celulas": [ "Red", "Suspicious/abnormal", "Intranodal necrosis/cyst, calcifications, peripheral or chaotic vascularity, associated absent hilum, irregular margins, conglomerate or growth." ] } ] }, { "id": "regiao_cervical.c1", "grupo": "regiao_cervical", "nome": "Cervical region — examination scope in Brazil", "nota": "This table avoids mixing cervical region with thyroid, salivary glands or vascular Doppler when the request does not include those items.", "fonte": "Colégio Brasileiro de Radiologia — Normatização de ultrassonografia", "colunas": [ "Structure", "How to handle in the report", "Practical color" ], "linhas": [ { "status": "green", "celulas": [ "Central and lateral cervical lymph nodes", "Included; describe location, size and morphology when seen or abnormal.", "Green if benign morphology" ] }, { "status": "green", "celulas": [ "Thyroid bed after total thyroidectomy", "Included only in this context; assess residual tissue, local recurrence and suspicious lymph nodes.", "Green if no focal lesion" ] }, { "status": "yellow", "celulas": [ "Parathyroid beds", "Assess; report parathyroid gland or muscle group mainly when detectable pathology is present.", "Yellow if the finding depends on laboratory tests" ] }, { "status": "yellow", "celulas": [ "Thyroid and salivary glands", "In the Brazilian standard, they have separate codes/exams; mention if assessed by specific request or relevant finding.", "Yellow because of scope" ] }, { "status": "yellow", "celulas": [ "Doppler and cervical vessels", "Doppler is not automatically part of the cervical region; carotid and jugular vessels require their own request/code.", "Yellow because of scope" ] } ] }, { "id": "regiao_cervical.c2", "grupo": "regiao_cervical", "nome": "Cervical mass or cyst — priority signs", "nota": "Ultrasound is useful, but persistent adult neck masses often require specialist clinical evaluation and/or cross-sectional imaging.", "fonte": "ACR Appropriateness Criteria Neck Mass/Adenopathy / AAO-HNS adult neck mass guideline", "colunas": [ "Color", "Finding", "Communication approach" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Typical benign superficial finding, small, without vascular solid component and without documented growth.", "Describe and correlate with physical examination." ] }, { "status": "yellow", "celulas": [ "Yellow", "Probable congenital cyst, inflammatory process or indeterminate mass without aggressive signs.", "Suggest clinical correlation and cross-sectional imaging/follow-up according to persistence." ] }, { "status": "red", "celulas": [ "Red", "Persistent mass in an adult, cystic mass in an adult, vascular solid component, invasion of planes, abscess or pulsatile mass.", "Communicate as suspicious/urgent according to context; consider CT, MRI or specialist evaluation." ] } ] }, { "id": "regiao_cervical.c3", "grupo": "regiao_cervical", "nome": "Documentation checklist — cervical region", "nota": "Avoid short abbreviations in reference reports; prefer “short axis”, “long axis”, “fatty hilum” and “peripheral vascularity”.", "fonte": "AIUM head and neck / ACR-AIUM-SPR-SRU practice parameter", "colunas": [ "Item", "Record", "Why" ], "linhas": [ { "status": "green", "celulas": [ "Location", "Side, level/compartment and relationship to anatomic landmarks.", "Allows comparison and planning for aspiration or surgery." ] }, { "status": "green", "celulas": [ "Measurements", "Three axes of the mass or lymph node; in a lymph node, emphasize the short axis.", "Standardizes follow-up and reduces ambiguity." ] }, { "status": "green", "celulas": [ "Morphology", "Shape, hilum, cortex, echogenicity, cystic/necrotic content, calcifications and margins.", "More important than size alone." ] }, { "status": "yellow", "celulas": [ "Doppler", "Use for vascularity of localized masses when requested or clinically needed.", "Helps, but does not replace B-mode or clinical context." ] } ] } ] }, { "metodo": "US", "chave": "linfonodos", "slug": "linfonodos", "url": "https://sonoaireport.com/en/referencias-ultrassom/linfonodos", "nome": "Lymph nodes (general)", "temPaginaPublica": true, "medidas": [ { "id": "linfonodos.0", "grupo": "linfonodos", "ruleId": null, "rotulo": "Short axis (normal cervical)", "valor": "≤ 10", "unidade": "mm", "nota": "varies by level/region", "fonte": "Radiology Key / Dr Koh", "faixas": [] } ], "classificacoes": [ { "id": "linfonodos.c0", "grupo": "linfonodos", "nome": "Lymph node — benign vs suspicious", "nota": "Combine signs; microcalcifications and cystic necrosis raise suspicion (e.g., papillary carcinoma metastasis).", "fonte": "Radiology Key / PubMed (critérios sonográficos)", "colunas": [ "Sign", "Benign", "Suspicious/malignant" ], "linhas": [ { "status": null, "celulas": [ "Shape (short/long)", "Oval (< 0.5)", "Round (≥ 0.5)" ] }, { "status": null, "celulas": [ "Fatty hilum", "Present", "Absent" ] }, { "status": null, "celulas": [ "Cortex", "Thin and uniform", "Thickened/eccentric" ] }, { "status": null, "celulas": [ "Vascularity", "Hilar", "Peripheral/chaotic" ] } ] } ] }, { "metodo": "US", "chave": "obstetrico_23tri", "slug": "obstetrico-23tri", "url": "https://sonoaireport.com/en/referencias-ultrassom/obstetrico-23tri", "nome": "Obstetric — 2nd/3rd trimester", "temPaginaPublica": true, "medidas": [ { "id": "obstetrico_23tri.0", "grupo": "obstetrico_23tri", "ruleId": null, "rotulo": "Amniotic fluid index (AFI)", "valor": "5–25", "unidade": "cm", "nota": "single deepest pocket normal: 2–8 cm", "fonte": "Ultrasoundpaedia / FMF", "faixas": [] }, { "id": "obstetrico_23tri.1", "grupo": "obstetrico_23tri", "ruleId": null, "rotulo": "Biometry (BPD, HC, AC, FL)", "valor": "—", "unidade": null, "nota": "use gestational-age tables (Hadlock/FMF) — no single value", "fonte": "Hadlock / FMF", "faixas": [] } ], "classificacoes": [ { "id": "obstetrico_23tri.c0", "grupo": "obstetrico_23tri", "nome": "Calculator — amniotic fluid (AFI / deepest pocket)", "nota": "SMFM prefers the single deepest pocket (fewer false-positive oligohydramnios). Correlate with gestational age, growth and membrane integrity.", "fonte": "Phelan/Moore (AFI) / SMFM / ISUOG", "colunas": [ "Range", "AFI", "Deepest pocket" ], "linhas": [ { "status": "red", "celulas": [ "Oligohydramnios", "≤ 5 cm", "< 2 cm" ] }, { "status": "green", "celulas": [ "Normal", "8–18 cm (5–24)", "2–8 cm" ] }, { "status": "red", "celulas": [ "Polyhydramnios", "≥ 24 cm", "≥ 8 cm" ] } ] }, { "id": "obstetrico_23tri.c1", "grupo": "obstetrico_23tri", "nome": "Calculator — fetal Doppler (umbilical/MCA/CPR)", "nota": "Indices are gestational-age specific (FMF references). Absent/reversed umbilical diastole is the most severe sign.", "fonte": "ISUOG Doppler guidelines / Delphi FGR consensus 2016", "colunas": [ "Finding", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "Normal umbilical, normal MCA", "Routine surveillance." ] }, { "status": "yellow", "celulas": [ "Umbilical PI >95th or MCA <5th or CPR <5th", "Redistribution/resistance: increase surveillance." ] }, { "status": "red", "celulas": [ "Absent umbilical diastole (AEDF)", "Advanced placental insufficiency." ] }, { "status": "red", "celulas": [ "Reversed umbilical diastole (REDF)", "Severe: fetal medicine; ductus venosus/delivery per GA." ] } ] }, { "id": "obstetrico_23tri.c2", "grupo": "obstetrico_23tri", "nome": "Placenta previa and accreta spectrum (PAS)", "nota": "Accreta risk rises sharply with previa over a cesarean scar. Document edge-to-os distance and invasion signs.", "fonte": "FIGO PAS 2019 / ISUOG placenta previa & PAS guideline", "colunas": [ "Situation", "Definition/sign", "Management" ], "linhas": [ { "status": "green", "celulas": [ "Normally sited placenta", "Edge ≥2 cm from internal os.", "No restriction by location." ] }, { "status": "yellow", "celulas": [ "Low-lying placenta", "Edge <2 cm from os, not covering.", "Reassess in the 3rd trimester." ] }, { "status": "red", "celulas": [ "Placenta previa", "Covers the internal os.", "Cesarean; plan delivery." ] }, { "status": "red", "celulas": [ "Accreta spectrum (PAS)", "Lacunae, loss of clear zone, hypervascularity, bulging (prior cesarean + previa).", "Referral center; multidisciplinary team." ] } ] }, { "id": "obstetrico_23tri.c3", "grupo": "obstetrico_23tri", "nome": "Cervical length (preterm birth)", "nota": "Measure transvaginally, empty bladder, no excess pressure; use the shortest of 3. 25 mm cutoff in the 2nd trimester.", "fonte": "FMF / SMFM / ISUOG cervical assessment", "colunas": [ "Cervix (transvaginal)", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "≥ 25 mm", "Low preterm birth risk." ] }, { "status": "yellow", "celulas": [ "15–24 mm", "Shortened: consider progesterone/follow-up." ] }, { "status": "red", "celulas": [ "< 15 mm or funneling", "High risk: refer; discuss cerclage/pessary." ] } ] }, { "id": "obstetrico_23tri.c4", "grupo": "obstetrico_23tri", "nome": "Fetal Doppler — alert thresholds", "nota": "Indices are gestational-age specific (FMF references). Absent/reversed umbilical end-diastole = severe.", "fonte": "FMF (Ciobanu 2019, UOG)", "colunas": [ "Vessel/index", "Abnormal", "Meaning" ], "linhas": [ { "status": null, "celulas": [ "Umbilical artery — PI", "> 95th centile", "increased placental resistance" ] }, { "status": null, "celulas": [ "Middle cerebral artery — PI", "< 5th centile", "redistribution (brain-sparing)" ] }, { "status": null, "celulas": [ "Cerebroplacental ratio (CPR)", "< 10th centile", "early placental insufficiency" ] } ] } ] }, { "metodo": "US", "chave": "cotovelo", "slug": "cotovelo", "url": "https://sonoaireport.com/en/referencias-ultrassom/cotovelo", "nome": "Elbow", "temPaginaPublica": true, "medidas": [ { "id": "cotovelo.0", "grupo": "cotovelo", "ruleId": null, "rotulo": "Minimum elbow protocol", "valor": "anterior + lateral + medial + posterior", "unidade": null, "nota": "add ulnar nerve, radial nerve, Doppler and dynamic maneuvers when clinically indicated", "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR", "faixas": [] }, { "id": "cotovelo.1", "grupo": "cotovelo", "ruleId": null, "rotulo": "Technique and comparison", "valor": "high-frequency linear transducer", "unidade": null, "nota": "scan in long and short axis; compare with the opposite side when measurement, pain or morphology is borderline", "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR", "faixas": [] }, { "id": "cotovelo.2", "grupo": "cotovelo", "ruleId": null, "rotulo": "Common extensor tendon — thickness", "valor": "< 4,2", "unidade": "mm", "nota": "green if fibrillar and without focal pain; 4.2 mm or more is yellow because it is a practical cutoff, not a universal standalone consensus", "fonte": "Radiology/AJR series; ESSR technique", "faixas": [] }, { "id": "cotovelo.3", "grupo": "cotovelo", "ruleId": null, "rotulo": "Common extensor tendon — cross-sectional area", "valor": "< 32", "unidade": "mm²", "nota": "32 mm² or more supports lateral epicondylalgia when there is hypoechogenicity, fissure, calcification, cortical irregularity or pain", "fonte": "Radiology/AJR series", "faixas": [] }, { "id": "cotovelo.4", "grupo": "cotovelo", "ruleId": null, "rotulo": "Common flexor-pronator tendon", "valor": "no universal cutoff", "unidade": null, "nota": "use thickness, echotexture, residual fibers, enthesopathy, Doppler and contralateral comparison", "fonte": "ESSR; AIUM/ACR/SPR/SRU 2017", "faixas": [] }, { "id": "cotovelo.5", "grupo": "cotovelo", "ruleId": null, "rotulo": "Ulnar nerve at cubital tunnel — cross-sectional area", "valor": "< 8 verde · 8–9,9 amarelo · ≥10 vermelho", "unidade": "mm²", "nota": "10 mm² or more is a widely used practical cutoff; confirm with symptoms, morphology, elbow-to-forearm ratio and nerve conduction when needed", "fonte": "Bayrak 2009; expert consensus 2021", "faixas": [] }, { "id": "cotovelo.6", "grupo": "cotovelo", "ruleId": null, "rotulo": "Elbow-to-forearm ulnar nerve area ratio", "valor": "< 1,3 verde · 1,3–1,49 amarelo · ≥1,5 contextual", "unidade": null, "nota": "do not use alone; it supports focal swelling when absolute area and symptoms agree", "fonte": "Peripheral nerve ultrasound literature", "faixas": [] }, { "id": "cotovelo.7", "grupo": "cotovelo", "ruleId": null, "rotulo": "Olecranon bursa", "valor": "normally collapsed or not visible", "unidade": null, "nota": "any distension is contextual; thick wall, debris, gas, hyperemia, wound or fever raise it to red", "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR", "faixas": [] }, { "id": "cotovelo.8", "grupo": "cotovelo", "ruleId": null, "rotulo": "Elbow effusion/synovitis", "valor": "no single universal number", "unidade": null, "nota": "effusion is yellow; with trauma, mechanical locking, fever, crystals, inflammatory arthritis or intense Doppler it may be red", "fonte": "AIUM/ACR/SPR/SRU 2017", "faixas": [] }, { "id": "cotovelo.9", "grupo": "cotovelo", "ruleId": null, "rotulo": "Distal biceps and triceps", "valor": "assess continuity, gap and retraction", "unidade": null, "nota": "complete tear, avulsion or traumatic gap is red; tendinopathy/partial tear is yellow", "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR", "faixas": [] }, { "id": "cotovelo.10", "grupo": "cotovelo", "ruleId": null, "rotulo": "Elbow ligaments", "valor": "dynamic stress when indicated", "unidade": null, "nota": "assess the lateral complex and ulnar collateral ligament; dynamic opening, avulsion or clinical instability is red", "fonte": "ESSR; AIUM/ACR/SPR/SRU 2017", "faixas": [] } ], "classificacoes": [ { "id": "cotovelo.c0", "grupo": "cotovelo", "nome": "Interactive assistant — elbow ultrasound", "nota": "The assistant uses colors to separate consensus normality, gray zone and clearly abnormal findings. It does not replace clinical judgment, radiographs, MRI or electrodiagnostic testing when the question is bone, deep intra-articular or neurophysiologic.", "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR; peripheral nerve ultrasound consensus", "colunas": [ "Color", "When to use", "Teaching action" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Measurement below practical cutoff and preserved morphology", "Record the compartment protocol and comparison when performed" ] }, { "status": "yellow", "celulas": [ "Yellow", "Thickening, small effusion, tendinopathy, simple bursitis, mild Doppler or finding without universal numeric consensus", "Describe morphology, pain, opposite side and limitation; avoid absolute conclusion from an isolated number" ] }, { "status": "red", "celulas": [ "Red", "Complete tear, avulsion, infection, neuropathy with deficit, deep mass, mechanical locking or dynamic instability", "Measure extent/gap/retraction, document Doppler/dynamics and recommend urgent correlation according to context" ] } ] }, { "id": "cotovelo.c1", "grupo": "cotovelo", "nome": "Anatomic roadmap by compartment", "nota": null, "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR elbow technical guideline", "colunas": [ "Compartment", "Required structures", "Attention point" ], "linhas": [ { "status": "yellow", "celulas": [ "Anterior", "Anterior recess, humeroradial/humeroulnar joint, distal biceps, brachialis, vessels and nerves when indicated", "Effusion, synovitis, loose body, bicipitoradial bursa and distal biceps tear" ] }, { "status": "yellow", "celulas": [ "Lateral", "Lateral epicondyle, common extensor tendon, lateral ligament complex, radial head/neck and radial nerve", "Lateral epicondylalgia, partial/complete tear, calcification, fissure and varus instability" ] }, { "status": "yellow", "celulas": [ "Medial", "Medial epicondyle, common flexor-pronator tendon, ulnar collateral ligament and ulnar nerve at cubital tunnel", "Assess nerve flexion/extension and valgus stress when indicated" ] }, { "status": "yellow", "celulas": [ "Posterior", "Triceps, olecranon, olecranon bursa and posterior recess", "Bursitis, triceps tear, posterior impingement, osteophyte and loose body" ] }, { "status": "yellow", "celulas": [ "Nerves and dynamics", "Ulnar nerve, radial nerve and posterior interosseous branch according to symptoms", "Cross-sectional area, proximal/distal caliber, focal compression, subluxation and snapping triceps" ] } ] }, { "id": "cotovelo.c2", "grupo": "cotovelo", "nome": "Tendons and ligaments — color reading", "nota": null, "fonte": "ESSR; AIUM/ACR/SPR/SRU 2017", "colunas": [ "Structure", "Green", "Yellow", "Red" ], "linhas": [ { "status": "yellow", "celulas": [ "Common extensor tendon", "fibrillar, thin, no focal pain", "thickness ≥4.2 mm, area ≥32 mm², hypoechogenicity, calcification or small fissure", "high-grade/complete tear, avulsion or traumatic gap" ] }, { "status": "yellow", "celulas": [ "Common flexor-pronator tendon", "fibrillar and symmetric", "tendinopathy, enthesopathy, calcification or partial tear", "high-grade/complete tear or medial avulsion" ] }, { "status": "red", "celulas": [ "Distal biceps", "continuity to radial tuberosity", "tendinopathy, bicipitoradial bursitis or partial tear", "complete tear, retraction or avulsion" ] }, { "status": "red", "celulas": [ "Triceps", "fibrillar, preserved insertion", "tendinopathy, enthesophyte or partial tear", "complete tear, avulsion or extensor deficit" ] }, { "status": "red", "celulas": [ "Ulnar collateral ligament and lateral complex", "continuous and without dynamic opening", "thickening, pain and mild/contextual laxity", "avulsion, dynamic opening, symptomatic throwing athlete or clinical instability" ] } ] }, { "id": "cotovelo.c3", "grupo": "cotovelo", "nome": "Nerves, Doppler and dynamic maneuvers", "nota": null, "fonte": "ESSR; peripheral nerve ultrasound consensus", "colunas": [ "Item", "Green", "Yellow", "Red" ], "linhas": [ { "status": "red", "celulas": [ "Ulnar nerve — cross-sectional area", "<8 mm² and fascicular", "8-9.9 mm² or elevated ratio without deficit", "≥10 mm², focal compression, hourglass or motor deficit" ] }, { "status": "yellow", "celulas": [ "Ulnar nerve dynamics", "stable during flexion/extension", "asymptomatic subluxation or mild snapping", "symptomatic dislocation, painful snapping triceps or neurologic deficit" ] }, { "status": "yellow", "celulas": [ "Doppler", "no hyperemia", "mild/moderate hyperemia in tendinopathy, bursa or synovitis", "intense hyperemia with fever, wound, complex bursa or possible septic arthritis" ] }, { "status": "red", "celulas": [ "Radial nerve or posterior interosseous branch", "fascicular, no compression", "enlargement or pain without deficit", "motor deficit, compression by mass/cyst or suspected denervation" ] } ] }, { "id": "cotovelo.c4", "grupo": "cotovelo", "nome": "Useful elbow differential diagnoses", "nota": null, "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR", "colunas": [ "Dominant symptom", "Common possibilities", "What ultrasound should look for" ], "linhas": [ { "status": "yellow", "celulas": [ "Lateral pain", "lateral epicondylalgia, lateral complex injury, radiocapitellar osteoarthritis, radial nerve", "common extensor tendon, calcifications, cortex, ligament and posterior interosseous branch" ] }, { "status": "yellow", "celulas": [ "Medial pain", "medial epicondylalgia, ulnar collateral ligament, ulnar nerve, throwing athlete", "common flexor-pronator tendon, valgus stress, ulnar nerve area and dynamics" ] }, { "status": "yellow", "celulas": [ "Posterior pain or swelling", "olecranon bursitis, gout, infection, triceps, posterior impingement", "bursa, wall, debris, Doppler, triceps and posterior recess" ] }, { "status": "red", "celulas": [ "Trauma with pop", "distal biceps tear, triceps tear, avulsion, occult fracture", "tendon continuity, gap, retraction, effusion and cortex; radiograph if bone concern" ] }, { "status": "red", "celulas": [ "Paresthesia or weakness", "ulnar neuropathy, radial neuropathy or compression by mass/cyst", "cross-sectional area, caliber, focal compression, dynamics, mass and denervated muscles" ] }, { "status": "yellow", "celulas": [ "Stiffness, locking or effusion", "synovitis, loose body, crystals, osteoarthritis, infectious arthritis", "recesses, Doppler, erosions, visible loose body and systemic warning signs" ] } ] }, { "id": "cotovelo.c5", "grupo": "cotovelo", "nome": "Teaching checklist for the elbow report", "nota": null, "fonte": "AIUM/ACR/SPR/SRU 2017; ESSR", "colunas": [ "Step", "Record" ], "linhas": [ { "status": null, "celulas": [ "1. Indication and side", "lateral, medial, posterior or anterior pain, trauma, neuropathy, rheumatology, postoperative setting or procedure" ] }, { "status": null, "celulas": [ "2. Compartments", "anterior, lateral, medial and posterior; state if any was not assessed" ] }, { "status": null, "celulas": [ "3. Tendons and ligaments", "thickness, echotexture, residual fibers, calcification, gap, retraction, enthesis and dynamic stress" ] }, { "status": null, "celulas": [ "4. Nerves and Doppler", "ulnar nerve, radial nerve/posterior interosseous branch, cross-sectional area, dynamics and hyperemia" ] }, { "status": null, "celulas": [ "5. Limitations", "ultrasound does not replace radiographs/MRI for deep bone, cartilage, deep intra-articular loose body or complex instability" ] } ] } ] }, { "metodo": "US", "chave": "partes_moles", "slug": "partes-moles", "url": "https://sonoaireport.com/en/referencias-ultrassom/partes-moles", "nome": "Skin / subcutaneous", "temPaginaPublica": true, "medidas": [], "classificacoes": [ { "id": "partes_moles.c0", "grupo": "partes_moles", "nome": "Superficial lesions — typical appearance", "nota": "US for lipoma: sens. ~95% / spec. ~94%; epidermal cyst: sens. ~80% / spec. ~95%. Red flags (solid > 5 cm, chaotic vascularity, growth) → work up for tumor.", "fonte": "SRU Consensus 2021 (Radiology) / KJR", "colunas": [ "Lesion", "US appearance" ], "linhas": [ { "status": null, "celulas": [ "Lipoma", "Oval, compressible, iso/hyperechoic, linear septa parallel to skin, minimal vascularity" ] }, { "status": null, "celulas": [ "Epidermal/sebaceous cyst", "Well-defined subcutaneous, variable content (anechoic→solid), \"submarine sign\", posterior enhancement" ] } ] } ] }, { "metodo": "US", "chave": "lipedema_linfedema", "slug": "lipedema-linfedema", "url": "https://sonoaireport.com/en/referencias-ultrassom/lipedema-linfedema", "nome": "Lipedema / lymphedema", "temPaginaPublica": true, "medidas": [ { "id": "lipedema_linfedema.0", "grupo": "lipedema_linfedema", "ruleId": null, "rotulo": "Subcutaneous thickness — thigh (comparison)", "valor": "no universal cutoff", "unidade": "mm", "nota": "Highly BMI-dependent; what matters is symmetry and the thigh→ankle gradient. In lipedema the subcutis is disproportionately thick, symmetric and without fluid.", "fonte": "Naouri J Eur Acad Dermatol 2010 / Consenso europeu 2020", "faixas": [] }, { "id": "lipedema_linfedema.1", "grupo": "lipedema_linfedema", "ruleId": null, "rotulo": "Dermal thickness", "valor": "≤ ~2", "unidade": "mm", "nota": "Dermal thickening with subcutaneous fluid favors lymphedema, not pure lipedema.", "fonte": "Suehiro (US do linfedema) / EFSUMB", "faixas": [ { "status": "green", "rotulo": "usual", "valor": "≤2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "2–3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "thickened (lymphatic component)", "valor": ">3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "lipedema_linfedema.2", "grupo": "lipedema_linfedema", "ruleId": null, "rotulo": "Subcutaneous fluid (anechoic clefts/lakes)", "valor": "absent in pure lipedema", "unidade": null, "nota": "\"Cobblestone\" or anechoic lakes pattern indicates a lymphatic component (lymphedema or lipolymphedema).", "fonte": "ISL Consensus 2020 / EFSUMB", "faixas": [] } ], "classificacoes": [ { "id": "lipedema_linfedema.c0", "grupo": "lipedema_linfedema", "nome": "Calculator — lipedema support (clinical + US)", "nota": "Lipedema is a clinical diagnosis. There is no single validated ultrasound classification; US documents the subcutis and rules out lymphedema.", "fonte": "Consenso europeu de lipedema 2020 (Phlebology) / Diretriz S1 alemã 2017", "colunas": [ "Color", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "Green", "Pattern consistent with lipedema: diffuse symmetric hypoechoic fat, no fluid; foot spared; negative Stemmer." ] }, { "status": "yellow", "celulas": [ "Yellow", "Probable but with overlap/advanced stage — document and correlate clinically." ] }, { "status": "red", "celulas": [ "Red", "Fluid/lymphedema signs (clefts, lakes, foot involvement, positive Stemmer): lipolymphedema — refer for lymphatic therapy." ] } ] }, { "id": "lipedema_linfedema.c1", "grupo": "lipedema_linfedema", "nome": "Clinical stages of lipedema", "nota": "Clinical stage refers to skin/tissue; pain, fatigue and functional impact do not necessarily follow the stage. Types 1–5 describe distribution (hip, thigh, calf, arms).", "fonte": "Consenso europeu 2020 / Wold-Allen 1951", "colunas": [ "Stage", "Skin surface", "Subcutis" ], "linhas": [ { "status": "yellow", "celulas": [ "I", "Smooth, regular", "Thickened and uniform, homogeneous hypoechoic fat" ] }, { "status": "yellow", "celulas": [ "II", "Uneven, \"mattress\", palpable nodules", "More evident nodules and septa" ] }, { "status": "red", "celulas": [ "III", "Deforming fat lobules", "Large lobules, contour distortion" ] }, { "status": "red", "celulas": [ "IV", "Lipedema + lymphedema (lipolymphedema)", "Fat + fluid/fibrosis; foot may be involved" ] } ] }, { "id": "lipedema_linfedema.c2", "grupo": "lipedema_linfedema", "nome": "Calculator — lymphedema staging (ISL)", "nota": "US complements the clinical exam; lymphoscintigraphy remains the standard to confirm lymphatic dysfunction.", "fonte": "ISL Consensus 2020 (Lymphology)", "colunas": [ "Color", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "Green", "No US signs of lymphedema (no fluid, normal dermis)." ] }, { "status": "yellow", "celulas": [ "Yellow", "Early/reversible edema: fine clefts, positive Stemmer, still pitting." ] }, { "status": "red", "celulas": [ "Red", "Established: anechoic lakes, thickened dermis, fibrosis (non-pitting)." ] } ] }, { "id": "lipedema_linfedema.c3", "grupo": "lipedema_linfedema", "nome": "ISL lymphedema stages", "nota": "ISL staging is clinical; US helps grade fluid/fibrosis and monitor decongestive therapy.", "fonte": "ISL Consensus 2020", "colunas": [ "Stage", "Clinical", "Typical US" ], "linhas": [ { "status": "green", "celulas": [ "0", "Latent/subclinical (no visible edema)", "No fluid; may show mild thickening" ] }, { "status": "yellow", "celulas": [ "I", "Edema reducing with elevation (pitting)", "Fine subcutaneous clefts" ] }, { "status": "red", "celulas": [ "II", "Does not reduce spontaneously; increasing fibrosis", "Anechoic lakes, thickened dermis" ] }, { "status": "red", "celulas": [ "III", "Elephantiasis, skin changes", "Dense fibrosis, variable fluid" ] } ] }, { "id": "lipedema_linfedema.c4", "grupo": "lipedema_linfedema", "nome": "Lipedema vs lymphedema — how to tell apart", "nota": "Coexistence (lipolymphedema) is common in advanced stages. When in doubt, combine findings and consider lymphoscintigraphy.", "fonte": "Consenso europeu 2020 / ISL 2020", "colunas": [ "Feature", "Lipedema", "Lymphedema" ], "linhas": [ { "status": null, "celulas": [ "Symmetry", "Bilateral and symmetric", "Often asymmetric/unilateral" ] }, { "status": null, "celulas": [ "Foot/dorsum", "Spared (cuff sign)", "Involved" ] }, { "status": null, "celulas": [ "Stemmer sign", "Negative", "Positive" ] }, { "status": null, "celulas": [ "Pressure pain", "Typical", "Less common" ] }, { "status": null, "celulas": [ "Subcutaneous fluid on US", "Absent", "Present (cobblestone/lakes)" ] }, { "status": null, "celulas": [ "Dermal thickening", "Absent/mild", "Present" ] } ] } ] }, { "metodo": "US", "chave": "ecocardiograma", "slug": "ecocardiograma", "url": "https://sonoaireport.com/en/referencias-ultrassom/ecocardiograma", "nome": "Echocardiography (transthoracic)", "temPaginaPublica": true, "medidas": [ { "id": "ecocardiograma.0", "grupo": "ecocardiograma", "ruleId": null, "rotulo": "LV ejection fraction (LVEF)", "valor": "≥ 53", "unidade": "%", "nota": "normal M 52–72 · F 54–74", "fonte": "ASE 2015 (Lang et al.)", "faixas": [] }, { "id": "ecocardiograma.1", "grupo": "ecocardiograma", "ruleId": null, "rotulo": "LV end-diastolic diameter", "valor": "M 42–58 · F 38–52", "unidade": "mm", "nota": null, "fonte": "ASE 2015", "faixas": [] }, { "id": "ecocardiograma.2", "grupo": "ecocardiograma", "ruleId": null, "rotulo": "Septum / posterior wall (diastole)", "valor": "6–10", "unidade": "mm", "nota": null, "fonte": "ASE 2015", "faixas": [] }, { "id": "ecocardiograma.3", "grupo": "ecocardiograma", "ruleId": null, "rotulo": "Left atrium — diameter", "valor": "M ≤ 40 · F ≤ 38", "unidade": "mm", "nota": "indexed volume ≤ 34 mL/m²", "fonte": "ASE 2015", "faixas": [] }, { "id": "ecocardiograma.4", "grupo": "ecocardiograma", "ruleId": null, "rotulo": "Aortic root (sinuses of Valsalva)", "valor": "M ≤ 40 · F ≤ 36", "unidade": "mm", "nota": "ideally index to body surface area", "fonte": "ASE 2015", "faixas": [] } ], "classificacoes": [] }, { "metodo": "US", "chave": "transcraniano", "slug": "transcraniano", "url": "https://sonoaireport.com/en/referencias-ultrassom/transcraniano", "nome": "Transcranial Doppler / ONSD", "temPaginaPublica": true, "medidas": [ { "id": "transcraniano.0", "grupo": "transcraniano", "ruleId": null, "rotulo": "MCA — mean velocity", "valor": "< 120", "unidade": "cm/s", "nota": "> 120 suggests vasospasm; > 200 critical", "fonte": "StatPearls", "faixas": [] }, { "id": "transcraniano.1", "grupo": "transcraniano", "ruleId": null, "rotulo": "Optic nerve sheath diameter (ONSD)", "valor": "≤ 5", "unidade": "mm", "nota": "> 5.8 mm suggests raised ICP", "fonte": "POCUS Atlas / touchNEUROLOGY", "faixas": [] } ], "classificacoes": [ { "id": "transcraniano.c0", "grupo": "transcraniano", "nome": "Lindegaard ratio (MCA/ICA) — vasospasm", "nota": null, "fonte": "J Vasc Surg / StatPearls", "colunas": [ "Ratio", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "< 3", "Hyperemia / normal" ] }, { "status": null, "celulas": [ "3–4,5", "Mild vasospasm" ] }, { "status": null, "celulas": [ "4,5–6", "Moderate vasospasm" ] }, { "status": null, "celulas": [ "> 6", "Severe vasospasm" ] } ] } ] }, { "metodo": "US", "chave": "ocular", "slug": "ocular", "url": "https://sonoaireport.com/en/referencias-ultrassom/ocular", "nome": "Ocular / ophthalmic", "temPaginaPublica": true, "medidas": [ { "id": "ocular.0", "grupo": "ocular", "ruleId": null, "rotulo": "Safe technique — scan through the eyelid", "valor": "abundant gel, linear probe, no direct pressure, ocular preset", "unidade": null, "nota": "The probe should float on the gel. In trauma, severe pain or suspected perforation, the priority is not to compress the globe.", "fonte": "StatPearls Ocular Ultrasound / ACEP Sonoguide", "faixas": [ { "status": "green", "rotulo": "safe", "valor": "no pressure + ocular preset", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "technical limitation", "valor": "no ocular preset or poor window", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "do not compress", "valor": "suspected open globe", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ocular.1", "grupo": "ocular", "ruleId": null, "rotulo": "Minimum sweep to learn anatomy", "valor": "transverse and longitudinal planes, resting eye and gentle eye movements", "unidade": null, "nota": "Identify the lens, vitreous, retina, posterior wall, optic nerve and retrobulbar space before searching for disease.", "fonte": "University of Iowa EyeRounds / EyeWiki", "faixas": [] }, { "id": "ocular.2", "grupo": "ocular", "ruleId": null, "rotulo": "Optic nerve sheath — adult", "valor": "≤ 5,0", "unidade": "mm", "nota": "Measure 3 mm behind the retina/posterior globe wall; ideally measure both eyes and interpret with the neurologic context.", "fonte": "ACEP Sonoguide / StatPearls / revisão de bainha do nervo óptico", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "≤5,0 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline or divergent", "valor": ">5,0–5,7 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high risk for raised intracranial pressure", "valor": "≥5,8 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ocular.3", "grupo": "ocular", "ruleId": null, "rotulo": "Optic nerve sheath — child", "valor": "≤4.5 in 1–15 years; ≤4.0 under 1 year", "unidade": "mm", "nota": "Pediatric thresholds vary; use as screening, not as a standalone diagnosis of raised intracranial pressure.", "fonte": "ACEP Sonoguide / revisão de bainha do nervo óptico", "faixas": [ { "status": "green", "rotulo": "consensus normal", "valor": "≤4.5 mm child; ≤4.0 mm infant", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline", "valor": "up to ~0.5 mm above cutoff", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely abnormal", "valor": "clearly above cutoff + clinical context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ocular.4", "grupo": "ocular", "ruleId": null, "rotulo": "Optic disc elevation", "valor": "≤ 0,6", "unidade": "mm", "nota": "Elevation above 0.6 mm favors papilledema in the right context; optic disc drusen can mimic pseudopapilledema.", "fonte": "StatPearls Ocular Ultrasound / estudos de papiledema", "faixas": [ { "status": "green", "rotulo": "no relevant elevation", "valor": "<0,4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "0,4–0,6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious for papilledema", "valor": ">0,6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ocular.5", "grupo": "ocular", "ruleId": null, "rotulo": "Adult ocular axial length", "valor": "~22–24,5", "unidade": "mm", "nota": "Varies with refraction, population and method. Very long values suggest axial myopia; short values may occur in hyperopia or small eyes.", "fonte": "EyeWiki / Scientific Reports axial length", "faixas": [ { "status": "green", "rotulo": "usual adult range", "valor": "22–24,5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "outside mean, correlate refraction", "valor": "20,5–21,9 ou 24,6–26,4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "markedly outside range", "valor": "<20,5 ou ≥26,5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "ocular.6", "grupo": "ocular", "ruleId": null, "rotulo": "Normal posterior segment", "valor": "anechoic vitreous; thin continuous retina on posterior wall; optic disc as reference", "unidade": null, "nota": "Dynamic eye movement helps separate true membranes from mobile vitreous echoes.", "fonte": "StatPearls / ACEP Sonoguide / EyeWiki", "faixas": [] }, { "id": "ocular.7", "grupo": "ocular", "ruleId": null, "rotulo": "Intraocular mass — required measurements", "valor": "base, height, location, reflectivity, shadowing and vascularity when indicated", "unidade": null, "nota": "Solid mass, growth, calcification in a child or associated detachment requires specialist ophthalmologic evaluation.", "fonte": "EyeWiki / revisão de ultrassonografia oftalmológica", "faixas": [ { "status": "green", "rotulo": "no mass", "valor": "regular wall", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate lesion", "valor": "document and compare", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high risk", "valor": "solid vascular mass, calcified lesion in a child, or growth", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "ocular.c0", "grupo": "ocular", "nome": "Interactive assistant — ocular ultrasound", "nota": "The Clear button resets the calculation. The output is a teaching triage to standardize reasoning and communication; ocular emergencies still require specialist evaluation.", "fonte": "StatPearls / ACEP Sonoguide / EyeWiki", "colunas": [ "Output", "Color", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "Likely normal", "Green", "No warning sign, measurements within range and posterior segment without pathologic membranes." ] }, { "status": "yellow", "celulas": [ "Caution / indeterminate", "Yellow", "Borderline measurement, mobile vitreous echoes, posterior vitreous detachment, limited technique or trauma indication without open-globe signs." ] }, { "status": "red", "celulas": [ "Urgent", "Red", "Suspected open globe, retinal detachment, foreign body, absent central retinal artery flow, retrobulbar hematoma, lens dislocation or likely raised intracranial pressure." ] } ] }, { "id": "ocular.c1", "grupo": "ocular", "nome": "Anatomic map for patients and learners", "nota": null, "fonte": "EyeWiki / StatPearls / ACEP Sonoguide", "colunas": [ "Structure", "How it appears", "Why it matters" ], "linhas": [ { "status": null, "celulas": [ "Lens", "Biconvex structure just behind the iris; normally centered.", "Subluxation or dislocation may occur in trauma and affect vision." ] }, { "status": null, "celulas": [ "Vitreous", "Dark/anechoic content filling most of the eye.", "Mobile echoes suggest blood, inflammation or vitreous degeneration." ] }, { "status": null, "celulas": [ "Retina", "Thin line along the posterior wall; when detached, it becomes a thicker membrane tethered to the optic disc.", "Retinal detachment is an emergency, especially if the macula is still attached." ] }, { "status": null, "celulas": [ "Choroid", "Deep vascular layer; detachments are often convex and do not cross the optic disc.", "Helps differentiate choroidal detachment from retinal detachment." ] }, { "status": null, "celulas": [ "Optic nerve and its sheath", "Dark structure behind the globe; the sheath is measured 3 mm behind the posterior wall.", "Enlargement may accompany raised intracranial pressure." ] }, { "status": null, "celulas": [ "Central retinal artery", "Doppler flow within the optic nerve entering the eye.", "Absent or markedly reduced flow in the right context suggests arterial occlusion." ] } ] }, { "id": "ocular.c2", "grupo": "ocular", "nome": "Safe technique step by step", "nota": null, "fonte": "ACEP Sonoguide / University of Iowa EyeRounds / StatPearls", "colunas": [ "Step", "Do", "Avoid" ], "linhas": [ { "status": "red", "celulas": [ "Before touching", "Ask about penetrating trauma, recent surgery, severe pain or globe deformity.", "Pressure if open globe is suspected." ] }, { "status": "green", "celulas": [ "Prepare", "Thick gel layer over the closed eyelid and linear probe.", "Dry contact or compression to “improve” the image." ] }, { "status": "green", "celulas": [ "Set up", "Ocular preset/low mechanical and thermal indices when available.", "Unnecessary high output." ] }, { "status": "yellow", "celulas": [ "Sweep", "Horizontal and vertical planes, with gentle eye movements to assess mobility.", "Concluding without quadrant assessment or dynamic motion." ] }, { "status": "yellow", "celulas": [ "Measure", "Optic nerve sheath 3 mm behind the retina; axial length along the visual axis when indicated.", "Oblique measurement or off-axis image." ] } ] }, { "id": "ocular.c3", "grupo": "ocular", "nome": "Retina, vitreous and choroid — how to differentiate", "nota": null, "fonte": "ACEP Sonoguide / StatPearls / EyeWiki", "colunas": [ "Finding", "Ultrasound clue", "Suggested action" ], "linhas": [ { "status": "green", "celulas": [ "Normal posterior segment", "Dark vitreous, no membrane; retina attached to wall.", "Correlate with clinical examination." ] }, { "status": "yellow", "celulas": [ "Vitreous hemorrhage", "Heterogeneous mobile echoes, more evident with high gain and eye movement.", "Assess hidden retina; guide ophthalmology according to context." ] }, { "status": "yellow", "celulas": [ "Posterior vitreous detachment", "Thin very mobile membrane, not tethered to the optic disc and may cross the midline.", "Differentiate from retina; urgent return if flashes, dark curtain or worsening." ] }, { "status": "red", "celulas": [ "Retinal detachment", "Thicker membrane, tethered to the optic disc, often V-shaped or funnel-shaped.", "Urgent ophthalmologic evaluation; macula-on is more time-sensitive." ] }, { "status": "red", "celulas": [ "Choroidal detachment", "Thick convex membranes, may appear “kissing”, spare the optic disc.", "Correlate trauma, surgery, hypotony or inflammation; specialist evaluation." ] } ] }, { "id": "ocular.c4", "grupo": "ocular", "nome": "Emergencies and warnings in ocular ultrasound", "nota": null, "fonte": "ACEP Sonoguide / StatPearls", "colunas": [ "Situation", "Useful findings", "Practical message" ], "linhas": [ { "status": "red", "celulas": [ "Open globe / globe rupture", "Irregular contour, abnormal anterior chamber, extruded contents; foreign body may be present.", "Do not compress. Stop scanning if suspicion is high." ] }, { "status": "red", "celulas": [ "Intraocular foreign body", "Very echogenic focus with shadowing or reverberation.", "Treat as penetrating trauma until proven otherwise." ] }, { "status": "red", "celulas": [ "Lens dislocation", "Lens displaced into vitreous or anterior chamber, outside the expected axis.", "Associate with trauma, connective-tissue disorder or surgery." ] }, { "status": "red", "celulas": [ "Retrobulbar hematoma", "Collection behind the globe, proptosis; globe may look “pointed”.", "Orbital emergency if pain, proptosis or vision loss is present." ] }, { "status": "red", "celulas": [ "Central retinal artery occlusion", "Absent or markedly reduced flow; sometimes an echogenic embolic focus near the disc.", "Short therapeutic window; immediate communication." ] }, { "status": "yellow", "celulas": [ "Orbital cellulitis / abscess", "Soft-tissue thickening, collection, restricted motion, pain.", "Ultrasound helps, but computed tomography/ophthalmology may be needed." ] } ] }, { "id": "ocular.c5", "grupo": "ocular", "nome": "Optic nerve sheath and papilledema — color reading", "nota": "These cutoffs do not replace neurologic evaluation. Hydration, hypercapnia, technique, image axis and ocular disease may change the measurement.", "fonte": "ACEP Sonoguide / StatPearls / revisão de bainha do nervo óptico", "colunas": [ "Measurement", "Green", "Yellow", "Red" ], "linhas": [ { "status": null, "celulas": [ "Adult", "≤5,0 mm", ">5,0–5,7 mm", "≥5,8 mm" ] }, { "status": null, "celulas": [ "Child 1–15 years", "≤4,5 mm", "4,6–5,0 mm", ">5,0 mm + clínica" ] }, { "status": null, "celulas": [ "Under 1 year", "≤4,0 mm", "4,1–4,5 mm", ">4,5 mm + clínica" ] }, { "status": null, "celulas": [ "Optic disc elevation", "<0,4 mm", "0,4–0,6 mm", ">0,6 mm" ] } ] }, { "id": "ocular.c6", "grupo": "ocular", "nome": "Biometry and masses — what to document", "nota": null, "fonte": "EyeWiki / Ophthalmologic ultrasound reviews", "colunas": [ "Use", "Document", "Watch for" ], "linhas": [ { "status": "green", "celulas": [ "Ocular biometry", "Axial length, method, right/left eye and measurement quality.", "Inter-eye difference and refraction." ] }, { "status": "yellow", "celulas": [ "Opaque media", "Dense cataract, hemorrhage or opacity blocking fundoscopy.", "Ultrasound assesses the hidden retina but does not replace complete examination." ] }, { "status": "red", "celulas": [ "Melanocytic or solid mass", "Base, height, shape, reflectivity, shadowing, subretinal fluid and vascularity.", "Growth or activity signs require a specialist." ] }, { "status": "red", "celulas": [ "Child with mass/calcification", "Echogenic intraocular mass, calcification or associated detachment.", "Consider retinoblastoma until proven otherwise." ] } ] }, { "id": "ocular.c7", "grupo": "ocular", "nome": "Teaching checklist for the ocular report", "nota": null, "fonte": "StatPearls / ACEP Sonoguide / EyeWiki", "colunas": [ "Item", "Question the report should answer" ], "linhas": [ { "status": null, "celulas": [ "Safety/technique", "Was it transpalpebral, no pressure, with limitation from pain/trauma?" ] }, { "status": null, "celulas": [ "Globe", "Are contour, volume and anterior chamber preserved?" ] }, { "status": null, "celulas": [ "Lens", "Is it centered or is there subluxation/dislocation?" ] }, { "status": null, "celulas": [ "Vitreous", "Is it anechoic or are there mobile echoes compatible with blood/inflammation?" ] }, { "status": null, "celulas": [ "Retina/choroid", "Is there a membrane? Is it tethered to the optic disc or does it spare the disc?" ] }, { "status": null, "celulas": [ "Optic nerve", "Were sheath and disc measured when there was a neurologic indication?" ] }, { "status": null, "celulas": [ "Doppler", "Was central retinal artery flow assessed when acute vision loss was present?" ] }, { "status": null, "celulas": [ "Conclusion", "Does the conclusion separate normal, indeterminate and urgent, with an objective recommendation?" ] } ] } ] }, { "metodo": "US", "chave": "pocus_uti_emergencia", "slug": "pocus-uti-emergencia", "url": "https://sonoaireport.com/en/referencias-ultrassom/pocus-uti-emergencia", "nome": "Bedside POCUS / ICU / emergency", "temPaginaPublica": true, "medidas": [ { "id": "pocus_uti_emergencia.0", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Inferior vena cava — diameter and respiratory variation", "valor": "≤2,1 cm + >50%", "unidade": null, "nota": "Echocardiographic pattern for estimating right atrial pressure during spontaneous breathing; do not use alone to decide fluids, especially with mechanical ventilation, athletes, pulmonary hypertension or right ventricular dysfunction.", "fonte": "ASE right-heart guideline / ASE POCUS nomenclature", "faixas": [ { "status": "green", "rotulo": "low or normal right-sided pressure", "valor": "≤2,1 cm e colapso >50%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "intermediate or context-dependent", "valor": "discordant diameter and collapse", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "probable congestion in the acute setting", "valor": ">2,1 cm e colapso <50% + clínica", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.1", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Inferior vena cava — distensibility with positive pressure", "valor": "≥18", "unidade": "%", "nota": "With positive-pressure ventilation, high variation may suggest fluid responsiveness in some studies, but depends on rhythm, tidal volume, pressure, lung compliance, abdominal pressure and right ventricular function.", "fonte": "ICU IVC distensibility studies / critical-care POCUS reviews", "faixas": [ { "status": "green", "rotulo": "low variation", "valor": "<18%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "possible responsiveness", "valor": "≥18%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "do not use alone in severe shock", "valor": "integrate heart and lung", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.2", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "FAST/eFAST — minimum windows", "valor": "pericardium, right upper quadrant, left upper quadrant, pelvis, pleurae and lung sliding", "unidade": null, "nota": "The goal is to detect pericardial, pleural or intraperitoneal free fluid and pneumothorax. In unstable trauma, any positive finding changes resuscitation and team priorities.", "fonte": "ACEP Sonoguide FAST/eFAST / ATLS practice", "faixas": [ { "status": "green", "rotulo": "complete and negative", "valor": "all windows assessed without fluid or pneumothorax", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "incomplete or serial", "valor": "poor window, equivocal finding or repeat", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "positive with instability", "valor": "free fluid, hemothorax, pneumothorax or pericardium", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.3", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Pericardial effusion — diastolic thickness", "valor": "<1 / 1–2 / >2", "unidade": "cm", "nota": "Teaching classification: small, moderate and large. Severity is not determined by thickness alone: right-chamber collapse, plethoric inferior vena cava, exaggerated respiratory variation and instability suggest tamponade.", "fonte": "ACEP cardiac tamponade / ASE POCUS cardiac nomenclature", "faixas": [ { "status": "green", "rotulo": "no effusion", "valor": "pericardium without fluid", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "small or moderate and stable", "valor": "<2 cm sem colapso", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high risk", "valor": ">2 cm, hemopericárdio ou sinais de tamponamento", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.4", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Lung — B-lines", "valor": "≥3", "unidade": "per intercostal space or zone", "nota": "Fewer than three B-lines in one space is usually normal. Diffuse bilateral pattern favors edema; focal pattern favors pneumonia, contusion, infarction, atelectasis or pleural disease.", "fonte": "ACEP Lung Sonoguide / international lung ultrasound recommendations", "faixas": [ { "status": "green", "rotulo": "aerated lung", "valor": "0–2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "interstitial syndrome", "valor": "≥3", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "diffuse edema with respiratory failure", "valor": "bilateral pattern + clinical context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.5", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Pneumothorax — main signs", "valor": "absent sliding, absent B-lines, barcode sign and lung point", "unidade": null, "nota": "Present lung sliding excludes pneumothorax at that point. Lung point is highly specific in the correct context; absent sliding alone is not specific.", "fonte": "ACEP Lung Sonoguide / BLUE protocol", "faixas": [ { "status": "green", "rotulo": "sliding present", "valor": "pneumothorax excluded at that point", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "isolated absent sliding", "valor": "may be atelectasis, apnea, mainstem intubation or adhesion", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "probable pneumothorax", "valor": "lung point or barcode sign + clinical context", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.6", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Abdominal free fluid in trauma", "valor": "any free fluid is FAST positive", "unidade": null, "nota": "FAST is most useful in unstable patients. In stable patients, a negative FAST does not exclude abdominal injury; consider computed tomography, observation and serial exam according to protocol.", "fonte": "ACEP FAST Sonoguide / FAST reviews", "faixas": [ { "status": "green", "rotulo": "no fluid in assessed windows", "valor": "FAST negative in completed fields", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "trace or limited window", "valor": "repeat or complement", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "free fluid with instability", "valor": "activate trauma/shock protocol", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.7", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Abdominal aorta in POCUS — largest outer diameter", "valor": "<3,0", "unidade": "cm", "nota": "Measure outer wall to outer wall, sweeping proximal, mid and distal aorta to the bifurcation. Aneurysm is defined from 3.0 cm; 2.5–2.9 cm remains ectatic/borderline.", "fonte": "ACEP Aorta Sonoguide / vascular ultrasound reviews", "faixas": [ { "status": "green", "rotulo": "no aneurysm if complete exam", "valor": "<2,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "ectasia or comparison zone", "valor": "2,5–2,9 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "abdominal aneurysm", "valor": "≥3,0 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.8", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Proximal venous compression for thrombosis", "valor": "walls should touch", "unidade": null, "nota": "Common femoral, femoral/deep femoral junction and popliteal veins should fully collapse with perpendicular compression. A noncompressible proximal vein is abnormal; incomplete exam should be repeated or complemented according to risk.", "fonte": "ACEP DVT Sonoguide / emergency compression ultrasound literature", "faixas": [ { "status": "green", "rotulo": "compressible", "valor": "walls touch at assessed points", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate", "valor": "pain, obesity, oblique compression or incomplete window", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "noncompressible", "valor": "compatible with proximal deep venous thrombosis", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.9", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Semiquantitative lung ultrasound score", "valor": "0–36", "unidade": null, "nota": "When the service uses 12 zones, each zone receives 0 to 3: A-lines or up to two B-lines, three or more B-lines, coalescent B-lines and consolidation. Severity cutoffs vary by population; use mainly for trend and loss of aeration.", "fonte": "ACEP Lung Sonoguide / lung ultrasound score literature", "faixas": [ { "status": "green", "rotulo": "low in completed fields", "valor": "0–5", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "intermediate / follow trend", "valor": "6–15", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "high in respiratory context", "valor": ">15 + clínica", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pocus_uti_emergencia.10", "grupo": "pocus_uti_emergencia", "ruleId": null, "rotulo": "Bedside guided procedures", "valor": "safe window + depth + vessels", "unidade": null, "nota": "For vascular access, thoracentesis, paracentesis, pericardiocentesis and drainage, record target, depth, needle path, structures to avoid, Doppler when useful and immediate complications.", "fonte": "ACEP POCUS guidelines / ACEP procedural ultrasound guidance", "faixas": [] } ], "classificacoes": [ { "id": "pocus_uti_emergencia.c0", "grupo": "pocus_uti_emergencia", "nome": "Calculator — diaphragm function (POCUS)", "nota": "TF% = (inspiratory − expiratory thickness)/expiratory. Useful in difficult weaning, unexplained dyspnea and suspected phrenic palsy. Low effort on mechanical ventilation reduces TF without disease.", "fonte": "Boon (Muscle Nerve) / ATS diaphragm US reviews", "colunas": [ "Parameter", "Normal", "Dysfunction" ], "linhas": [ { "status": "green", "celulas": [ "Thickening fraction", "≥ 30%", "< 20%" ] }, { "status": "yellow", "celulas": [ "Expiratory thickness", "≥ 1,5 mm", "< 1,5 mm (atrofia)" ] }, { "status": "red", "celulas": [ "Excursion (quiet breathing)", "≥ 10–15 mm", "< 10 mm" ] } ] }, { "id": "pocus_uti_emergencia.c1", "grupo": "pocus_uti_emergencia", "nome": "Trauma — FAST/eFAST and AAST grading", "nota": "US does not grade parenchymal injury well — AAST grading is CT/surgical. eFAST detects free fluid and pneumothorax; use CEUS/CT to characterize solid organs.", "fonte": "AAST Organ Injury Scale (rev. 2018) / ACEP eFAST", "colunas": [ "Item", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "Negative FAST", "No free fluid in windows; does not exclude injury — repeat/serial if unstable." ] }, { "status": "red", "celulas": [ "Positive FAST + unstable", "Free fluid → laparotomy; changes resuscitation priority." ] }, { "status": "yellow", "celulas": [ "AAST I–II (spleen/liver/kidney)", "Superficial laceration/small hematoma; often non-operative management." ] }, { "status": "red", "celulas": [ "AAST IV–V", "Deep laceration, devascularization or hilar injury; high surgical/embolization risk." ] } ] }, { "id": "pocus_uti_emergencia.c2", "grupo": "pocus_uti_emergencia", "nome": "Interactive assistant — acute POCUS, FAST/eFAST, inferior vena cava, thorax, aorta and thrombosis", "nota": "The calculator organizes findings for rapid communication. In emergency care, the result must be confirmed on the monitor, in the patient and in the institutional protocol before any invasive decision.", "fonte": "ACEP POCUS guidelines / ACEP Sonoguide / ASE POCUS nomenclature", "colunas": [ "Output", "Color", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "POCUS without critical finding in completed fields", "Green", "Lung sliding present, FAST negative in assessed windows, aorta below 3.0 cm if scanned, compressible veins if tested and no selected alert." ] }, { "status": "yellow", "celulas": [ "Borderline, incomplete or context-dependent POCUS", "Yellow", "Intermediate inferior vena cava, unassessed window, trace fluid, small/moderate stable pericardial effusion, focal B-lines, ectatic aorta, indeterminate venous compression or need for serial repeat." ] }, { "status": "red", "celulas": [ "POCUS with critical or relevant abnormal finding", "Red", "Free fluid in trauma/shock, hemothorax, probable pneumothorax, tamponade, markedly reduced cardiac function, absent cardiac activity, overloaded right ventricle, aorta >=3.0 cm or noncompressible proximal vein." ] } ] }, { "id": "pocus_uti_emergencia.c3", "grupo": "pocus_uti_emergencia", "nome": "Interactive calculator — pleural effusion in POCUS", "nota": "Document side, patient position, window used, measurement used by the formula, and whether the fluid is free or loculated.", "fonte": "Balik 2006 / Ibitoye 2018 / Hassan 2017 / EFSUMB / ERS", "colunas": [ "Method", "How to measure", "Formula / use" ], "linhas": [ { "status": "yellow", "celulas": [ "Balik — supine", "Maximum pleural separation in millimeters, in the largest free pocket.", "Estimated volume = 20 × separation in millimeters. Useful at bedside; meaningful average error, does not replace measured drainage." ] }, { "status": "yellow", "celulas": [ "Goecke 1 — sitting", "Craniocaudal effusion height in centimeters.", "Estimated volume = height × 90. Simple, but less complete than adding the subpulmonary distance." ] }, { "status": "yellow", "celulas": [ "Goecke 2 / Hassan — sitting", "Lateral height + distance between lung base and diaphragm, in centimeters.", "Estimated volume = (height + distance) × 70. Good correlation in drainage studies, still an estimate." ] }, { "status": "red", "celulas": [ "Do not use formula alone", "Septations, internal echoes, pleural nodules, trauma, fever or marked dyspnea.", "Color should be driven by complexity and clinical context; large volume does not define etiology." ] } ] }, { "id": "pocus_uti_emergencia.c4", "grupo": "pocus_uti_emergencia", "nome": "FAST/eFAST — protocol and color reading", "nota": null, "fonte": "ACEP FAST Sonoguide / trauma POCUS reviews", "colunas": [ "Window", "What to look for", "Color reading" ], "linhas": [ { "status": "green", "celulas": [ "Pericardium", "Fluid between heart and pericardium, mainly in subxiphoid or parasternal window.", "Green if absent; red with penetrating trauma, instability or tamponade signs." ] }, { "status": "red", "celulas": [ "Right upper quadrant", "Hepatorenal space, inferior liver tip and right subdiaphragmatic/pleural region.", "Free fluid is positive; in shock/trauma it should be communicated immediately." ] }, { "status": "red", "celulas": [ "Left upper quadrant", "Perisplenic, left subdiaphragmatic and left pleural regions.", "More difficult window; fluid around the spleen or above the diaphragm is relevant." ] }, { "status": "red", "celulas": [ "Pelvis", "Fluid posterior to bladder, cul-de-sac or rectovesical space.", "May be the first positive window; empty bladder reduces sensitivity." ] }, { "status": "red", "celulas": [ "eFAST thorax", "Hemothorax above the diaphragm and pneumothorax by absent sliding, barcode sign or lung point.", "Lung point or hemothorax in unstable trauma is red." ] }, { "status": "yellow", "celulas": [ "Serial exam", "Repeat after deterioration, intervention, repositioning or initially limited window.", "Yellow when incomplete; green or red depends on repeat exam." ] } ] }, { "id": "pocus_uti_emergencia.c5", "grupo": "pocus_uti_emergencia", "nome": "Inferior vena cava — teaching interpretation", "nota": null, "fonte": "ASE right-heart guideline / critical-care IVC studies", "colunas": [ "Finding", "Color", "How to use" ], "linhas": [ { "status": "green", "celulas": [ "≤2,1 cm + colapso >50%", "Green", "Suggests low/normal right atrial pressure during spontaneous breathing if image and context are adequate." ] }, { "status": "yellow", "celulas": [ "Discordant or intermediate", "Yellow", "Do not decide fluids by the inferior vena cava alone; look for hyperdynamic/reduced heart, B-lines, perfusion, lactate and clinical response." ] }, { "status": "red", "celulas": [ ">2,1 cm + colapso <50%", "Red if unstable", "Suggests elevated right-sided pressure/congestion; in shock consider obstruction, tamponade, right failure, pulmonary embolism or fluid overload." ] }, { "status": "yellow", "celulas": [ "Distensibilidade ≥18% em pressão positiva", "Yellow", "May suggest fluid responsiveness in some conditions; loses reliability with low tidal volume, arrhythmia, abdominal hypertension or right-sided dysfunction." ] } ] }, { "id": "pocus_uti_emergencia.c6", "grupo": "pocus_uti_emergencia", "nome": "Pericardium and tamponade", "nota": null, "fonte": "ACEP cardiac tamponade / ASE POCUS nomenclature", "colunas": [ "Finding", "Interpretation", "Priority" ], "linhas": [ { "status": "green", "celulas": [ "No pericardial fluid", "Reassuring for the question “is there effusion?”", "Green if the window is adequate." ] }, { "status": "yellow", "celulas": [ "Small effusion", "Less than 1 cm; measure and correlate symptoms, malignancy, uremia, postoperative state or inflammation.", "Yellow unless penetrating trauma or deterioration." ] }, { "status": "yellow", "celulas": [ "Moderate effusion", "Between 1 and 2 cm; look for right-chamber collapse and plethoric inferior vena cava.", "Yellow or red depending on stability." ] }, { "status": "red", "celulas": [ "Large, complex or hemopericardium", "Greater than 2 cm, clots or trauma increase risk.", "Red in the acute setting." ] }, { "status": "red", "celulas": [ "Tamponade signs", "Right ventricular diastolic collapse, right atrial systolic collapse, plethoric inferior vena cava or compatible instability.", "Immediate communication." ] } ] }, { "id": "pocus_uti_emergencia.c7", "grupo": "pocus_uti_emergencia", "nome": "Lung POCUS — useful profiles", "nota": null, "fonte": "ACEP Lung Sonoguide / BLUE protocol / lung ultrasound recommendations", "colunas": [ "Profile", "Findings", "Practical reading" ], "linhas": [ { "status": "green", "celulas": [ "A-lines with sliding", "Horizontal artifacts and sliding pleura.", "Aerated lung at that point; may be normal or obstructive depending on context." ] }, { "status": "yellow", "celulas": [ "Diffuse bilateral B-lines", "Three or more B-lines per space/zone in several zones.", "Favors interstitial edema; red with severe respiratory failure." ] }, { "status": "yellow", "celulas": [ "Focal B-lines or consolidation", "Asymmetric pattern, irregular pleura, dynamic air bronchogram or subpleural consolidation.", "Consider pneumonia, contusion, atelectasis, infarction or pleural disease." ] }, { "status": "red", "celulas": [ "Probable pneumothorax", "Absent sliding with absent B-lines, barcode sign and/or lung point.", "Red with trauma, ventilation or instability." ] }, { "status": "yellow", "celulas": [ "Pleural effusion", "Anechoic or complex fluid above the diaphragm.", "Use volume calculator as an estimate; complexity and symptoms define urgency." ] } ] }, { "id": "pocus_uti_emergencia.c8", "grupo": "pocus_uti_emergencia", "nome": "Aorta and venous thrombosis in shock/dyspnea POCUS", "nota": "Vascular POCUS is excellent for focused questions, but a limited exam does not replace complete vascular Doppler or CT when suspicion remains high.", "fonte": "ACEP Aorta Sonoguide / ACEP DVT Sonoguide / ACEP POCUS guidelines", "colunas": [ "Question", "Green", "Yellow", "Red" ], "linhas": [ { "status": "green", "celulas": [ "Abdominal aorta", "<2.5 cm and complete outer-wall-to-outer-wall sweep.", "2.5–2.9 cm: ectatic/borderline; compare and document technique.", ">=3.0 cm: aneurysm. Pain, hypotension or syncope makes the finding critical." ] }, { "status": "red", "celulas": [ "Suspected dissection/rupture", "No indirect signs and low clinical concern if exam is complete.", "Exam limited by gas/pain: do not exclude vascular catastrophe.", "Flap, hematoma, free fluid, severe pain or shock: vascular/emergency pathway." ] }, { "status": "green", "celulas": [ "Proximal venous thrombosis", "Femoral and popliteal veins compressible at assessed points.", "Incomplete compression, pain, obesity, duplicated vein or partial window.", "Noncompressible proximal vein or visible thrombus: compatible with deep venous thrombosis." ] }, { "status": "yellow", "celulas": [ "Pulmonary embolism integration", "No thrombosis and no right ventricular dilation lowers probability but does not exclude.", "Dyspnea with discordant findings requires clinical protocol.", "Proximal thrombosis + dilated right ventricle/shock increases concern for relevant pulmonary embolism." ] } ] }, { "id": "pocus_uti_emergencia.c9", "grupo": "pocus_uti_emergencia", "nome": "Lung score — loss of aeration by zone", "nota": "The 0–36 sum assumes 12 zones. Absolute cutoffs vary by population; in emergency/ICU care, serial trend is often more useful than a single measure.", "fonte": "ACEP Lung Sonoguide / lung ultrasound score literature", "colunas": [ "Zone score", "Ultrasound finding", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "0", "A-lines or up to two B-lines with sliding.", "Preserved aeration at that point." ] }, { "status": "yellow", "celulas": [ "1", "Three or more well-spaced B-lines.", "Mild aeration loss / early interstitial syndrome." ] }, { "status": "yellow", "celulas": [ "2", "Coalescent B-lines or partial white lung.", "Moderate to marked loss; follow trend and distribution." ] }, { "status": "red", "celulas": [ "3", "Tissue-like pattern/subpleural consolidation.", "Severe aeration loss; correlate pneumonia, atelectasis, contusion, infarction or severe edema." ] } ] }, { "id": "pocus_uti_emergencia.c10", "grupo": "pocus_uti_emergencia", "nome": "Guided procedures — safety checklist", "nota": null, "fonte": "ACEP POCUS guidelines / ACEP procedural ultrasound guidance", "colunas": [ "Procedure", "Before puncture", "During/after" ], "linhas": [ { "status": "green", "celulas": [ "Vascular access", "Identify vein and artery, compressibility, thrombus, depth and free path.", "Prefer needle-tip visualization; confirm flow/position according to protocol." ] }, { "status": "yellow", "celulas": [ "Thoracentesis", "Confirm free fluid, diaphragm, lung, depth and intercostal vessels when possible.", "Reassess lung sliding and complications after the procedure." ] }, { "status": "yellow", "celulas": [ "Paracentesis", "Map ascites, bowel loops, bladder, epigastric vessels and wall thickness.", "Record site, depth, free/loculated fluid and tolerance." ] }, { "status": "red", "celulas": [ "Pericardiocentesis", "Define largest pocket, relationship with liver/lung/coronaries and safest window.", "In tamponade, communication and trained team are priority; POCUS guides but does not replace institutional protocol." ] }, { "status": "yellow", "celulas": [ "Abscess or collection drainage", "Confirm fluid, septations, gas, vessels and deep structures.", "Document path, aspirated content and whether immediate complication occurred." ] } ] }, { "id": "pocus_uti_emergencia.c11", "grupo": "pocus_uti_emergencia", "nome": "Undifferentiated shock — RUSH-style integration", "nota": null, "fonte": "ACEP POCUS guidelines / RUSH literature / BLUE protocol", "colunas": [ "Question", "POCUS finding", "Interpretation" ], "linhas": [ { "status": "red", "celulas": [ "Pump", "Markedly reduced ventricular function, absent activity or effusion with tamponade.", "Consider cardiogenic shock, arrest without effective activity or obstructive shock." ] }, { "status": "yellow", "celulas": [ "Tank", "Very small/collapsible inferior vena cava, free fluid, aortic aneurysm or pulmonary congestion.", "Separate hypovolemia, hemorrhage, congestion and vascular causes." ] }, { "status": "red", "celulas": [ "Pipes", "Deep venous thrombosis, dilated right ventricle, pneumothorax or aortic aneurysm.", "Raises suspicion for pulmonary embolism, obstruction or vascular catastrophe." ] }, { "status": "yellow", "celulas": [ "Lung", "Diffuse B-lines, consolidation, effusion or absent sliding.", "Helps choose between fluids, vasopressor, ventilation and drainage according to protocol." ] } ] }, { "id": "pocus_uti_emergencia.c12", "grupo": "pocus_uti_emergencia", "nome": "POCUS documentation checklist", "nota": null, "fonte": "ACEP POCUS guidelines / ASE POCUS nomenclature", "colunas": [ "Item", "What to document" ], "linhas": [ { "status": null, "celulas": [ "Clinical question", "Shock, trauma, dyspnea, arrest, sepsis, procedure or serial reassessment." ] }, { "status": null, "celulas": [ "Technique", "Probe, obtained windows, patient position, ventilation and limitations." ] }, { "status": null, "celulas": [ "Positive and negative findings", "Mention free fluid, pericardium, lung sliding, B-lines, cardiac function, inferior vena cava, aorta and venous compression when assessed." ] }, { "status": null, "celulas": [ "Measurements and calculations", "Inferior vena cava diameters, collapsibility/distensibility index, effusion thickness, mitral variation, aorta, lung score and pleural effusion estimate when useful." ] }, { "status": null, "celulas": [ "Clinical integration", "State whether the finding changes immediate management, requires complementary imaging, serial repeat or urgent communication." ] } ] } ] }, { "metodo": "US", "chave": "pulmao", "slug": "pulmao", "url": "https://sonoaireport.com/en/referencias-ultrassom/pulmao", "nome": "Lung / thorax (POCUS)", "temPaginaPublica": true, "medidas": [ { "id": "pulmao.0", "grupo": "pulmao", "ruleId": null, "rotulo": "Pleural effusion — maximum interpleural separation", "valor": "measure", "unidade": "mm", "nota": "Largest distance between parietal and visceral pleura in the largest free pocket; basis of the Balik formula in supine patients.", "fonte": "Balik 2006 / EFSUMB / ERS", "faixas": [ { "status": "green", "rotulo": "no measurable fluid", "valor": "<10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "estimable, context-dependent", "valor": "10–30 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "large or symptomatic", "valor": ">30 mm + clínica", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pulmao.1", "grupo": "pulmao", "ruleId": null, "rotulo": "Pleural effusion — craniocaudal height", "valor": "measure", "unidade": "cm", "nota": "In sitting or upright patients, measure the vertical fluid extent along the lateral/dorsolateral chest wall.", "fonte": "Goecke / Ibitoye / Hassan", "faixas": [ { "status": "green", "rotulo": "not measurable", "valor": "0 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "small to moderate", "valor": "<10 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "large, correlate symptoms", "valor": "≥10 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pulmao.2", "grupo": "pulmao", "ruleId": null, "rotulo": "Lung base–diaphragm distance", "valor": "measure", "unidade": "cm", "nota": "Subpulmonary distance used in Goecke 2 and Hassan formulas; improves the estimate when added to lateral height.", "fonte": "Goecke / Hassan / Ibitoye", "faixas": [] }, { "id": "pulmao.3", "grupo": "pulmao", "ruleId": null, "rotulo": "B-lines", "valor": "≥ 3", "unidade": "per space or field", "nota": "Diffuse bilateral pattern favors interstitial edema; focal or asymmetric pattern favors pneumonia, contusion, atelectasis or fibrosis.", "fonte": "BLUE / ERS statement", "faixas": [ { "status": "green", "rotulo": "few/isolated", "valor": "0–2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "interstitial syndrome", "valor": "≥3", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "diffuse pattern with distress", "valor": "clinical urgency", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "pulmao.4", "grupo": "pulmao", "ruleId": null, "rotulo": "Nodular pleural or diaphragmatic thickening", "valor": "> 10", "unidade": "mm", "nota": "When associated with pleural/diaphragmatic nodules or complex effusion, it is suspicious for malignancy; fluid should be analyzed when indicated.", "fonte": "EFSUMB chest ultrasound / pleural malignancy reviews", "faixas": [ { "status": "green", "rotulo": "no thickening/nodule", "valor": "absent", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "smooth/contextual thickening", "valor": "<10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious", "valor": ">10 mm ou nodular", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "pulmao.c0", "grupo": "pulmao", "nome": "Interactive calculator — pleural effusion", "nota": "Document side, patient position, window used, measurement used by the formula, and whether the fluid is free or loculated.", "fonte": "Balik 2006 / Ibitoye 2018 / Hassan 2017 / EFSUMB / ERS", "colunas": [ "Method", "How to measure", "Formula / use" ], "linhas": [ { "status": "yellow", "celulas": [ "Balik — supine", "Maximum pleural separation in millimeters, in the largest free pocket.", "Estimated volume = 20 × separation in millimeters. Useful at bedside; meaningful average error, does not replace measured drainage." ] }, { "status": "yellow", "celulas": [ "Eibenberger — supine", "Separation between lung and posterior chest wall in millimeters.", "Estimated volume = 47.6 × separation − 837. May become negative for small volumes; use as comparison." ] }, { "status": "yellow", "celulas": [ "Goecke 1 — sitting", "Craniocaudal effusion height in centimeters.", "Estimated volume = height × 90. Simple, but less complete than adding the subpulmonary distance." ] }, { "status": "yellow", "celulas": [ "Goecke 2 / Hassan — sitting", "Lateral height + distance between lung base and diaphragm, in centimeters.", "Estimated volume = (height + distance) × 70. Good correlation in drainage studies, still an estimate." ] }, { "status": "red", "celulas": [ "Do not use formula alone", "Septations, internal echoes, pleural nodules, trauma, fever or marked dyspnea.", "Color should be driven by complexity and clinical context; large volume does not define etiology." ] } ] }, { "id": "pulmao.c1", "grupo": "pulmao", "nome": "Pleural effusion — ultrasound appearance and meaning", "nota": null, "fonte": "EFSUMB chest ultrasound / ERS statement / BTS pleural disease", "colunas": [ "Appearance", "Practical interpretation", "Color" ], "linhas": [ { "status": "green", "celulas": [ "No measurable pleural fluid", "Normal for the question “is there effusion?”; still assess sliding, lines and consolidations according to symptoms.", "Green: consensus normal for effusion." ] }, { "status": "yellow", "celulas": [ "Anechoic, free, mobile", "May be transudate or exudate; ultrasound does not establish etiology without clinical/laboratory context.", "Yellow: abnormal but not necessarily complicated." ] }, { "status": "yellow", "celulas": [ "Complex non-septated", "Echoes/debris may occur in exudate, older hemothorax, inflammation or malignancy; correlate.", "Yellow: contextual zone." ] }, { "status": "red", "celulas": [ "Septated, loculated or thick debris", "Suggests complicated effusion, organized empyema or hemothorax; drainage may be difficult and diagnostic aspiration is often relevant.", "Red when infection, trauma, marked loculation or clinical worsening is present." ] }, { "status": "red", "celulas": [ "Pleural/diaphragmatic nodules or nodular thickening >10 mm", "Suspicious for malignancy, especially with recurrent or unilateral effusion.", "Red: consensus suspicious abnormality." ] } ] }, { "id": "pulmao.c2", "grupo": "pulmao", "nome": "Lung signs — teaching interpretation", "nota": null, "fonte": "BLUE protocol / ERS thoracic ultrasound / EFSUMB", "colunas": [ "Sign", "How to recognize", "Interpretation" ], "linhas": [ { "status": "green", "celulas": [ "Lung sliding present", "Pleural line shimmers/moves with breathing.", "Excludes pneumothorax at that scanned point." ] }, { "status": "green", "celulas": [ "A-lines with sliding", "Repeated horizontal artifacts below the pleural line.", "Aerated lung at that point; may be normal or obstructive depending on clinical context." ] }, { "status": "yellow", "celulas": [ "Three or more B-lines", "Vertical artifacts arising from pleura, erasing A-lines and reaching the bottom of the screen.", "Interstitial syndrome: edema if diffuse bilateral; pneumonia, contusion or fibrosis if focal/asymmetric." ] }, { "status": "red", "celulas": [ "Absent sliding + lung point", "Transition between no-sliding and sliding areas.", "Highly specific for pneumothorax in the correct context." ] }, { "status": "red", "celulas": [ "Subpleural consolidation with dynamic air bronchogram", "Tissue-like area with moving hyperechoic dots/lines.", "Favors pneumonia; distinguish from atelectasis by air movement and context." ] } ] }, { "id": "pulmao.c3", "grupo": "pulmao", "nome": "Technique and thorax report checklist", "nota": null, "fonte": "BTS pleural procedures 2023 / ERS / EFSUMB", "colunas": [ "Item", "What to report" ], "linhas": [ { "status": "green", "celulas": [ "Scanned windows", "Anterior, lateral and posterior when possible; at bedside, describe recumbent-position limitations." ] }, { "status": "green", "celulas": [ "Pleural effusion", "Side, estimated volume, formula used, patient position, free or loculated, anechoic/complex appearance." ] }, { "status": "yellow", "celulas": [ "Interstitium", "Distribution of B-lines: focal, multifocal or diffuse; symmetry and relationship with pleural line." ] }, { "status": "red", "celulas": [ "Immediate alerts", "Probable pneumothorax, infected complex effusion, suspected hemothorax, large effusion with distress or suspicious malignant signs." ] } ] }, { "id": "pulmao.c4", "grupo": "pulmao", "nome": "Lung signs — interpretation (BLUE)", "nota": null, "fonte": "Lichtenstein BLUE / Radiopaedia", "colunas": [ "Sign", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "Lung sliding present", "Excludes pneumothorax at that point" ] }, { "status": null, "celulas": [ "A-lines (horizontal)", "Normally aerated lung (or pneumothorax if no sliding)" ] }, { "status": null, "celulas": [ "≥ 3 B-lines per field", "Interstitial syndrome (edema, pneumonia, fibrosis)" ] }, { "status": null, "celulas": [ "No sliding + lung point", "Pneumothorax (lung point is specific)" ] }, { "status": null, "celulas": [ "Anechoic collection above diaphragm", "Pleural effusion (curtain/quad/sinusoid signs)" ] } ] } ] }, { "metodo": "US", "chave": "sop", "slug": "sop", "url": "https://sonoaireport.com/en/referencias-ultrassom/sop", "nome": "Polycystic ovary (PCOS)", "temPaginaPublica": true, "medidas": [ { "id": "sop.0", "grupo": "sop", "ruleId": null, "rotulo": "Follicle number per ovary (FNPO)", "valor": "≥ 20", "unidade": "follicles 2–9 mm", "nota": "PCOS US criterion (2018 update; previously ≥ 12)", "fonte": "Intl Guideline 2018/2023 (ESHRE/ASRM)", "faixas": [] }, { "id": "sop.1", "grupo": "sop", "ruleId": null, "rotulo": "Ovarian volume", "valor": "≥ 10", "unidade": "mL", "nota": "alternative criterion (no cyst/corpus luteum)", "fonte": "Rotterdam / Intl Guideline", "faixas": [] } ], "classificacoes": [ { "id": "sop.c0", "grupo": "sop", "nome": "Rotterdam — PCOS diagnosis (2 of 3)", "nota": "Needs 2 of 3 + exclusion of other causes. Do not apply the US criterion within < 8 years post-menarche.", "fonte": "Intl Evidence-based Guideline (ESHRE/ASRM)", "colunas": [ "Criterion", "Definition" ], "linhas": [ { "status": null, "celulas": [ "Oligo/anovulation", "clinical" ] }, { "status": null, "celulas": [ "Hyperandrogenism", "clinical or biochemical" ] }, { "status": null, "celulas": [ "Polycystic ovaries on US", "FNPO ≥ 20 OR volume ≥ 10 mL" ] } ] } ] }, { "metodo": "US", "chave": "arterias_renais", "slug": "arterias-renais", "url": "https://sonoaireport.com/en/referencias-ultrassom/arterias-renais", "nome": "Renal arteries (native Doppler)", "temPaginaPublica": true, "medidas": [ { "id": "arterias_renais.0", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Common clinical indications", "valor": "Resistant or abrupt-onset hypertension; progressive or unexpected renal function decline; renal function decline after angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; abdominal bruit; kidney size difference greater than 2 cm; follow-up of known stenosis, angioplasty, or stent; suspected renal infarction, aortic dissection, aneurysm, pseudoaneurysm, arteriovenous fistula, or renal venous disease.", "unidade": null, "nota": "When renovascular hypertension is suspected, duplex Doppler is a widely accepted initial option when the acoustic window is adequate.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter for Duplex Sonography of Native Renal Vessels, 2023; ACR Appropriateness Criteria Renovascular Hypertension", "faixas": [] }, { "id": "arterias_renais.1", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Minimum technical protocol", "valor": "Measure the longest length of each kidney; assess the aorta at the renal artery level; map the main renal arteries from origin to hilum, including proximal, mid, and distal segments; look for accessory arteries when possible; record intrarenal waveforms in upper, mid, and lower poles; apply Doppler angle correction and keep the angle at 60 degrees or less.", "unidade": null, "nota": "If a segment is not visualized, the report should state that clearly rather than assuming normality.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter for Duplex Sonography of Native Renal Vessels, 2023", "faixas": [] }, { "id": "arterias_renais.2", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Main renal artery peak systolic velocity", "valor": "< 180 cm/s", "unidade": null, "nota": "Usually normal when isolated and waveform shape is preserved. Values from 180 to 199 cm/s are borderline in many protocols; 200 cm/s or higher increases suspicion for hemodynamically relevant stenosis, especially with an elevated renal-to-aortic ratio.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter; Schaberle et al. Ultrasound diagnostics of renal artery stenosis; Ultrasoundpaedia renal artery protocol", "faixas": [] }, { "id": "arterias_renais.3", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Renal-to-aortic ratio", "valor": "< 3.5", "unidade": null, "nota": "Calculated as the highest renal artery peak systolic velocity divided by the aortic peak systolic velocity at the renal artery level. A ratio of 3.5 or higher is a strong criterion for significant stenosis when the aortic velocity is reliable.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter; Schaberle et al. Ultrasound diagnostics of renal artery stenosis; Ultrasoundpaedia renal artery protocol", "faixas": [] }, { "id": "arterias_renais.4", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Intrarenal acceleration time", "valor": "<= 70 ms", "unidade": null, "nota": "Time greater than 70 ms, especially with a tardus-parvus waveform, suggests proximal stenosis. In isolation it may be borderline and should be compared with direct criteria.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter; Ultrasoundpaedia renal artery protocol", "faixas": [] }, { "id": "arterias_renais.5", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Intrarenal acceleration index", "valor": ">= 300 cm/s²", "unidade": null, "nota": "Values below 300 cm/s² support a tardus-parvus pattern, but they are most useful when combined with prolonged acceleration time and direct criteria.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter; Ultrasoundpaedia renal artery protocol", "faixas": [] }, { "id": "arterias_renais.6", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Intrarenal resistive index", "valor": "Usually < 0.70", "unidade": null, "nota": "Values from 0.70 to 0.79 suggest increased parenchymal resistance or relevant clinical context. A value of 0.80 or higher is abnormal and often reflects chronic parenchymal disease or worse prognosis, but it does not confirm stenosis by itself.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter; Ultrasoundpaedia renal artery protocol", "faixas": [] }, { "id": "arterias_renais.7", "grupo": "arterias_renais", "ruleId": null, "rotulo": "Kidney length and asymmetry", "valor": "Typical adult: 9 to 12 cm; difference > 2 cm is relevant", "unidade": null, "nota": "A small kidney, asymmetry greater than 2 cm, or cortical loss increases suspicion for chronic disease, renal ischemia, or sequelae of longstanding stenosis.", "fonte": "ACR-AIUM-SPR-SRU Practice Parameter; StatPearls Renal Artery Stenosis", "faixas": [] } ], "classificacoes": [ { "id": "arterias_renais.c0", "grupo": "arterias_renais", "nome": "Teaching calculator — renal artery Doppler", "nota": null, "fonte": null, "colunas": [], "linhas": [ { "status": "green", "celulas": [ "Green", "Renal velocity < 180 cm/s, renal-to-aortic ratio < 3.0 to 3.5, acceleration time <= 70 ms, resistive index < 0.70, and no relevant kidney asymmetry." ] }, { "status": "yellow", "celulas": [ "Yellow", "Velocity 180 to 199 cm/s, renal-to-aortic ratio 3.0 to 3.49, isolated acceleration time > 70 ms, resistive index 0.70 to 0.79, or limited acoustic window." ] }, { "status": "red", "celulas": [ "Red", "Velocity >= 200 cm/s, renal-to-aortic ratio >= 3.5, post-stenotic turbulence, associated tardus-parvus waveform, absent flow with clinical concern, kidney asymmetry > 2 cm, or resistive index >= 0.80." ] } ] }, { "id": "arterias_renais.c1", "grupo": "arterias_renais", "nome": "Direct criteria for renal artery stenosis", "nota": null, "fonte": null, "colunas": [], "linhas": [ { "status": "green", "celulas": [ "Peak systolic velocity < 180 cm/s", "Low likelihood of hemodynamically significant stenosis when the artery was well visualized and there is no turbulence." ] }, { "status": "yellow", "celulas": [ "Velocity 180 to 199 cm/s", "Borderline range: some laboratories use 180 cm/s as a sensitive cutoff; others prefer 200 cm/s for higher specificity." ] }, { "status": "red", "celulas": [ "Velocity >= 200 cm/s", "High suspicion for significant stenosis, especially when accompanied by renal-to-aortic ratio >= 3.5, focal narrowing, aliasing, or post-stenotic turbulence." ] }, { "status": "red", "celulas": [ "Renal-to-aortic ratio >= 3.5", "Strong direct criterion when the aortic velocity is technically reliable. It may be less reliable with aortic disease or very low or very high aortic flow." ] } ] }, { "id": "arterias_renais.c2", "grupo": "arterias_renais", "nome": "Indirect intrarenal criteria", "nota": null, "fonte": null, "colunas": [], "linhas": [ { "status": "green", "celulas": [ "Normal low-resistance waveform", "Rapid systolic upstroke, continuous diastolic flow, and no perceptible delay in acceleration." ] }, { "status": "yellow", "celulas": [ "Acceleration time > 70 ms", "Borderline if isolated; becomes more suspicious when unilateral, asymmetric, or associated with low acceleration." ] }, { "status": "red", "celulas": [ "Tardus-parvus waveform", "Slow rounded systolic upstroke, usually with prolonged acceleration time and reduced acceleration index; suggests significant proximal stenosis." ] }, { "status": "yellow", "celulas": [ "Acceleration index < 300 cm/s²", "Supports a tardus-parvus pattern, especially when combined with prolonged acceleration time." ] } ] }, { "id": "arterias_renais.c3", "grupo": "arterias_renais", "nome": "Resistive index and renal parenchyma", "nota": null, "fonte": null, "colunas": [], "linhas": [ { "status": "green", "celulas": [ "< 0.70", "Usual adult range when symmetric and clinically compatible." ] }, { "status": "yellow", "celulas": [ "0.70 to 0.79", "Mild to moderate increased resistance; correlate with age, chronic kidney disease, diabetes, hypertension, and venous pressure." ] }, { "status": "red", "celulas": [ ">= 0.80", "Abnormal. Suggests chronic parenchymal disease or poorer renal reserve; should not be used alone to diagnose stenosis." ] } ] }, { "id": "arterias_renais.c4", "grupo": "arterias_renais", "nome": "Pitfalls and differential diagnosis", "nota": null, "fonte": null, "colunas": [], "linhas": [ { "status": "yellow", "celulas": [ "Limited acoustic window", "Bowel gas, obesity, breathing, deep arteries, or nonvisualized origins may reduce sensitivity. Report nonassessed segments." ] }, { "status": "yellow", "celulas": [ "Accessory renal artery", "May be the only stenotic artery or supply part of the kidney. Look for it when clinical suspicion or perfusion asymmetry exists." ] }, { "status": "yellow", "celulas": [ "Fibromuscular dysplasia", "More common in young women; often involves the mid or distal segment and may not show the same ostial atherosclerotic pattern." ] }, { "status": "red", "celulas": [ "Occlusion or renal infarction", "Segmental or global absent flow, acute pain, perfusion defect, or clinical concern requires urgent interpretation and possible complementary imaging." ] }, { "status": "yellow", "celulas": [ "Abnormal aorta", "Aneurysm, dissection, stenosis, very low flow, or very high flow can make the renal-to-aortic ratio less reliable." ] } ] }, { "id": "arterias_renais.c5", "grupo": "arterias_renais", "nome": "After renal angioplasty or stent", "nota": null, "fonte": null, "colunas": [], "linhas": [ { "status": "yellow", "celulas": [ "Compare with post-procedure baseline", "In-stent velocities may be naturally higher. Comparison with the first post-procedure Doppler is essential." ] }, { "status": "yellow", "celulas": [ "Persistently very high velocity", "Many studies use higher cutoffs for restenosis, for example above 250 cm/s, but there is no universal consensus; correlate with renal-to-aortic ratio, turbulence, and clinical evolution." ] }, { "status": "red", "celulas": [ "Loss of flow or clinical worsening", "May indicate thrombosis, occlusion, critical restenosis, or vascular complication and should be communicated with priority." ] } ] }, { "id": "arterias_renais.c6", "grupo": "arterias_renais", "nome": "Report checklist", "nota": null, "fonte": null, "colunas": [], "linhas": [ { "status": "yellow", "celulas": [ "Required measurements when possible", "Aortic peak systolic velocity; highest peak systolic velocity in each renal artery; renal-to-aortic ratio; assessed segments; intrarenal waveforms; resistive index; bilateral kidney length." ] }, { "status": "yellow", "celulas": [ "Suggested impression", "State whether direct or indirect criteria for significant stenosis are present, whether the examination was limited, which side is suspicious, and whether findings suggest parenchymal disease or vascular complication." ] } ] } ] }, { "metodo": "US", "chave": "transplante_renal", "slug": "transplante-renal", "url": "https://sonoaireport.com/en/referencias-ultrassom/transplante-renal", "nome": "Renal transplant (Doppler)", "temPaginaPublica": true, "medidas": [ { "id": "transplante_renal.0", "grupo": "transplante_renal", "ruleId": null, "rotulo": "Minimum technical protocol", "valor": "Grayscale + color Doppler + spectral Doppler", "unidade": null, "nota": "Document graft size, parenchyma, collecting system, bladder/ureter when applicable, perigraft space, graft artery and vein, anastomoses, adjacent iliac artery/vein, and intrarenal waveforms in upper, mid and lower poles.", "fonte": "ACR-AIUM-SPR-SRU 2024 / UT Southwestern 2020", "faixas": [] }, { "id": "transplante_renal.1", "grupo": "transplante_renal", "ruleId": null, "rotulo": "Peak systolic velocity in the graft artery", "valor": "<200 / 200-249 / 250-299 / >=300", "unidade": "cm/s", "nota": "An isolated value can be false positive, especially immediately after surgery or in a tortuous artery. Risk increases with focal acceleration plus aliasing, iliac ratio >=2.0 and intrarenal tardus-parvus waveform.", "fonte": "ACR-AIUM-SPR-SRU 2024 / Clinical Radiology 2003 / AJR 2017", "faixas": [ { "status": "green", "rotulo": "usually normal", "valor": "<200 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline or context-dependent", "valor": "200-249 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "suspicious if isolated", "valor": "250-299 cm/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "strong when combined with direct/indirect criteria", "valor": ">=300 cm/s ou >=250 cm/s + aliasing/razão alta/tardus-parvus", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "transplante_renal.2", "grupo": "transplante_renal", "ruleId": null, "rotulo": "Graft artery / iliac artery ratio", "valor": "<1,8 / 1,8-1,99 / >=2,0", "unidade": null, "nota": "Helps reduce false positives from high output or elevated systemic velocities. Measure the iliac artery adjacent to the anastomosis and use the same technique on follow-up.", "fonte": "ACR-AIUM-SPR-SRU 2024 / UT Southwestern 2020 / BMUS teaching material", "faixas": [ { "status": "green", "rotulo": "no proportional criterion", "valor": "<1,8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "gray zone", "valor": "1,8-1,99", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "abnormal when focal acceleration is present", "valor": ">=2,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "transplante_renal.3", "grupo": "transplante_renal", "ruleId": null, "rotulo": "Intrarenal tardus-parvus waveform", "valor": "Acceleration time >70 ms or acceleration index <300 cm/s²", "unidade": null, "nota": "This is an indirect criterion; it carries more weight when distal to a focal acceleration. It can also occur with proximal iliac stenosis, hypotension or suboptimal technique.", "fonte": "UT Southwestern 2020 / BMUS teaching material", "faixas": [ { "status": "green", "rotulo": "preserved waveform", "valor": "rapid systolic upstroke", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "isolated or technical", "valor": "time >70 ms or index <300 without focal jet", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "strong indirect criterion", "valor": "tardus-parvus + high velocity/ratio", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "transplante_renal.4", "grupo": "transplante_renal", "ruleId": null, "rotulo": "Intrarenal resistive index", "valor": "0,60-0,70 / 0,70-0,80 / >0,80", "unidade": null, "nota": "It does not by itself separate rejection, tubular injury, drug toxicity, obstruction, venous compression or systemic congestion. Trend and clinical context matter more than one isolated measurement.", "fonte": "UT Southwestern 2020 / Radiopaedia / review literature", "faixas": [ { "status": "green", "rotulo": "common in stable graft", "valor": "0,60-0,70", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline or nonspecific", "valor": "0,70-0,80", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "elevated, correlate", "valor": ">0,80", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "concerning if persistent or with dysfunction", "valor": ">=0,90, fluxo diastólico ausente/reverso", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "transplante_renal.5", "grupo": "transplante_renal", "ruleId": null, "rotulo": "Graft renal vein", "valor": "Venous flow present, no thrombus and no marked focal acceleration", "unidade": null, "nota": "Absent venous flow, thrombus, marked graft enlargement and reversed arterial diastolic flow are critical findings and should be communicated.", "fonte": "ACR-AIUM-SPR-SRU 2024 / transplant vascular complication reviews", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "patent vein", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "evaluate compression or technique", "valor": "focal acceleration without thrombus", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "critical", "valor": "no flow, thrombus or reversed arterial diastolic flow", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "transplante_renal.6", "grupo": "transplante_renal", "ruleId": null, "rotulo": "Collecting system and perigraft collections", "valor": "Describe grade, size, location and compressive effect", "unidade": null, "nota": "Mild dilatation may be transient; moderate/severe dilatation, complex collection or compressive collection changes management, especially with pain, fever, reduced urine output or rising creatinine.", "fonte": "ACR-AIUM-SPR-SRU 2024 / renal transplant ultrasound reviews", "faixas": [ { "status": "green", "rotulo": "no relevant finding", "valor": "no dilatation and no compressive collection", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "follow/correlate", "valor": "mild dilatation or small simple collection", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "relevant abnormality", "valor": "marked dilatation, complex or compressive collection", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "transplante_renal.c0", "grupo": "transplante_renal", "nome": "Interactive calculator — renal transplant Doppler", "nota": null, "fonte": "ACR-AIUM-SPR-SRU 2024 / Clinical Radiology 2003 / AJR 2017 / UT Southwestern 2020", "colunas": [], "linhas": [ { "status": "green", "celulas": [ "Green", "Arterial and venous flow present, graft artery velocity <200 cm/s, ratio <1.8, preserved intrarenal waveform, resistive index approximately 0.60-0.70 and no compressive collection." ] }, { "status": "yellow", "celulas": [ "Yellow", "Velocity 200-299 cm/s without a strong combination, ratio 1.8-1.99, resistive index >0.70 or isolated >0.80, mildly prolonged acceleration time, mild dilatation or small simple collection." ] }, { "status": "red", "celulas": [ "Red", "No arterial or venous flow, venous thrombosis, reversed arterial diastolic flow, global hypoperfusion, velocity >=300 cm/s or >=250 cm/s with aliasing/ratio >=2/tardus-parvus, complex or compressive collection, or marked dilatation." ] } ] }, { "id": "transplante_renal.c1", "grupo": "transplante_renal", "nome": "Acquisition checklist", "nota": null, "fonte": "ACR-AIUM-SPR-SRU 2024 / UT Southwestern 2020", "colunas": [ "Step", "What to record" ], "linhas": [ { "status": null, "celulas": [ "Grayscale", "Graft location, length, cortical thickness/echogenicity, corticomedullary differentiation, renal sinus, collecting system, ureter/stent when visible, bladder and residual urine if indicated." ] }, { "status": null, "celulas": [ "Perigraft space", "Look for hematoma, seroma, lymphocele, urinoma or abscess; measure, locate and describe complexity and compressive effect." ] }, { "status": null, "celulas": [ "Arterial Doppler", "Measure adjacent iliac artery, anastomosis, proximal, mid and hilar graft artery; look for multiple arteries, kinking, aliasing and turbulence." ] }, { "status": null, "celulas": [ "Intrarenal Doppler", "Record waveforms in upper, mid and lower poles, with resistive index, acceleration time and acceleration index when stenosis is the clinical question." ] }, { "status": null, "celulas": [ "Venous Doppler", "Confirm patent renal and iliac veins without thrombus; in hematuria or recent biopsy, look for arteriovenous fistula and pseudoaneurysm." ] } ] }, { "id": "transplante_renal.c2", "grupo": "transplante_renal", "nome": "Graft artery stenosis — color reading", "nota": null, "fonte": "Clinical Radiology 2003 / AJR 2017 / UT Southwestern 2020", "colunas": [ "Color", "Practical criteria", "How to report" ], "linhas": [ { "status": null, "celulas": [ "Green", "No relevant focal acceleration; velocity <200 cm/s; iliac ratio <1.8; no distal tardus-parvus.", "No ultrasound criteria for hemodynamically significant stenosis on the current study." ] }, { "status": null, "celulas": [ "Yellow", "Velocity 200-249 cm/s, or isolated 250-299 cm/s in postoperative/surveillance context, or borderline ratio, especially with tortuosity or difficult angle.", "Borderline/contextual finding; correlate with renal function, blood pressure and prior Doppler." ] }, { "status": null, "celulas": [ "Red", "Velocity >=300 cm/s, or >=250 cm/s associated with aliasing/turbulence, ratio >=2.0 and intrarenal tardus-parvus waveform.", "Combination of findings suspicious for hemodynamically significant stenosis; communicate and consider confirmation according to local protocol." ] } ] }, { "id": "transplante_renal.c3", "grupo": "transplante_renal", "nome": "Resistive index — cautious interpretation", "nota": null, "fonte": "UT Southwestern 2020 / Radiopaedia / review literature", "colunas": [ "Range", "Color", "Comment" ], "linhas": [ { "status": null, "celulas": [ "0,60-0,70", "Green", "Common range in stable grafts, but always compare with baseline and clinical context." ] }, { "status": null, "celulas": [ "0,70-0,80", "Yellow", "Intermediate zone; may be normal in some patients and abnormal in others." ] }, { "status": null, "celulas": [ ">0,80", "Yellow", "Elevated and nonspecific: rejection, tubular injury, toxicity, obstruction, venous compression, systemic congestion and cardiovascular factors may overlap." ] }, { "status": null, "celulas": [ ">=0,90 ou diástole ausente/reversa", "Red", "Concerning when persistent or associated with dysfunction; reversed diastolic flow requires prompt communication." ] } ] }, { "id": "transplante_renal.c4", "grupo": "transplante_renal", "nome": "Complications requiring communication", "nota": null, "fonte": "ACR-AIUM-SPR-SRU 2024 / UT Southwestern 2020 / vascular complication reviews", "colunas": [ "Finding", "Why it matters", "Color" ], "linhas": [ { "status": null, "celulas": [ "No arterial flow in the graft", "May represent arterial thrombosis, technical complication or severe hypoperfusion.", "Red" ] }, { "status": null, "celulas": [ "No venous flow or thrombus in renal vein", "May cause acute graft congestion and rapid functional loss.", "Red" ] }, { "status": null, "celulas": [ "Reversed arterial diastolic flow", "May occur with venous thrombosis, severe rejection, edema/high pressure or significant compression.", "Red" ] }, { "status": null, "celulas": [ "Complex, infected or compressive collection", "May indicate hematoma, abscess, urinoma or lymphocele affecting ureter/vessels.", "Red" ] }, { "status": null, "celulas": [ "Post-biopsy arteriovenous fistula or pseudoaneurysm", "May cause hematuria, vascular steal, enlargement or need for embolization.", "Yellow/Red" ] } ] }, { "id": "transplante_renal.c5", "grupo": "transplante_renal", "nome": "Didactic impression template", "nota": null, "fonte": "SonoAI synthesis from cited sources", "colunas": [], "linhas": [ { "status": "green", "celulas": [ "No critical findings", "Renal graft with preserved perfusion on color/spectral Doppler. Patent graft artery and vein. No combined criteria for hemodynamically significant stenosis on the current study. Correlate with renal function and baseline study." ] }, { "status": "yellow", "celulas": [ "Borderline finding", "Acceleration/resistive index/collection in a borderline or nonspecific range. Comparison with prior Doppler and correlation with creatinine, urine output, blood pressure and symptoms are recommended." ] }, { "status": "red", "celulas": [ "Critical finding", "Doppler findings compatible with relevant vascular or compressive graft complication. Immediate communication with the care team and confirmation/management according to institutional protocol are recommended." ] } ] } ] }, { "metodo": "US", "chave": "intestino", "slug": "intestino", "url": "https://sonoaireport.com/en/referencias-ultrassom/intestino", "nome": "Bowel / IBD (Crohn)", "temPaginaPublica": true, "medidas": [ { "id": "intestino.0", "grupo": "intestino", "ruleId": null, "rotulo": "Bowel wall thickness", "valor": "≤ 3", "unidade": "mm", "nota": "> 3 mm suggests inflammation (sens. 89% / spec. 96%)", "fonte": "Abdom Radiol / PMC", "faixas": [] } ], "classificacoes": [ { "id": "intestino.c0", "grupo": "intestino", "nome": "Calculator — appendicitis (US + Alvarado)", "nota": "Alvarado: migratory pain (1), anorexia (1), nausea (1), RLQ tenderness (2), rebound (1), fever (1), leukocytosis (2), left shift (1). ≥7 = high probability; 5–6 = observe; ≤4 = low.", "fonte": "ACR appropriateness / Alvarado 1986 / SPR pediatric US", "colunas": [ "Finding", "Reading" ], "linhas": [ { "status": "green", "celulas": [ "Appendix <6 mm, compressible", "Usually normal." ] }, { "status": "yellow", "celulas": [ "6–7 mm or not visualized", "Borderline: weigh secondary signs; non-visualization does not exclude." ] }, { "status": "red", "celulas": [ "≥7 mm non-compressible + signs", "Appendicitis likely (inflamed fat, hyperemia, appendicolith)." ] }, { "status": "red", "celulas": [ "Periappendiceal collection/fluid", "Suspected perforation/abscess." ] } ] }, { "id": "intestino.c1", "grupo": "intestino", "nome": "Activity signs (Crohn on US)", "nota": null, "fonte": "Intestinal US in IBD (PMC)", "colunas": [ "Sign", "Finding" ], "linhas": [ { "status": null, "celulas": [ "Wall", "Thickness > 3 mm" ] }, { "status": null, "celulas": [ "Vascularity", "Hypervascularity (Limberg ≥ 2)" ] }, { "status": null, "celulas": [ "Mesenteric fat", "Proliferation/inflammation (creeping fat)" ] }, { "status": null, "celulas": [ "Complications", "Lymph nodes, stricture, fistula, abscess, ascites" ] } ] } ] }, { "metodo": "US", "chave": "elastografia_hepatica", "slug": "elastografia-hepatica", "url": "https://sonoaireport.com/en/referencias-ultrassom/elastografia-hepatica", "nome": "Liver elastography / steatosis", "temPaginaPublica": true, "medidas": [], "classificacoes": [ { "id": "elastografia_hepatica.c0", "grupo": "elastografia_hepatica", "nome": "Calculator — liver stiffness (kPa) + Baveno VII", "nota": "Fibrosis cutoffs vary by etiology and technique (TE/pSWE/2D-SWE). The calculator adjusts by etiology; quality control (IQR/median ≤0.30) is mandatory.", "fonte": "Baveno VII 2022 / EFSUMB-WFUMB elastography guidelines", "colunas": [ "Range (kPa)", "Baveno VII / reading" ], "linhas": [ { "status": "green", "celulas": [ "< 10", "Compensated advanced chronic liver disease unlikely." ] }, { "status": "yellow", "celulas": [ "10–15", "Gray zone — suggests advanced disease, confirm." ] }, { "status": "red", "celulas": [ "≥ 15", "Compensated advanced chronic liver disease probable." ] }, { "status": "red", "celulas": [ "≥ 25", "Clinically significant portal hypertension probable (CSPH)." ] } ] }, { "id": "elastografia_hepatica.c1", "grupo": "elastografia_hepatica", "nome": "Liver fibrosis — SWE (orientative)", "nota": "Cutoffs vary by device, probe and etiology — use your scanner's table. Example values (2D-SWE).", "fonte": "Egypt J Radiol / Radiology Key (2D-SWE)", "colunas": [ "Stage", "Stiffness (kPa)" ], "linhas": [ { "status": null, "celulas": [ "F0–F1", "< ~7" ] }, { "status": null, "celulas": [ "≥ F2 (significant)", "~ 7–8,5" ] }, { "status": null, "celulas": [ "≥ F3 (advanced)", "~ 9,5–10,4" ] }, { "status": null, "celulas": [ "F4 (cirrhosis)", "≥ ~11,3–13" ] } ] }, { "id": "elastografia_hepatica.c2", "grupo": "elastografia_hepatica", "nome": "Steatosis — CAP (FibroScan)", "nota": "Adjust for NAFLD/diabetes (+10) and BMI. Cutoffs vary by study (222–294 dB/m).", "fonte": "J Med Ultrason (CAP meta-análise)", "colunas": [ "Grade", "CAP (dB/m)" ], "linhas": [ { "status": null, "celulas": [ "S1 (> S0)", "≥ ~248" ] }, { "status": null, "celulas": [ "S2 (> S1)", "≥ ~268" ] }, { "status": null, "celulas": [ "S3 (> S2)", "≥ ~280" ] } ] } ] }, { "metodo": "US", "chave": "obstetrico_calc", "slug": "obstetrico-calc", "url": "https://sonoaireport.com/en/referencias-ultrassom/obstetrico-calc", "nome": "Obstetric — calculator & tables", "temPaginaPublica": true, "medidas": [ { "id": "obstetrico_calc.0", "grupo": "obstetrico_calc", "ruleId": null, "rotulo": "CRL → GA (Robinson-Fleming)", "valor": "IG(dias) = 8,052·√(CCN·1,037) + 23,73", "unidade": null, "nota": "CRL in mm (5–84 mm)", "fonte": "Robinson & Fleming 1975", "faixas": [] }, { "id": "obstetrico_calc.1", "grupo": "obstetrico_calc", "ruleId": null, "rotulo": "CRL → GA (INTERGROWTH-21st)", "valor": "IG(dias) = 59,3615 + 0,4614·CCN", "unidade": null, "nota": "valid 11+0–13+6 wk", "fonte": "INTERGROWTH-21st 2014", "faixas": [] }, { "id": "obstetrico_calc.2", "grupo": "obstetrico_calc", "ruleId": null, "rotulo": "Estimated fetal weight (Hadlock IV)", "valor": "log10(PFE)=1,3596+0,0064·CC+0,0424·CA+0,174·CF+0,00061·DBP·CA−0,00386·CA·CF", "unidade": null, "nota": "measurements in cm; EFW in g", "fonte": "Hadlock 1985", "faixas": [] }, { "id": "obstetrico_calc.3", "grupo": "obstetrico_calc", "ruleId": null, "rotulo": "EFW — INTERGROWTH-21st (AC+HC)", "valor": "log(PFE)=5,084820−54,06633·(CA/100)³−95,80076·(CA/100)³·ln(CA/100)+3,136370·(CC/100)", "unidade": null, "nota": "natural log; AC/HC in cm; 2nd world reference", "fonte": "INTERGROWTH-21st (Stirnemann 2017)", "faixas": [] } ], "classificacoes": [ { "id": "obstetrico_calc.c0", "grupo": "obstetrico_calc", "nome": "EFW by gestational age — Hadlock (g)", "nota": "SGA < p10 · AGA p10–p90 · LGA > p90. Use the calculator above for automatic classification. Second world reference: INTERGROWTH-21st (official table, Stirnemann 2017).", "fonte": "Hadlock 1991 (percentis)", "colunas": [ "Wk", "p10", "p50", "p90" ], "linhas": [ { "status": null, "celulas": [ "20", "286", "330", "380" ] }, { "status": null, "celulas": [ "21", "345", "398", "458" ] }, { "status": null, "celulas": [ "22", "412", "476", "548" ] }, { "status": null, "celulas": [ "23", "489", "565", "650" ] }, { "status": null, "celulas": [ "24", "576", "665", "765" ] }, { "status": null, "celulas": [ "25", "673", "778", "894" ] }, { "status": null, "celulas": [ "26", "780", "902", "1038" ] }, { "status": null, "celulas": [ "27", "898", "1039", "1196" ] }, { "status": null, "celulas": [ "28", "1026", "1189", "1368" ] }, { "status": null, "celulas": [ "29", "1165", "1350", "1554" ] }, { "status": null, "celulas": [ "30", "1313", "1523", "1753" ] }, { "status": null, "celulas": [ "31", "1470", "1707", "1964" ] }, { "status": null, "celulas": [ "32", "1635", "1901", "2187" ] }, { "status": null, "celulas": [ "33", "1807", "2103", "2419" ] }, { "status": null, "celulas": [ "34", "1985", "2312", "2659" ] }, { "status": null, "celulas": [ "35", "2167", "2527", "2904" ] }, { "status": null, "celulas": [ "36", "2352", "2745", "3153" ] }, { "status": null, "celulas": [ "37", "2537", "2966", "3403" ] }, { "status": null, "celulas": [ "38", "2723", "3186", "3652" ] }, { "status": null, "celulas": [ "39", "2905", "3403", "3897" ] }, { "status": null, "celulas": [ "40", "3084", "3617", "4135" ] } ] } ] }, { "metodo": "CT", "chave": "tc_neuro", "slug": "tc-neuro", "nome": "Head & Neuro CT (brain, trauma, stroke, sinuses and CTA)", "temPaginaPublica": false, "medidas": [ { "id": "tc_neuro.0", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Cortical gray matter — attenuation", "valor": "+37 a +45 UH (≈ +40 UH)", "unidade": "UH", "nota": "Early ischemic change on CT is a drop of a few HU in gray matter, not overt hypodensity: loss of the insular ribbon and obscuration of the lentiform nucleus appear as the gray-white difference narrows. Use a narrow window (width 30-40 HU).", "fonte": "StatPearls/NCBI Bookshelf 2023 · DenOtter & Schubert, \"Hounsfield Unit\" (NBK547721) · Barber et al., Lancet 2000;355:1670-4 (ASPECTS)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "+37 a +45 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Loss of gray-white differentiation", "valor": "diferença cinzenta−branca < 5 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Frank hypoattenuation (cytotoxic edema/established infarct)", "valor": "< +30 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.1", "grupo": "tc_neuro", "ruleId": null, "rotulo": "White matter — attenuation", "valor": "+20 a +30 UH (≈ +25 UH)", "unidade": "UH", "nota": "The most stable internal reference in the study: if white matter is off-range in both hemispheres, suspect calibration error or artifact before reporting diffuse disease.", "fonte": "StatPearls/NCBI Bookshelf 2023 · DenOtter & Schubert, \"Hounsfield Unit\" (NBK547721)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "+20 a +30 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Diffuse hypoattenuation (microangiopathy, vasogenic edema)", "valor": "< +20 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.2", "grupo": "tc_neuro", "ruleId": null, "rotulo": "CSF — attenuation", "valor": "0 a +15 UH", "unidade": "UH", "nota": "Water is 0 HU by definition; CSF sits slightly above. Separating a subdural hygroma (CSF density) from a chronic subdural hematoma (above CSF density) is an ROI measurement, not a visual impression.", "fonte": "StatPearls/NCBI Bookshelf 2023 · DenOtter & Schubert, \"Hounsfield Unit\" (NBK547721)", "faixas": [ { "status": "green", "rotulo": "Normal CSF", "valor": "0 a +15 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Proteinaceous collection / hygroma vs chronic hematoma", "valor": "+15 a +30 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Blood within CSF space", "valor": "> +30 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.3", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Acute blood / clot — attenuation", "valor": "+50 a +70 UH (limite superior relatado até ~+90 UH)", "unidade": "UH", "nota": "Blood attenuation is proportional to hemoglobin concentration (New & Aronow, 1976). Smith 1981 showed experimentally that blood with hemoglobin of 8-10 g/dL is ISODENSE to brain — with significant anemia an acute subdural hematoma may be missed (evidence level: experimental model plus 2 case reports). Always check hemoglobin/hematocrit when the clinical picture does not match the density.", "fonte": "New PFJ & Aronow S, Radiology 1976;121(3):635-40 · Smith WP Jr, Batnitzky S, Rengachary SS, AJR 1981;136(3):543-6 (PMID 6781293; relato de 2 casos + modelo experimental) · Duy PQ et al., J Neuroimaging 2019", "faixas": [ { "status": "green", "rotulo": "No hyperdense blood", "valor": "≤ +45 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — compare with venous sinus and contralateral side", "valor": "+45 a +55 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Acute hemorrhage", "valor": "+55 a +90 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.4", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Subdural hematoma — density by age of collection", "valor": "Agudo (<3 d) hiperdenso em 100%; subagudo (3 d–3 sem) isodenso em ~70%; crônico (>3 sem) hipodenso em ~76%", "unidade": null, "nota": "The isodense phase is when subdural hematoma is most often missed: look for indirect signs (sulcal effacement, displaced gray-white junction, midline shift without a visible lesion) and consider contrast or MRI. Fluid levels or mixed density suggest rebleeding into a chronic hematoma. Small series (50 patients, 42 with timing data) — the percentages are indicative, not deterministic.", "fonte": "Scotti G, TerBrugge K, Melançon D, Bélanger G. J Neurosurg 1977;47(3):311-5 (PMID 894336)", "faixas": [ { "status": "red", "rotulo": "Acute — hyperdense", "valor": "> +50 UH, até 3 dias", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Subacute — isodense to cortex (diagnostic pitfall)", "valor": "+30 a +50 UH, 3 dias a 3 semanas", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Chronic — hypodense, near CSF; potential surgical lesion (drainage), NOT a normal finding", "valor": "< +30 UH, > 3 semanas", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.5", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Macroscopic fat — attenuation", "valor": "Qualquer ROI inequivocamente < −30 UH caracteriza gordura macroscópica; gordura pura tem intervalo de referência de 95% de −123 a −89 UH", "unidade": "UH", "nota": "Any distinctly negative ROI inside an intracranial lesion changes the diagnosis: fat droplets in sulci and ventricles indicate a ruptured dermoid. The practical detection threshold is −30 HU — lipomas and dermoids routinely measure −40 to −80 HU and must NOT be dismissed as volume averaging. The −123 to −89 HU range is a reference interval for pure fat, not a diagnostic threshold. Do not confuse with post-traumatic or postoperative air, which is ≈ −1000 HU.", "fonte": "Limiar prático de −30 UH: prática radiológica consagrada · intervalo de referência de gordura pura: Fat Hounsfield Unit Reference Interval Derived through an Indirect Method, 2023 (PMC10252728) · StatPearls/NCBI Bookshelf 2023, \"Hounsfield Unit\"", "faixas": [ { "status": "green", "rotulo": "Unequivocal macroscopic fat (lipoma, dermoid, teratoma)", "valor": "< −30 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Slightly negative density — repeat with a smaller ROI, away from CSF or air interfaces", "valor": "−30 a −10 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.6", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Calcification vs blood — attenuation threshold", "valor": "Sangue até ~+90 UH; calcificação a partir de ~+100 UH (convenção prática, não corte validado)", "unidade": "UH", "nota": "The ~+100 HU threshold is a practical reading convention, not a cut-off derived from a primary study — treat it as guidance, not a rule. Physiologic calcifications are far denser than blood and are a normal finding. When torn between hemorrhage and calcification in a nodule, dual-energy CT or comparison with a prior study settles it: blood changes density over days, calcium does not.", "fonte": "New PFJ & Aronow S, Radiology 1976;121(3):635-40 (atenuação do sangue) · limiar de calcificação: convenção prática, sem fonte primária validada", "faixas": [ { "status": "yellow", "rotulo": "Overlap zone — very dense clot vs early calcification", "valor": "+90 a +100 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Calcification — physiologic in most cases (pineal, choroid plexus, falx, basal ganglia in the elderly)", "valor": "> +100 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.7", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Cortical bone and otic capsule — attenuation", "valor": "≈ +1000 UH (cápsula ótica/cóclea até ~+2000 UH; metal > +3000 UH)", "unidade": "UH", "nota": "Useful reference to separate a metallic foreign body (>+3000 HU, with beam-hardening artifact) from a bone fragment in trauma. A dedicated bone window is mandatory for fracture — a non-displaced linear fracture vanishes on soft-tissue windows.", "fonte": "StatPearls/NCBI Bookshelf 2023 · DenOtter & Schubert, \"Hounsfield Unit\" (NBK547721)", "faixas": [] }, { "id": "tc_neuro.8", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Evans index", "valor": "≤ 0,30 (maior largura dos cornos frontais ÷ maior diâmetro INTERNO do crânio no mesmo corte)", "unidade": null, "nota": "Measure on the axial slice of MAXIMAL frontal horn width, parallel to the AC-PC line; the denominator is the maximal inner skull diameter on the same slice. The literature is DIVIDED and the report should reflect that: Missori 2016 (1221 consecutive emergency-department patients, aged 45-101) showed the per-age MEAN never exceeds 0.30 and that roughly 1 in 5 scans exceeds 0.30, concluding that EI > 0.30 should reflect an underlying neurological condition in every individual — i.e. it argues IN FAVOR of the fixed cut-off. Brix 2017, in 534 participants aged 65-84, found 29% of healthy controls with EI ≥ 0.30 and proposed age- and sex-adjusted cut-offs. Evans alone does not diagnose normal pressure hydrocephalus: combine with callosal angle and DESH.", "fonte": "Missori P et al., Oncotarget 2016;7(11):11860-3 (PMID 26919252) · Brix MK et al., Eur J Radiol 2017;95:28-32", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "≤ 0,30", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Above the classic cut-off but within the age- and sex-adjusted cut-off (≥ 65 years)", "valor": "> 0,30 e ≤ corte ajustado da faixa etária", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Definite ventriculomegaly", "valor": "> 0,30 em < 65 anos, ou > corte ajustado em ≥ 65 anos", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.9", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Bicaudate index — age-specific upper limit", "valor": "≤ 0,12 (≤45 a) · ≤ 0,14 (55 a) · ≤ 0,16 (65 a) · ≤ 0,17 (>65 a) — percentil 95", "unidade": null, "nota": "MIND THE DENOMINATOR: ratio of the width of the lateral ventricles at the level of the caudate heads to the distance between the OUTER tables of the skull at the same level (Barr 1978 definition). Using the inner table shrinks the denominator, inflates the index and produces false-positive hydrocephalus. It is the measurement of choice for acute post-SAH hydrocephalus because it has age-stratified norms. A single 0.20 cut-off sits ABOVE every age-specific limit (0.12 to 0.17) and therefore can only produce FALSE NEGATIVES — worst in young patients, whose limit is 0.12. Barr's normal controls: 0.092 ± 0.003 (derived with the outer-table denominator). Dupont's limits come from SAH patients without acute hydrocephalus, not healthy volunteers.", "fonte": "Dupont S & Rabinstein AA, Neurol Res 2013;35(2):103-6 (PMID 23336389) · Barr AN et al., Neurology 1978;28(11):1196-200 (PMID 152416)", "faixas": [ { "status": "green", "rotulo": "Within the age-specific limit", "valor": "≤ percentil 95 da faixa etária", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Ventricular dilatation / acute hydrocephalus", "valor": "> percentil 95 da faixa etária", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.10", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Callosal angle (MRI-derived normative data; requires thin coronal reformats on CT)", "valor": "< 90° sugere hidrocefalia de pressão normal idiopática", "unidade": "graus", "nota": "MIND THE MODALITY: the normative data come from 3D MRI (Ishii 2008; 34 iNPH / 34 Alzheimer / 34 controls), not CT. On CT it is reproducible only with thin coronal reformats PERPENDICULAR to the AC-PC line at the posterior commissure — routine thick-slice axial CT does not reproduce the value, and small plane rotations significantly change the result. The 90° cut-off (control mean − 2 SD) separated iNPH from Alzheimer disease with 93% accuracy, 97% sensitivity and 88% specificity; note the comparator group is Alzheimer disease, not the general population.", "fonte": "Ishii K et al., Eur Radiol 2008;18(11):2678-83 (PMID 18500524; RM 3D) · Neuroradiology 2021;63:1305-13 (efeito da rotação do plano)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "≥ 100° (controles 112° ± 11°; Alzheimer 104° ± 15°)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline", "valor": "90° a 100°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Suggestive of iNPH", "valor": "< 90° (HPNi 66° ± 14°)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.11", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Midline shift", "valor": "> 5 mm é o corte de conduta em trauma", "unidade": "mm", "nota": "Measure at the septum pellucidum or pineal, on the slice through the foramen of Monro: draw the anatomic midline (crista galli → internal occipital protuberance) and measure the perpendicular to the displaced structure. Always report together with basal cistern status — a small shift with effaced cisterns is worse than a larger shift with patent cisterns.", "fonte": "Bullock MR et al., Neurosurgery 2006;58(3 Suppl):S2-1–S2-62 (Guidelines for the Surgical Management of TBI) · Maas AIR et al., Neurosurgery 2005;57(6):1173-82 (escore de Rotterdam)", "faixas": [ { "status": "green", "rotulo": "No shift", "valor": "0 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Shift ≤ 5 mm — scores 0 on Rotterdam", "valor": "> 0 e ≤ 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Shift > 5 mm — scores on Rotterdam and enters surgical criteria", "valor": "> 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.12", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Basal (perimesencephalic) cisterns", "valor": "Normais / comprimidas / ausentes — item de maior peso do escore de Rotterdam", "unidade": null, "nota": "Assess the three limbs of the perimesencephalic cistern separately. Absent cisterns, midline shift and a hemorrhagic mass volume ≥25 mL were independent predictors of early death in trauma. It is the most reproducible CT descriptor of intracranial hypertension — always state it in polytrauma, even when normal.", "fonte": "Maas AIR et al., Neurosurgery 2005;57(6):1173-82 · Academic Radiology 2014 (Early CT Findings to Predict Early Death in TBI)", "faixas": [ { "status": "green", "rotulo": "Patent and symmetric", "valor": "0 ponto no Rotterdam", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Compressed", "valor": "1 ponto no Rotterdam", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Absent (effaced) — intracranial hypertension", "valor": "2 pontos no Rotterdam", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.13", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Acute epidural hematoma — volume and thickness", "valor": "> 30 cm³ → evacuação independentemente da Escala de Coma de Glasgow", "unidade": "cm³ / mm", "nota": "All four non-operative criteria must be met simultaneously. Report volume (ABC/2), maximal thickness, midline shift and the presence of a swirl sign (internal hypodense area = active bleeding) — the latter predicts rapid expansion.", "fonte": "Bullock MR et al., \"Surgical management of acute epidural hematomas\", Neurosurgery 2006;58(3 Suppl):S7-15", "faixas": [ { "status": "green", "rotulo": "Non-operative management possible (serial CT and neurologic monitoring)", "valor": "< 30 cm³ E espessura < 15 mm E desvio < 5 mm E ECG > 8 sem déficit focal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Clinical decision zone", "valor": "espessura ≥ 15 mm ou desvio ≥ 5 mm com volume < 30 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Surgical indication", "valor": "> 30 cm³ (qualquer ECG)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.14", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Acute subdural hematoma — thickness", "valor": "> 10 mm de espessura OU > 5 mm de desvio → evacuação independentemente da Escala de Coma de Glasgow", "unidade": "mm", "nota": "Measure maximal thickness perpendicular to the inner table on the slice with the largest collection. In subdural hematoma the midline shift is often disproportionate to thickness (due to associated hemispheric edema) — that disproportion is a poor-prognosis sign and should be stated in the report.", "fonte": "Bullock MR et al., \"Surgical management of acute subdural hematomas\", Neurosurgery 2006;58(3 Suppl):S16-24", "faixas": [ { "status": "green", "rotulo": "Below the isolated surgical threshold", "valor": "espessura < 10 mm E desvio < 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Monitoring — surgery if clinical deterioration", "valor": "< 10 mm com ECG < 9: queda ≥ 2 pontos na ECG, pupilas assimétricas/fixas ou PIC > 20 mmHg", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Surgical indication", "valor": "> 10 mm OU desvio > 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.15", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Traumatic parenchymal lesion — volume", "valor": "> 50 cm³ em qualquer topografia → considerar evacuação", "unidade": "cm³", "nota": "The GCS band for the frontal/temporal criterion is 6 to 8 (not 'any GCS < 9') and the shift is ≥ 5 mm, per the Bullock 2006 text. Hemorrhagic contusions expand: a follow-up CT at 6-12 h is the rule for frontobasal or temporal contusions, even small ones. Report ABC/2 volume, perilesional edema and the distance from a temporal lesion to the midbrain (uncal herniation risk).", "fonte": "Bullock MR et al., \"Surgical management of traumatic parenchymal lesions\", Neurosurgery 2006;58(3 Suppl):S25-46", "faixas": [ { "status": "yellow", "rotulo": "Consider evacuation for frontal or temporal lesion", "valor": "> 20 cm³ com desvio ≥ 5 mm e/ou compressão cisternal, em paciente com ECG 6 a 8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Consider evacuation regardless of location", "valor": "> 50 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.16", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Intracerebral hemorrhage volume by the ABC/2 method", "valor": "Volume (cm³) = (A × B × C) ÷ 2", "unidade": "cm³", "nota": "A = largest hematoma diameter on the slice of greatest area; B = diameter perpendicular to A on the same slice; C = number of slices with hematoma × slice thickness (counting as a full slice only those with ≥75% of the largest area, and as half a slice those with 25-75%). Broderick's mortality bands are valid ONLY with the coupled GCS condition — volume alone does not predict. Only 1 of 71 patients with volume ≥30 cm³ regained functional independence at 30 days. The formula overestimates irregularly shaped hematomas.", "fonte": "Kothari RU et al., Stroke 1996;27(8):1304-5 · Broderick JP et al., Stroke 1993;24(7):987-93", "faixas": [ { "status": "yellow", "rotulo": "19% 30-day mortality when combined with GCS ≥ 9", "valor": "< 30 cm³ E ECG ≥ 9", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Intermediate risk", "valor": "30 a 60 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "91% 30-day mortality when combined with GCS ≤ 8", "valor": "≥ 60 cm³ E ECG ≤ 8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.17", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Hyperdense middle cerebral artery sign", "valor": "Atenuação absoluta > 43 UH E razão > 1,2 em relação à ACM contralateral", "unidade": "UH", "nota": "Criterion derived from a SMALL single-centre series: 18 cases and 80 controls, with 10 true positives (9 with acute ischemic stroke, 1 with herpes encephalitis); the authors themselves conclude that 'confirmation in other centres is required'. Use as support, not as a standalone criterion. The false positives Koo identified were mature cerebral infarction and non-ischemic pathologies — do NOT assume the >1.2 ratio excludes atheromatous calcification, which is often asymmetric and can itself raise the ratio. The MCA dot sign is the M2/M3 equivalent within the sylvian cistern.", "fonte": "Koo CK, Teasdale E, Muir KW. Cerebrovasc Dis 2000;10(6):419-23 (PMID 11070370)", "faixas": [ { "status": "green", "rotulo": "No hyperdense thrombus", "valor": "≤ 43 UH ou razão ≤ 1,2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "True sign — intraluminal thrombus", "valor": "> 43 UH E razão > 1,2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.18", "grupo": "tc_neuro", "ruleId": null, "rotulo": "ASPECTS — reperfusion therapy threshold", "valor": "≥ 6 é o critério AHA/ASA 2019 para trombectomia mecânica em até 6 h; ASPECTS baixo NÃO é mais exclusão automática", "unidade": null, "nota": "In the 2019 AHA/ASA guideline, a patient with anterior-circulation large vessel occlusion treated within 6 h must have a reassuring noncontrast CT with ASPECTS ≥ 6. IMPORTANT UPDATE: large-core trials (RESCUE-Japan LIMIT 2022, SELECT2 2023, ANGEL-ASPECT 2023, TENSION 2023, TESLA 2024) demonstrated thrombectomy benefit at ASPECTS 3-5 — the report should state the ASPECTS, never declare the patient ineligible. Between 6 and 24 h, selection shifts to CT perfusion or DW-MRI following DAWN and DEFUSE 3 criteria. Barber (2000) showed a sharp rise in dependency/death at ASPECTS ≤ 7.", "fonte": "Powers WJ et al., Stroke 2019;50(12):e344-e418 (2019 Update to the 2018 AHA/ASA AIS Guidelines) · Barber PA et al., Lancet 2000;355(9216):1670-4 · ensaios de core extenso: RESCUE-Japan LIMIT (NEJM 2022), SELECT2 e ANGEL-ASPECT (NEJM 2023), TENSION (Lancet 2023), TESLA (2024)", "faixas": [ { "status": "green", "rotulo": "Reassuring CT — eligible for thrombectomy within 6 h", "valor": "ASPECTS 8 a 10", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Eligible under the 6-h criterion, but already with a marked increase in dependency and death (≤ 7)", "valor": "ASPECTS 6 a 7", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Large core — outside the classic ASPECTS ≥ 6 criterion, but does NOT exclude thrombectomy: individualized decision with neurointervention", "valor": "ASPECTS 0 a 5", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.19", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Optic nerve sheath diameter on CT", "valor": "> 5,0 mm sugere pressão intracraniana elevada (marcador de apoio; sensibilidade e especificidade variam muito entre séries)", "unidade": "mm", "nota": "Measure 3 mm behind the globe, perpendicular to the nerve axis. Published cut-offs vary (5.0 to 5.6 mm) with the chosen ICP threshold and technique, and sensitivity/specificity figures depend heavily on the series — it is a SUPPORTING marker, never standalone, and should not be reported as a diagnosis of intracranial hypertension. Available sources are of heterogeneous quality and do not constitute consolidated normative data.", "fonte": "Eur J Radiol 2021 (comparação ultrassonografia × TC para ONSD na detecção de PIC elevada — citação incompleta na literatura de origem) · Relationship of ONSD and Intracranial Hypertension in TBI, 2020 (PMC7717459)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "≤ 5,0 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — correlate with basal cisterns and clinical status", "valor": "5,0 a 5,5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Associated with intracranial hypertension and worse neurologic outcome", "valor": "> 5,5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.20", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Gray-white matter ratio (GWR) after cardiac arrest", "valor": "GWR no nível dos gânglios da base < 1,10 associa-se a desfecho neurológico ruim com alta especificidade", "unidade": null, "nota": "Compute as mean gray matter HU (caudate and putamen) divided by mean white matter HU (corpus callosum and posterior limb of the internal capsule), at the basal ganglia level. Very early CT (<6 h) underestimates injury. NEVER use it alone for prognostication: post-arrest prognosis is multimodal (neurologic exam, EEG, neuron-specific enolase, imaging) and the radiologist describes the finding, not the decision. Published thresholds vary between 1.10 and 1.20 depending on the series and ROI technique.", "fonte": "Gray-White Matter Ratio at the Level of the Basal Ganglia as a Predictor of Neurologic Outcomes in Cardiac Arrest Survivors: A Literature Review, 2022 (PMC8967346) — revisão narrativa, sem normativa consolidada", "faixas": [ { "status": "green", "rotulo": "Preserved differentiation", "valor": "GWR ≥ 1,20", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Intermediate zone — do not prognosticate on this datum", "valor": "GWR 1,10 a 1,20", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Poor outcome — high specificity", "valor": "GWR < 1,10", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.21", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Internal auditory canal — normal CT measurements (adult)", "valor": "Largura do poro 7,10 mm · comprimento 9,84 mm · diâmetro vertical 4,47 mm (médias de Marques 2012)", "unidade": "mm", "nota": "Inter-individual variability is wide and a few millimeters of side-to-side asymmetry can be normal — canal widening suggests vestibular schwannoma, but confirmation is contrast-enhanced MRI, not CT. In Marques 2012 the pediatric measurements exceeded the adult ones (porus 7.53 vs 7.10 mm; length 11.17 vs 9.84 mm; vertical diameter 4.82 vs 4.47 mm), with statistically significant differences in length and diameter. The < 2 mm threshold is a classic stenosis convention (not derived from the Marques study) and mandates MRI assessment of the cochlear nerve before cochlear implantation.", "fonte": "Marques SR et al., Iran J Radiol 2012;9(2):71-8 (PMID 23329967; Morphometric Analysis of the Internal Auditory Canal by CT)", "faixas": [ { "status": "red", "rotulo": "Narrow canal (hypoplasia — assess the cochlear nerve with MRI)", "valor": "< 2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_neuro.22", "grupo": "tc_neuro", "ruleId": null, "rotulo": "Carotid stenosis on CTA — minimal residual lumen diameter", "valor": "1,3 mm ≈ 70% NASCET · 2,2 mm ≈ 50% NASCET", "unidade": "mm", "nota": "Direct millimeter measurement on CTA had 88.2% sensitivity, 92.4% specificity and 98.2% negative predictive value for ≥70% stenosis. TECHNIQUE AS PER THE SOURCE: Bartlett measured the narrowest residual lumen on the AXIAL SOURCE IMAGES, and the series records that assessment was confident even in the presence of calcification; the distal ICA (denominator) is measured beyond the bulb, where the walls are parallel. It is on MIP/oblique reconstructions that dense calcification interferes — when in doubt, always return to the source images. Near-occlusion with distal collapse invalidates the percentage calculation and must be reported as such.", "fonte": "Bartlett ES, Walters TD, Symons SP, Fox AJ. \"Quantification of carotid stenosis on CT angiography\", AJNR Am J Neuroradiol 2006;27(1):13-9 (PMID 16418349)", "faixas": [ { "status": "green", "rotulo": "Mild stenosis (< 50% NASCET)", "valor": "> 2,2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Moderate stenosis (50-69% NASCET)", "valor": "1,3 a 2,2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Severe stenosis (≥ 70% NASCET)", "valor": "≤ 1,3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "tc_neuro.c0", "grupo": "tc_neuro", "nome": "ASPECTS — Alberta Stroke Program Early CT Score", "nota": null, "fonte": "Barber PA, Demchuk AM, Zhang J, Buchan AM. Lancet 2000;355(9216):1670-4 · Powers WJ et al., Stroke 2019;50(12):e344-e418 · ensaios de core extenso 2022-2024", "colunas": [ "Region", "Axial level", "Score", "Comment" ], "linhas": [ { "status": null, "celulas": [ "Núcleo caudado (C)", "Gangliônico (tálamo e gânglios da base)", "1", "Subtrair 1 ponto para cada região com hipoatenuação ou perda de diferenciação" ] }, { "status": null, "celulas": [ "Núcleo lentiforme (L)", "Gangliônico", "1", "Obscurecimento do lentiforme é dos sinais precoces mais frequentes" ] }, { "status": null, "celulas": [ "Cápsula interna (CI)", "Gangliônico", "1", "Avaliar o braço posterior" ] }, { "status": null, "celulas": [ "Ínsula / fita insular (I)", "Gangliônico", "1", "Perda da fita insular é o sinal precoce clássico de oclusão de M1" ] }, { "status": null, "celulas": [ "M1 — córtex frontal anterior da ACM", "Gangliônico", "1", "—" ] }, { "status": null, "celulas": [ "M2 — córtex da ACM lateral à fita insular", "Gangliônico", "1", "—" ] }, { "status": null, "celulas": [ "M3 — córtex posterior da ACM", "Gangliônico", "1", "—" ] }, { "status": null, "celulas": [ "M4 — território anterior da ACM", "Supragangliônico (rostral aos gânglios da base)", "1", "Imediatamente superior a M1" ] }, { "status": null, "celulas": [ "M5 — território lateral da ACM", "Supragangliônico", "1", "Imediatamente superior a M2" ] }, { "status": null, "celulas": [ "M6 — território posterior da ACM", "Supragangliônico", "1", "Imediatamente superior a M3" ] }, { "status": null, "celulas": [ "TOTAL", "—", "10 = TC normal / 0 = todo o território da ACM acometido", "ASPECTS ≤ 7: aumento acentuado de dependência e óbito (Barber 2000). ASPECTS ≥ 6: critério AHA/ASA 2019 para trombectomia em até 6 h. ASPECTS 3-5 (core extenso): NÃO é exclusão — ensaios RESCUE-Japan LIMIT, SELECT2, ANGEL-ASPECT, TENSION e TESLA mostraram benefício da trombectomia; decisão individualizada com a neurointervenção" ] } ] }, { "id": "tc_neuro.c1", "grupo": "tc_neuro", "nome": "Modified Fisher scale — subarachnoid hemorrhage", "nota": null, "fonte": "Frontera JA, Claassen J, Schmidt JM et al. \"Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified Fisher scale\". Neurosurgery 2006;59(1):21-7 (PMID 16823296; braço placebo de 4 ensaios de tirilazad, n=1355) · escala original: Fisher CM, Kistler JP, Davis JM. Neurosurgery 1980;6(1):1-9 (limiar de 1 mm para camada fina × espessa)", "colunas": [ "Grade", "Noncontrast CT (cisternal blood)", "Intraventricular hemorrhage", "Symptomatic vasospasm risk" ], "linhas": [ { "status": null, "celulas": [ "0", "Sem HSA", "Ausente", "Grupo de referência (grau 0-1)" ] }, { "status": null, "celulas": [ "1", "HSA fina, focal ou difusa", "Ausente", "Grupo de referência (grau 0-1)" ] }, { "status": null, "celulas": [ "2", "HSA fina, focal ou difusa", "Presente", "OR bruto 1,6 (IC95% 1,0-2,5) vs grau 0-1" ] }, { "status": null, "celulas": [ "3", "HSA espessa (preenche completamente ao menos uma cisterna ou fissura)", "Ausente", "OR bruto 1,6 (IC95% 1,1-2,2) vs grau 0-1" ] }, { "status": null, "celulas": [ "4", "HSA espessa", "Presente", "OR bruto 2,2 (IC95% 1,6-3,1) vs grau 0-1" ] } ] }, { "id": "tc_neuro.c2", "grupo": "tc_neuro", "nome": "Lund-Mackay score — paranasal sinuses", "nota": null, "fonte": "Lund VJ & Mackay IS. \"Staging in rhinosinusitis\". Rhinology 1993;31(4):183-4 · sistematização em StatPearls/NCBI Bookshelf (Lund-Mackay Scoring System for Staging Sinusitis, NBK441934)", "colunas": [ "Structure (scored on each side)", "0", "1", "2" ], "linhas": [ { "status": null, "celulas": [ "Seio maxilar", "Sem opacificação", "Opacificação parcial", "Opacificação total" ] }, { "status": null, "celulas": [ "Células etmoidais anteriores", "Sem opacificação", "Opacificação parcial", "Opacificação total" ] }, { "status": null, "celulas": [ "Células etmoidais posteriores", "Sem opacificação", "Opacificação parcial", "Opacificação total" ] }, { "status": null, "celulas": [ "Seio esfenoidal", "Sem opacificação", "Opacificação parcial", "Opacificação total" ] }, { "status": null, "celulas": [ "Seio frontal", "Sem opacificação", "Opacificação parcial", "Opacificação total" ] }, { "status": null, "celulas": [ "Complexo ostiomeatal", "Não obstruído", "(não pontua 1)", "Obstruído" ] }, { "status": null, "celulas": [ "TOTAL", "0 = estudo normal", "—", "24 = opacificação total bilateral (12 pontos por lado)" ] } ] }, { "id": "tc_neuro.c3", "grupo": "tc_neuro", "nome": "Rotterdam CT score — traumatic brain injury", "nota": null, "fonte": "Maas AIR, Hukkelhoven CWPM, Marshall LF, Steyerberg EW. \"Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors\". Neurosurgery 2005;57(6):1173-82", "colunas": [ "Item", "Finding", "Points" ], "linhas": [ { "status": null, "celulas": [ "Cisternas basais", "Normais", "0" ] }, { "status": null, "celulas": [ "Cisternas basais", "Comprimidas", "1" ] }, { "status": null, "celulas": [ "Cisternas basais", "Ausentes", "2" ] }, { "status": null, "celulas": [ "Desvio da linha média", "Ausente ou ≤ 5 mm", "0" ] }, { "status": null, "celulas": [ "Desvio da linha média", "> 5 mm", "1" ] }, { "status": null, "celulas": [ "Lesão expansiva extradural", "Presente", "0" ] }, { "status": null, "celulas": [ "Lesão expansiva extradural", "Ausente", "1" ] }, { "status": null, "celulas": [ "Sangue intraventricular ou HSA traumática", "Ausente", "0" ] }, { "status": null, "celulas": [ "Sangue intraventricular ou HSA traumática", "Presente", "1" ] }, { "status": null, "celulas": [ "ESCORE FINAL", "Soma dos itens + 1", "1 (melhor prognóstico) a 6 (pior prognóstico)" ] } ] }, { "id": "tc_neuro.c4", "grupo": "tc_neuro", "nome": "Surgical thresholds for traumatic hematomas (Brain Trauma Foundation / CNS)", "nota": null, "fonte": "Bullock MR, Chesnut R, Ghajar J et al. \"Guidelines for the Surgical Management of Traumatic Brain Injury\". Neurosurgery 2006;58(3 Suppl):S2-1–S2-62 (extradural S7-15; subdural S16-24; lesões parenquimatosas S25-46)", "colunas": [ "Lesion", "CT criterion", "Recommended management" ], "linhas": [ { "status": null, "celulas": [ "Hematoma extradural agudo", "Volume > 30 cm³", "Evacuação cirúrgica independentemente da Escala de Coma de Glasgow" ] }, { "status": null, "celulas": [ "Hematoma extradural agudo", "Volume < 30 cm³ E espessura < 15 mm E desvio < 5 mm E ECG > 8 sem déficit focal", "Pode ser conduzido sem cirurgia, com TC seriada e vigilância neurológica (os QUATRO critérios simultaneamente)" ] }, { "status": null, "celulas": [ "Hematoma subdural agudo", "Espessura > 10 mm OU desvio da linha média > 5 mm", "Evacuação cirúrgica independentemente da Escala de Coma de Glasgow" ] }, { "status": null, "celulas": [ "Hematoma subdural agudo", "Espessura < 10 mm E desvio < 5 mm, com ECG < 9", "Cirurgia se queda ≥ 2 pontos na ECG entre o trauma e a admissão, pupilas assimétricas/fixas ou PIC > 20 mmHg" ] }, { "status": null, "celulas": [ "Lesão parenquimatosa traumática", "Volume > 50 cm³ em qualquer topografia", "Considerar evacuação" ] }, { "status": null, "celulas": [ "Lesão parenquimatosa traumática", "Lesão frontal ou temporal > 20 cm³ com desvio ≥ 5 mm e/ou compressão cisternal, com ECG de 6 a 8", "Considerar evacuação" ] } ] }, { "id": "tc_neuro.c5", "grupo": "tc_neuro", "nome": "Carotid stenosis on CTA — NASCET equivalence", "nota": null, "fonte": "Bartlett ES et al., AJNR Am J Neuroradiol 2006;27(1):13-9 (PMID 16418349) · North American Symptomatic Carotid Endarterectomy Trial Collaborators, N Engl J Med 1991;325(7):445-53", "colunas": [ "Minimal residual diameter (CTA)", "Equivalent NASCET stenosis", "Clinical reading" ], "linhas": [ { "status": null, "celulas": [ "Método", "% = (1 − diâmetro residual ÷ diâmetro da carótida interna distal normal) × 100", "O denominador NASCET é a CI distal de calibre normal, medida além do bulbo onde as paredes são paralelas — nunca o bulbo" ] }, { "status": null, "celulas": [ "> 2,2 mm", "< 50%", "Estenose leve" ] }, { "status": null, "celulas": [ "≈ 2,2 mm", "≈ 50%", "Limiar de estenose moderada" ] }, { "status": null, "celulas": [ "1,3 a 2,2 mm", "50 a 69%", "Estenose moderada" ] }, { "status": null, "celulas": [ "≤ 1,3 mm", "≥ 70%", "Estenose grave — sensibilidade 88,2%, especificidade 92,4%, VPN 98,2%" ] }, { "status": null, "celulas": [ "Técnica", "Medir no corte axial fonte", "Bartlett mediu nos cortes-fonte e relatou avaliação confiável mesmo com calcificação; MIP/oblíquo é onde a calcificação atrapalha" ] }, { "status": null, "celulas": [ "Referência terapêutica", "Sintomáticos com estenose de 70 a 99%", "Endarterectomia reduziu o AVC ipsilateral em 17,0% ± 3,5% em 2 anos (e o AVC maior ou fatal em 10,6% ± 2,6%) no NASCET" ] } ] }, { "id": "tc_neuro.c6", "grupo": "tc_neuro", "nome": "Evans index — age- and sex-adjusted cut-offs in the elderly (Brix 2017 proposal; see divergence with Missori)", "nota": null, "fonte": "Brix MK, Westman E, Simmons A et al. \"The Evans' Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly\". Eur J Radiol 2017;95:28-32 · Missori P et al., Oncotarget 2016;7(11):11860-3 (PMID 26919252)", "colunas": [ "Age group", "Cut-off, men", "Cut-off, women" ], "linhas": [ { "status": null, "celulas": [ "Adulto < 65 anos", "0,30", "0,30" ] }, { "status": null, "celulas": [ "65 a 69 anos", "0,34", "0,32" ] }, { "status": null, "celulas": [ "70 a 74 anos", "0,36", "0,33" ] }, { "status": null, "celulas": [ "75 a 79 anos", "0,37", "0,34" ] }, { "status": null, "celulas": [ "80 a 84 anos", "0,37", "0,36" ] }, { "status": null, "celulas": [ "RESSALVA", "A literatura é divergente", "Brix 2017 (534 participantes de 65-84 anos; 29% dos controles saudáveis com EI ≥ 0,30) propõe estes cortes ajustados. Missori 2016 (1221 pacientes consecutivos de pronto-socorro, 45-101 anos) conclui o OPOSTO: 'EI > 0,30 deve refletir condição neurológica subjacente em todo indivíduo'. Não apresente o ajuste por idade como consenso" ] } ] } ] }, { "metodo": "CT", "chave": "tc_torax", "slug": "tc-torax", "nome": "Chest CT", "temPaginaPublica": false, "medidas": [ { "id": "tc_torax.0", "grupo": "tc_torax", "ruleId": null, "rotulo": "Incidental pulmonary nodule — follow-up threshold", "valor": "6 mm (100 mm³)", "unidade": "mm", "nota": "The minimum size threshold for routine follow-up was raised to 6 mm in 2017. Nodules < 6 mm need no follow-up, but high-risk patients with suspicious morphology and/or upper lobe location may warrant a 12-month CT.", "fonte": "Fleischner Society 2017 (Radiology 2017;284:228-243) · MacMahon et al., Tabela 1A", "faixas": [ { "status": "green", "rotulo": "< 6 mm (< 100 mm³) — no routine follow-up", "valor": "< 6", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "6–8 mm (100–250 mm³) — follow-up CT", "valor": "6-8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 8 mm (> 250 mm³) — consider CT at 3 months, PET/CT or tissue sampling", "valor": "> 8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.1", "grupo": "tc_torax", "ruleId": null, "rotulo": "Nodule measurement method (Fleischner)", "valor": "Média dos eixos longo e curto, arredondada ao milímetro mais próximo", "unidade": null, "nota": "Automated or semi-automated volumetry may replace manual linear measurement and is more reproducible: volume thresholds are 100 and 250 mm³ instead of 6 and 8 mm. Volumetry is software-dependent — growth comparisons require identical software.", "fonte": "Fleischner Society 2017 (Radiology 2017;284:228-243) · MacMahon et al.", "faixas": [] }, { "id": "tc_torax.2", "grupo": "tc_torax", "ruleId": null, "rotulo": "Section thickness for nodule characterization", "valor": "≤ 1,5 mm (tipicamente 1,0 mm), cortes contíguos", "unidade": "mm", "nota": "Every adult chest CT should be reconstructed and archived with contiguous thin sections plus coronal and sagittal series. Thick sections increase volume averaging and preclude assessment of part-solid components, fat and calcium — precisely the features that change management.", "fonte": "Fleischner Society 2017 (Radiology 2017;284:228-243) · MacMahon et al. (consenso de sociedade, sem graduação GRADE)", "faixas": [] }, { "id": "tc_torax.3", "grupo": "tc_torax", "ruleId": null, "rotulo": "Solitary pulmonary nodule enhancement (contrast CT)", "valor": "≤ 15 HU", "unidade": "HU", "nota": "Multicenter study of 356 solid nodules 5–40 mm, relatively spherical, homogeneous, without calcification or fat, imaged at 1, 2, 3 and 4 minutes. Sensitivity 98%, specificity 58%, accuracy 77% — it rules malignancy OUT rather than in. Outside this morphological profile the cut-off does not apply.", "fonte": "Swensen et al., Radiology 2000;214:73-80 (estudo multicêntrico)", "faixas": [ { "status": "green", "rotulo": "≤ 15 HU — strongly predictive of benignity", "valor": "≤ 15", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 15 HU — indeterminate / suspicious", "valor": "> 15", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.4", "grupo": "tc_torax", "ruleId": null, "rotulo": "Pulmonary hamartoma — CT criteria", "valor": "≤ 2,5 cm + borda lisa + gordura focal (isolada ou alternando com calcificação)", "unidade": null, "nota": "In the original series of 47 hamartomas, none of 283 cancers or 72 metastases met all three criteria. Note: 17 hamartomas without detectable fat or calcium could not be diagnosed by CT — absence of fat does not exclude hamartoma.", "fonte": "Siegelman et al., Radiology 1986;160:313-317", "faixas": [] }, { "id": "tc_torax.5", "grupo": "tc_torax", "ruleId": null, "rotulo": "Growth on screening (Lung-RADS)", "valor": "> 1,5 mm no diâmetro médio em intervalo de 12 meses", "unidade": "mm", "nota": "A nodule crossing a new size threshold is reclassified even if it does not meet the growth definition. A solid or part-solid nodule growing across multiple screening exams without reaching 1.5 mm in any 12-month interval is suspicious and may be classified 4B — and may not be PET-avid.", "fonte": "ACR Lung-RADS v2022, notas 5, 6 e 8 (American College of Radiology, nov/2022)", "faixas": [] }, { "id": "tc_torax.6", "grupo": "tc_torax", "ruleId": null, "rotulo": "Nodule measurement on screening (Lung-RADS)", "valor": "Eixos longo e curto com 1 casa decimal; média relatada com 1 casa decimal", "unidade": "mm", "nota": "Long and short axes may be measured in any plane that reflects the true nodule size. Volumes, when obtained, are reported to the nearest whole mm³. Each exam is coded by its most suspicious nodule.", "fonte": "ACR Lung-RADS v2022, nota 4 (American College of Radiology)", "faixas": [] }, { "id": "tc_torax.7", "grupo": "tc_torax", "ruleId": null, "rotulo": "Atypical pulmonary cyst — wall thickness", "valor": "2 mm", "unidade": "mm", "nota": "New in v2022. If wall thickening is the dominant feature, the lesion is a cavitary nodule and is measured as a solid nodule (total mean diameter). Multiple cysts suggest LCH or LAM and are not classified in Lung-RADS.", "fonte": "ACR Lung-RADS v2022, nota 12 (American College of Radiology)", "faixas": [ { "status": "green", "rotulo": "< 2 mm, unilocular and uniform — thin-walled cyst; not an atypical cyst and receives no category from this finding", "valor": "< 2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Thick wall with growing cystic (air) component, without increasing wall thickness or nodularity — Lung-RADS 3", "valor": "3", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "≥ 2 mm (uniform, asymmetric or nodular thickening) or multilocular cyst — Lung-RADS 4A", "valor": "≥ 2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Thick wall with growing thickness/nodularity, or growing multilocular cyst — Lung-RADS 4B", "valor": "4B", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.8", "grupo": "tc_torax", "ruleId": null, "rotulo": "Benign juxtapleural nodule (Lung-RADS 2)", "valor": "< 10 mm (524 mm³) de diâmetro médio", "unidade": "mm", "nota": "New in v2022 — the threshold rose from 6 to 10 mm. It applies only if the nodule is also solid, with smooth margins and oval, lentiform or triangular shape (intrapulmonary lymph node profile), at baseline or as a new nodule.", "fonte": "ACR Lung-RADS v2022 (American College of Radiology)", "faixas": [] }, { "id": "tc_torax.9", "grupo": "tc_torax", "ruleId": null, "rotulo": "Trachea — coronal diameter", "valor": "Homens 13–25 mm · Mulheres 10–21 mm", "unidade": "mm", "nota": "Limits of ±3 standard deviations (99.7% of the population) derived from 808 subjects aged 10–79 (430 men, 378 women) without respiratory disease; the values above are those published for adults aged 20–79 and should not be applied to children or adolescents. The series was based on PA and lateral radiographs and is extrapolated to CT in practice — measure at the same level and respiratory phase when comparing studies. No correlation with weight or height.", "fonte": "Breatnach, Abbott & Fraser, AJR 1984;142:903-906", "faixas": [ { "status": "green", "rotulo": "Within 13–25 mm (M) or 10–21 mm (F)", "valor": "13-25 / 10-21", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the limit — tracheomegaly; below the lower limit — reduced caliber, investigate stenosis", "valor": "fora", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.10", "grupo": "tc_torax", "ruleId": null, "rotulo": "Trachea — sagittal diameter", "valor": "Homens 13–27 mm · Mulheres 10–23 mm", "unidade": "mm", "nota": "Same cohort as the coronal diameter, with the same age-range and modality caveats. A trachea exceeding these limits, associated with diverticula and bronchiectasis, suggests tracheobronchomegaly (Mounier-Kuhn syndrome).", "fonte": "Breatnach, Abbott & Fraser, AJR 1984;142:903-906", "faixas": [ { "status": "green", "rotulo": "Within 13–27 mm (M) or 10–23 mm (F)", "valor": "13-27 / 10-23", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the limit — tracheomegaly (consider Mounier-Kuhn)", "valor": "> limite", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.11", "grupo": "tc_torax", "ruleId": null, "rotulo": "Ascending thoracic aorta — CT", "valor": "33 ± 4 mm (limite superior do normal 41 mm)", "unidade": "mm", "nota": "Measured on gated non-contrast cardiac CT at the pulmonary artery bifurcation in 2,952 low-risk adults (upper limit of normal 41 mm). COMPARE with the card 'Ascending aorta — upper limit by age and sex': that stratified series allows up to 45.0 mm in men over 60. The two numbers are not interchangeable — do not report dilation without checking age, sex and measurement method. Many centers use 40 mm as a reporting trigger, which is local convention rather than a guideline definition. The 2022 ACC/AHA guideline advises inner-edge to inner-edge measurement with ECG gating, repeated sinus-to-sinus to capture the maximum diameter; intervention thresholds are 5.0–5.5 cm depending on center and etiology, bearing in mind that many dissections occur below those thresholds — diameter alone is an imperfect predictor.", "fonte": "Wolak et al., JACC Cardiovasc Imaging 2008;1:200-209 · método de medida: 2022 ACC/AHA Aortic Disease Guideline (Circulation 2022;146:e334-e482)", "faixas": [ { "status": "green", "rotulo": "≤ 41 mm", "valor": "≤ 41", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "> 41 mm — above this cohort's upper limit of normal", "valor": "> 41", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "≥ 45 mm — threshold for close surveillance and for surgery in selected settings (bicuspid aortic valve, genetic syndromes, concomitant valve surgery)", "valor": "≥ 45", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.12", "grupo": "tc_torax", "ruleId": null, "rotulo": "Descending thoracic aorta — CT", "valor": "24 ± 3 mm (limite superior do normal 30 mm)", "unidade": "mm", "nota": "Same cohort (n = 1,931 for the descending segment), measured at the pulmonary artery bifurcation. Age, body surface area, sex and hypertension are independently associated with caliber; diabetes is associated with the ascending aorta and smoking specifically with the descending aorta.", "fonte": "Wolak et al., JACC Cardiovasc Imaging 2008;1:200-209", "faixas": [ { "status": "green", "rotulo": "≤ 30 mm", "valor": "≤ 30", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 30 mm — dilated", "valor": "> 30", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.13", "grupo": "tc_torax", "ruleId": null, "rotulo": "Ascending aorta — upper limit by age and sex", "valor": "Mulheres 38,0 / 40,7 / 42,4 mm · Homens 40,2 / 42,9 / 45,0 mm (20–40, 41–60, > 60 anos)", "unidade": "mm", "nota": "Total diameter values (wall included), which is how CT and MRI measure, in 1,442 patients. Intraluminal equivalents are smaller — women 35.6 / 38.3 / 40.0 mm and men 37.8 / 40.5 / 42.6 mm — and are the ones comparable to echocardiography and angiography. Diameter is 1.7 mm smaller in diastole than in systole. COMPARE with the card 'Ascending thoracic aorta — CT', which gives a single 41 mm limit without age stratification: a 65-year-old man at 44 mm is normal by this series and 'dilated' by the other. Use one criterion only and record which in the report.", "fonte": "Mao et al., Acad Radiol 2008;15:827-834 (n = 1.442, TCMD 64 canais e EBT)", "faixas": [] }, { "id": "tc_torax.14", "grupo": "tc_torax", "ruleId": null, "rotulo": "Main pulmonary artery", "valor": "Homens ≥ 29 mm · Mulheres ≥ 27 mm = aumentado", "unidade": "mm", "nota": "Sex-specific normative values from the Framingham healthy referent cohort (n = 706 without obesity, hypertension, smoking, COPD, prior PE, diabetes or cardiovascular disease), on gated non-contrast cardiac CT. The exact 90th percentiles were 28.9 mm in men and 26.9 mm in women, rounded to 29 and 27 mm. An enlarged trunk suggests pulmonary hypertension but does not confirm it.", "fonte": "Truong et al., Circ Cardiovasc Imaging 2012;5:147-154 (Framingham Heart Study)", "faixas": [ { "status": "green", "rotulo": "< 29 mm (M) / < 27 mm (F)", "valor": "< 29 / < 27", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "≥ 29 mm (M) / ≥ 27 mm (F) — enlarged pulmonary trunk", "valor": "≥ 29 / ≥ 27", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.15", "grupo": "tc_torax", "ruleId": null, "rotulo": "Pulmonary artery to aorta ratio (PA:A)", "valor": "0,9", "unidade": null, "nota": "The 0.9 value is the Framingham normative cut-off (exact 90th percentile 0.91, rounded to 0.9). Fleischner 2015 uses PA:A > 1 as a marker of pulmonary artery enlargement, associated with COPD exacerbation risk. Practical advantage: the ratio is less sensitive to technique differences than the absolute measurement.", "fonte": "Truong et al., Circ Cardiovasc Imaging 2012;5:147-154 · Lynch et al., Radiology 2015;277:192-205 (Fleischner Society)", "faixas": [ { "status": "green", "rotulo": "< 0.9", "valor": "< 0,9", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "0.9 to 1.0 — borderline", "valor": "0,9-1,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 1.0 — pulmonary artery enlargement", "valor": "> 1,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.16", "grupo": "tc_torax", "ruleId": null, "rotulo": "RV/LV ratio on CTPA (RV overload in PE)", "valor": "≥ 1,0 = disfunção de ventrículo direito", "unidade": null, "nota": "Measured from the maximal transverse ventricular diameters on four-chamber reconstruction. It is one of the imaging criteria separating intermediate-risk from low-risk PE in the ESC/ERS stratification, alongside cardiac biomarkers and clinical score — the finding is prognostic, not diagnostic of PE.", "fonte": "2019 ESC/ERS Guidelines for acute pulmonary embolism (Eur Heart J 2020;41:543-603) · Konstantinides et al.", "faixas": [ { "status": "green", "rotulo": "< 1.0 — no sign of RV dysfunction", "valor": "< 1,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "≥ 1.0 — consistent with RV dysfunction", "valor": "≥ 1,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.17", "grupo": "tc_torax", "ruleId": null, "rotulo": "Mediastinal lymph node — short axis", "valor": "≤ 10 mm", "unidade": "mm", "nota": "Always measure the SHORT axis in the transverse plane. The cut-off derives from a small series (56 patients) using American Thoracic Society mapping: the largest normal nodes are subcarinal and right tracheobronchial, requiring slightly greater tolerance at those stations. Size alone does not define malignancy: in NSCLC staging, an enlarged node requires PET/CT or sampling, and a normal-sized node does not exclude micrometastasis.", "fonte": "Glazer, Gross, Quint, Francis, Bookstein & Orringer, AJR 1985;144:261-265", "faixas": [ { "status": "green", "rotulo": "≤ 10 mm", "valor": "≤ 10", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 10 mm — enlarged node", "valor": "> 10", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.18", "grupo": "tc_torax", "ruleId": null, "rotulo": "Parietal pleural thickening", "valor": "> 1 cm sugere doença pleural maligna", "unidade": "mm", "nota": "One of the four Leung criteria (74 patients: 39 malignant, 35 benign). Specificity is high but sensitivity is only 36% — absence of the finding does not exclude malignancy. Malignant mesothelioma could not be distinguished from pleural metastases by CT in this series.", "fonte": "Leung, Müller & Miller, AJR 1990;154:487-492", "faixas": [ { "status": "green", "rotulo": "≤ 10 mm", "valor": "≤ 10", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 10 mm — 94% specificity for malignant pleural disease", "valor": "> 10", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.19", "grupo": "tc_torax", "ruleId": null, "rotulo": "Quantitative emphysema (%LAA-950)", "valor": "> 6% do pulmão com atenuação < -950 HU", "unidade": "%", "nota": "Percentage of lung voxels below -950 HU. Strongly dependent on reconstruction kernel, dose and inspiratory level — only compare scans with identical protocols. Visual assessment remains the descriptive reference and may diverge from the quantitative value.", "fonte": "Lynch et al., Radiology 2015;277:192-205 (Fleischner Society — subtipos de DPOC definíveis na TC)", "faixas": [ { "status": "green", "rotulo": "≤ 6%", "valor": "≤ 6", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 6% — quantitative emphysema present", "valor": "> 6", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.20", "grupo": "tc_torax", "ruleId": null, "rotulo": "Moderate centrilobular emphysema — extent", "valor": "> 5% da zona pulmonar superior", "unidade": "%", "nota": "Cut-off separating mild from moderate centrilobular emphysema in the Fleischner visual grading: many well-defined centrilobular lucencies occupying more than 5% of the upper lung zone. Below it, 'mild' spans more than 0.5% up to 5% and 'trace' is up to 0.5%.", "fonte": "Lynch et al., Radiology 2015;277:192-205 (Fleischner Society)", "faixas": [] }, { "id": "tc_torax.21", "grupo": "tc_torax", "ruleId": null, "rotulo": "Broncho-arterial ratio (BA)", "valor": "> 1 sugere bronquiectasia", "unidade": null, "nota": "Defined as bronchial lumen diameter divided by that of the accompanying artery. In 85 subjects without cardiopulmonary disease, the ratio increased with age (r = 0.768) and exceeded 1 in 41% of subjects over 65. In older patients, do not diagnose bronchiectasis on the ratio alone — require associated signs. Relative wall thickness (T/D) did not vary with age, but was greater in elderly smokers.", "fonte": "Matsuoka et al., AJR 2003;180:513-518", "faixas": [ { "status": "green", "rotulo": "≤ 1 at any age", "valor": "≤ 1", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "> 1 in a person over 65 — may be physiological", "valor": "> 1 (> 65a)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "> 1 with wall thickening, lack of distal tapering, or bronchi visible at the periphery", "valor": "> 1 + sinais", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_torax.22", "grupo": "tc_torax", "ruleId": null, "rotulo": "Honeycombing — cyst diameter", "valor": "3 a 10 mm, podendo chegar a 2,5 cm", "unidade": "mm", "nota": "Clustered, thick-walled cystic spaces of similar diameters, typically subpleural and stacked in layers. It is the finding that defines the UIP pattern and separates it from probable UIP — hence distinguishing true honeycombing from subpleural traction bronchiolectasis changes the classification.", "fonte": "Definição e tamanho: Fleischner Society Glossary — Hansell et al., Radiology 2008;246:697-722 · papel no padrão PIU: ATS/ERS/JRS/ALAT 2022 — Raghu et al., Am J Respir Crit Care Med 2022;205:e18-e47", "faixas": [] }, { "id": "tc_torax.23", "grupo": "tc_torax", "ruleId": null, "rotulo": "Pleural effusion volume on CT", "valor": "V ≈ d² × l (d = maior profundidade num único corte; l = maior extensão do derrame)", "unidade": "mL", "nota": "Small series: 15 patients and 25 effusions (14 right, 11 left). Correlation with 3D reconstruction of 0.97 on the right and 0.95 on the left when loculated effusions are excluded; in the full series it falls to 0.91 and 0.85. Purely visual estimation consistently overestimates by 300–500 mL — use the formula when volume drives management, bearing in mind the size of the validating sample.", "fonte": "Mergo et al., J Thorac Imaging 1999;14:122-125", "faixas": [] } ], "classificacoes": [ { "id": "tc_torax.c0", "grupo": "tc_torax", "nome": "Fleischner 2017 — incidental SOLID nodules", "nota": null, "fonte": "Fleischner Society 2017 (Radiology 2017;284:228-243), Tabela 1A · MacMahon, Naidich, Goo, Lee, Leung, Mayo et al.", "colunas": [ "Nodule", "< 6 mm (< 100 mm³)", "6–8 mm (100–250 mm³)", "> 8 mm (> 250 mm³)" ], "linhas": [ { "status": null, "celulas": [ "Único — baixo risco", "Sem seguimento de rotina", "TC em 6–12 meses, depois considerar TC em 18–24 meses", "Considerar TC, PET/TC ou amostragem tecidual em 3 meses" ] }, { "status": null, "celulas": [ "Único — alto risco", "TC opcional em 12 meses", "TC em 6–12 meses, depois TC em 18–24 meses", "Considerar TC, PET/TC ou amostragem tecidual em 3 meses" ] }, { "status": null, "celulas": [ "Múltiplos — baixo risco", "Sem seguimento de rotina", "TC em 3–6 meses, depois considerar TC em 18–24 meses", "TC em 3–6 meses, depois considerar TC em 18–24 meses" ] }, { "status": null, "celulas": [ "Múltiplos — alto risco", "TC opcional em 12 meses", "TC em 3–6 meses, depois em 18–24 meses", "TC em 3–6 meses, depois em 18–24 meses" ] }, { "status": null, "celulas": [ "Observações da própria tabela", "Nódulos < 6 mm dispensam seguimento de rotina, mas alto risco com morfologia suspeita e/ou lobo superior pode merecer controle em 12 meses", "Dimensões = média dos eixos longo e curto, arredondada ao milímetro", "Em múltiplos, use o nódulo mais suspeito para guiar a conduta; intervalos variam com tamanho e risco" ] } ] }, { "id": "tc_torax.c1", "grupo": "tc_torax", "nome": "Fleischner 2017 — incidental SUBSOLID nodules", "nota": null, "fonte": "Fleischner Society 2017 (Radiology 2017;284:228-243), Tabela 1B · MacMahon et al.", "colunas": [ "Nodule", "< 6 mm (< 100 mm³)", "≥ 6 mm (≥ 100 mm³)" ], "linhas": [ { "status": null, "celulas": [ "Único — vidro fosco puro", "Sem seguimento de rotina", "TC em 6–12 meses para confirmar persistência, depois TC a cada 2 anos até completar 5 anos" ] }, { "status": null, "celulas": [ "Único — parte-sólido", "Sem seguimento de rotina", "TC em 3–6 meses para confirmar persistência; se inalterado e o componente sólido permanecer < 6 mm, TC anual por 5 anos" ] }, { "status": null, "celulas": [ "Múltiplos", "TC em 3–6 meses; se estável, considerar TC em 2 e 4 anos", "TC em 3–6 meses; conduta subsequente guiada pelo(s) nódulo(s) mais suspeito(s)" ] }, { "status": null, "celulas": [ "Observações da própria tabela", "Em nódulos suspeitos < 6 mm, considerar controle em 2 e 4 anos; múltiplos nódulos em vidro fosco < 6 mm costumam ser benignos", "Na prática, o parte-sólido só é definível a partir de 6 mm; se surgir componente sólido ou houver crescimento, considerar ressecção · Parte-sólido persistente com componente sólido ≥ 6 mm deve ser considerado altamente suspeito" ] } ] }, { "id": "tc_torax.c2", "grupo": "tc_torax", "nome": "ACR Lung-RADS v2022 — lung cancer screening", "nota": null, "fonte": "ACR Lung-RADS® v2022, release novembro/2022 — American College of Radiology (documento oficial de categorias e notas 1 a 16)", "colunas": [ "Category", "Findings (key thresholds)", "Management", "Estimated prevalence" ], "linhas": [ { "status": null, "celulas": [ "0 — Incompleto", "Exame prévio ainda sendo localizado para comparação; parte ou todo o pulmão não avaliável; achados sugestivos de processo inflamatório ou infeccioso", "Comparar com exame prévio; complementar com imagem adicional; ou TCBD em 1–3 meses", "~1%" ] }, { "status": null, "celulas": [ "1 — Negativo", "Sem nódulos pulmonares; ou nódulo com calcificação completa, central, em pipoca ou em anéis concêntricos; ou nódulo contendo gordura", "TCBD de rastreamento em 12 meses", "39%" ] }, { "status": null, "celulas": [ "2 — Benigno", "Sólido < 6 mm no basal ou novo < 4 mm; parte-sólido < 6 mm de diâmetro médio total no basal; vidro fosco < 30 mm (basal, novo ou em crescimento) ou ≥ 30 mm estável/de crescimento lento; justapleural < 10 mm sólido, de margens lisas e forma oval, lentiforme ou triangular; nódulo de via aérea subsegmentar; lesão categoria 3 estável ou menor no controle de 6 meses", "TCBD de rastreamento em 12 meses", "45%" ] }, { "status": null, "celulas": [ "3 — Provavelmente benigno", "Sólido ≥ 6 a < 8 mm no basal ou novo de 4 a < 6 mm; parte-sólido ≥ 6 mm total com componente sólido < 6 mm, ou novo < 6 mm total; vidro fosco ≥ 30 mm no basal ou novo; cisto de parede espessa com componente cístico em crescimento; lesão 4A estável ou menor no controle de 3 meses", "TCBD em 6 meses", "9%" ] }, { "status": null, "celulas": [ "4A — Suspeito", "Sólido ≥ 8 a < 15 mm no basal, em crescimento < 8 mm, ou novo de 6 a < 8 mm; parte-sólido ≥ 6 mm total com componente sólido ≥ 6 a < 8 mm, ou componente sólido novo/em crescimento < 4 mm; nódulo de via aérea segmentar ou mais proximal no basal; cisto de parede espessa ou multiloculado", "TCBD em 3 meses; considerar PET/TC se houver nódulo ou componente sólido ≥ 8 mm", "4%" ] }, { "status": null, "celulas": [ "4B — Muito suspeito", "Sólido ≥ 15 mm no basal, ou novo/em crescimento ≥ 8 mm; parte-sólido com componente sólido ≥ 8 mm no basal, ou componente sólido novo/em crescimento ≥ 4 mm; nódulo de via aérea segmentar ou mais proximal estável ou em crescimento; cisto de parede espessa com nodularidade crescente ou multiloculado em crescimento; nódulo sólido/parte-sólido de crescimento lento ao longo de vários exames", "TC diagnóstica com ou sem contraste; PET/TC se componente sólido ≥ 8 mm; amostragem tecidual; e/ou encaminhamento para avaliação clínica", "2%" ] }, { "status": null, "celulas": [ "4X", "Nódulo categoria 3 ou 4 com achados adicionais que aumentam a suspeita de câncer — espiculação, linfonodomegalia, metástase franca, nódulo em vidro fosco que dobra de tamanho em 1 ano", "Como categoria 4B; 4X é categoria própria, não um modificador", "< 1%" ] }, { "status": null, "celulas": [ "S — Significativo", "Modificador aplicável às categorias 0 a 4 para achado clinicamente significativo (ou potencialmente significativo) NÃO relacionado ao câncer de pulmão", "Conforme as recomendações do ACR para achados incidentais", "10%" ] } ] }, { "id": "tc_torax.c3", "grupo": "tc_torax", "nome": "HRCT — UIP patterns (ATS/ERS/JRS/ALAT 2022)", "nota": null, "fonte": "ATS/ERS/JRS/ALAT 2022 — Raghu et al., Am J Respir Crit Care Med 2022;205:e18-e47 (atualiza o consenso de 2018; ver também Fleischner Society 2018 — Lynch et al., Lancet Respir Med 2018;6:138-153)", "colunas": [ "Pattern", "Distribution", "HRCT features" ], "linhas": [ { "status": "none", "celulas": [ "PIU (UIP)", "Predomínio subpleural e basal; frequentemente heterogênea, com áreas de pulmão normal entremeadas à fibrose; pode ser assimétrica ou, ocasionalmente, difusa", "Faveolamento, com ou sem bronquiectasias/bronquiolectasias de tração; reticulado sobreposto; espessamento irregular dos septos interlobulares; vidro fosco discreto; pode haver ossificação pulmonar" ] }, { "status": "none", "celulas": [ "Provável PIU", "Predomínio subpleural e basal; frequentemente heterogênea, com pulmão normal entremeado ao reticulado e às bronquiectasias de tração", "Reticulado com bronquiectasias/bronquiolectasias de tração, SEM faveolamento; pode haver vidro fosco discreto. Poupança subpleural marcante NÃO é critério de provável PIU — aponta para diagnóstico alternativo" ] }, { "status": "none", "celulas": [ "Indeterminado para PIU", "Variável ou difusa; no subtipo 'PIU precoce' pode haver predomínio subpleural e basal", "Dois subtipos: (i) PIU precoce — reticulado sutil, podendo haver vidro fosco discreto ou distorção leve; (ii) verdadeiramente indeterminado — achados de fibrose pulmonar que não sugerem nenhuma etiologia específica" ] }, { "status": "none", "celulas": [ "Diagnóstico alternativo", "Predomínio peribroncovascular com poupança subpleural; distribuição perilinfática; predomínio em lobos superiores ou médios", "Cistos (LAM, histiocitose de células de Langerhans, PIL, PID); atenuação em mosaico ou sinal das três densidades (pneumonite de hipersensibilidade); vidro fosco predominante; micronódulos centrolobulares profusos; nódulos (sarcoidose); consolidação (pneumonia em organização). No mediastino: placas pleurais (asbestose) e esôfago dilatado (doença do tecido conjuntivo)" ] } ] }, { "id": "tc_torax.c4", "grupo": "tc_torax", "nome": "Emphysema — CT visual classification (Fleischner 2015)", "nota": null, "fonte": "Fleischner Society 2015 — Lynch et al., Radiology 2015;277:192-205 (CT-Definable Subtypes of COPD)", "colunas": [ "Pattern / grade", "CT definition" ], "linhas": [ { "status": null, "celulas": [ "Centrolobular — traços", "Lucências centrolobulares esparsas, separadas por amplas regiões de pulmão normal, ocupando até cerca de 0,5% da zona pulmonar" ] }, { "status": null, "celulas": [ "Centrolobular — discreto", "Múltiplas lucências centrolobulares ocupando mais de 0,5% e até cerca de 5% da zona pulmonar" ] }, { "status": null, "celulas": [ "Centrolobular — moderado", "Múltiplas lucências centrolobulares bem definidas, ocupando mais de 5% da zona pulmonar superior" ] }, { "status": null, "celulas": [ "Centrolobular — confluente", "Áreas de baixa atenuação tornam-se confluentes e a distribuição centrolobular fica menos evidente" ] }, { "status": null, "celulas": [ "Centrolobular — destrutivo avançado", "Redução generalizada da atenuação pulmonar, sem hipoatenuação focal, com septos interlobulares preservados ou estirados e distorção arquitetural" ] }, { "status": null, "celulas": [ "Paraseptal — discreto", "Focos subpleurais de baixa atenuação separados por septos interlobulares íntegros, medindo menos de 1 cm" ] }, { "status": null, "celulas": [ "Paraseptal — substancial", "Numerosas áreas subpleurais bem demarcadas ao longo da parede torácica e das margens pleurais mediastinais, podendo ultrapassar 1 cm" ] }, { "status": null, "celulas": [ "Panlobular", "Redução difusa e relativamente uniforme da atenuação pulmonar, com simplificação da arquitetura e redução do calibre vascular, acometendo o lóbulo por inteiro e tipicamente predominando nos lobos inferiores. É o terceiro padrão da classificação, ao lado do centrolobular e do paraseptal, e não recebe subclassificação por extensão (só o centrolobular, com 5 graus, e o paraseptal, com 2)" ] } ] }, { "id": "tc_torax.c5", "grupo": "tc_torax", "nome": "Diffuse pleural disease — CT criteria for malignancy", "nota": null, "fonte": "Leung, Müller & Miller, AJR 1990;154:487-492 (74 pacientes com doença pleural difusa comprovada: 39 malignos, 35 benignos)", "colunas": [ "CT criterion", "Specificity", "Sensitivity" ], "linhas": [ { "status": null, "celulas": [ "Espessamento pleural circunferencial", "100%", "41%" ] }, { "status": null, "celulas": [ "Espessamento pleural nodular", "94%", "51%" ] }, { "status": null, "celulas": [ "Espessamento da pleura parietal > 1 cm", "94%", "36%" ] }, { "status": null, "celulas": [ "Envolvimento da pleura mediastinal", "88%", "56%" ] }, { "status": null, "celulas": [ "Pelo menos um dos quatro critérios presente", "83%", "72%" ] } ] } ] }, { "metodo": "CT", "chave": "tc_abdome", "slug": "tc-abdome", "nome": "Computed tomography — abdomen and pelvis", "temPaginaPublica": false, "medidas": [ { "id": "tc_abdome.0", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Liver — parenchymal attenuation on unenhanced CT", "valor": "50–65", "unidade": "UH", "nota": "Mean 58.8 ± 10.8 HU in 3,357 asymptomatic adults. The threshold applies to UNENHANCED CT only: after contrast, attenuation depends on dose, cardiac output and scan timing. A normal liver is usually equal to or denser than the spleen. Watch the upper end: a liver above ~75 HU suggests iron overload, amiodarone, Wilson disease or metal deposition — and in that setting the steatosis criteria (40 HU and liver/spleen relationship) are invalid.", "fonte": "AJR 2010;194:623 · Boyce, Pickhardt et al. — Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT", "faixas": [ { "status": "green", "rotulo": "usual attenuation", "valor": ">48 e ≤75 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "loss-of-specificity zone", "valor": "40–48 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "hyperattenuation — investigate deposition", "valor": ">75 UH (ferro, amiodarona, Wilson); critérios de esteatose inválidos", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "moderate-to-severe steatosis", "valor": "≤40 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.1", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Hepatic steatosis — absolute threshold on unenhanced CT", "valor": "≤ 40", "unidade": "UH", "nota": "Liver ≤40 HU identifies moderate-to-severe steatosis (≥30% macrovesicular fat) with near-complete specificity; between 40 and 48 HU specificity already drops. Unenhanced CT has moderate sensitivity and high specificity for at least moderate steatosis — it does not grade mild steatosis nor quantify fat (that is MRI/PDFF). Pooled accuracy figures should be checked against the meta-analysis before being quoted as numbers.", "fonte": "AJR 2010 · Boyce/Pickhardt et al. + Radiology · meta-análise \"Diagnostic Accuracy of CT for the Detection of Hepatic Steatosis: A Systematic Review and Meta-Analysis\" (doi 10.1148/radiol.241171)", "faixas": [ { "status": "green", "rotulo": "no relevant steatosis", "valor": ">48 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline / possible mild steatosis", "valor": "40–48 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "moderate-to-severe steatosis", "valor": "≤40 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.2", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Hepatic steatosis — liver-to-spleen relationship (unenhanced)", "valor": "fígado − baço ≤ −10 UH ou razão fígado/baço ≤ 1,1", "unidade": "UH", "nota": "The spleen works as an internal reference when protocol or kV vary. A difference ≤ −10 HU is the most specific criterion; the ≤1.1 ratio captures milder degrees and is far less specific — in the same cohort prevalence was 45.9% by ratio versus 6.2% by the 40 HU cutoff. Never apply after contrast, since liver and spleen enhance with different kinetics; nor in a hyperattenuating liver from deposition.", "fonte": "Eur Radiol 2012 · Pickhardt et al. — Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis + AJR 2010 · Boyce/Pickhardt et al.", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "fígado ≥ baço", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "likely mild steatosis (low-specificity criterion)", "valor": "diferença entre −10 e 0 UH (razão ≤1,1)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "significant steatosis", "valor": "fígado − baço ≤ −10 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.3", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Caudate-to-right-lobe ratio — cirrhotic morphology", "valor": "< 0,65 (método clássico) · < 0,90 (método modificado)", "unidade": "razão", "nota": "Classic method (Harbin 1980): ratio of transverse caudate lobe width to transverse right lobe width, cutoff 0.65 — it separated cirrhotic from non-cirrhotic livers with 84% sensitivity, 100% specificity and 94% accuracy. Modified method (Awaya 2002): measured from the right portal vein bifurcation with its own 0.90 cutoff — NEVER apply 0.65 to a measurement made by the modified method, and do not mix the two in the same report. It is a morphologic sign: it replaces neither elastography nor histology, and early cirrhosis may have a normal ratio.", "fonte": "Radiology 1980;135:273 · Harbin, Robert, Ferrucci — Diagnosis of cirrhosis based on regional changes in hepatic morphology (método clássico, corte 0,65) + Radiology 2002;224:769 · Awaya H et al. — Cirrhosis: modified caudate–right lobe ratio (método modificado, corte 0,90)", "faixas": [ { "status": "green", "rotulo": "preserved morphology", "valor": "<0,65 (clássico) ou <0,90 (modificado)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suggests cirrhosis", "valor": "≥0,65 (clássico) ou ≥0,90 (modificado)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.4", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Spleen — splenic index on CT", "valor": "< 480", "unidade": "cm³ (CC × largura × espessura)", "nota": "Splenic index = craniocaudal length × width × thickness, in centimeters. From 480 upward it defines splenomegaly. It is the most reliable CT measurement of the spleen; single measurements are for screening, not confirmation. Record the index whenever follow-up (portal hypertension, myeloproliferative disease, lymphoma) depends on volume change.", "fonte": "Abdominal Radiology 2017;42:1444 · Indiran et al. — Does coronal oblique length of spleen on CT reflect splenic index?", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "<480", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "splenomegaly", "valor": "≥480", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.5", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Spleen — maximum coronal oblique length", "valor": "< 12", "unidade": "cm", "nota": "Measured on the maximum coronal OBLIQUE axis. ≥12 cm has 97.8% sensitivity but only 34.1% specificity for splenomegaly (PPV 91%, NPV 70%, in a high-prevalence cohort): it screens, it does not confirm. The same series derived cutoffs for other planes (craniocaudal >9.5 cm; width >10.6 cm) — these are DIFFERENT planes with their own cutoffs and are not interchangeable: never compare a measurement in one plane against the cutoff of another. Confirm with the splenic index before reporting splenomegaly.", "fonte": "Abdominal Radiology 2017 · Indiran et al.", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "<12 cm no eixo coronal oblíquo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "positive screen, confirm", "valor": "≥12 cm com índice esplênico <480", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "confirmed splenomegaly", "valor": "≥12 cm com índice esplênico ≥480", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.6", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Spleen — estimated volume on CT", "valor": "107–315 (média 215)", "unidade": "cm³", "nota": "Estimated volume = 30 + 0.58 × (width × length × thickness). In the original series splenic volume showed little dependence on sex and body habitus; variation with age is described and should be taken into account in older adults. The parameter's strength is intra-patient comparison across serial studies, not asserting population normality.", "fonte": "Eur Radiol 1997;7:246 · Prassopoulos et al. — Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus", "faixas": [ { "status": "yellow", "rotulo": "small spleen", "valor": "<107 cm³ — considerar atrofia/autoesplenectomia", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "green", "rotulo": "normal range", "valor": "107–315 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "enlarged", "valor": ">315 cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.7", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Pancreas — anteroposterior diameter by segment", "valor": "cabeça até 3,0 · colo/corpo até 2,5 · cauda até 2,0", "unidade": "cm", "nota": "Mean pancreatic volume ~79 cm³ (37–168 cm³). With aging, volume and body/tail decrease while the AP diameter of the head increases up to about age 71; head and total volume are smaller in women. Between-subject variation exceeds age and sex effects — fatty replacement and senile lobulation are not pathologic atrophy. Focal enlargement matters only with contour, duct or peripancreatic fat change.", "fonte": "Pancreas 2012;41:589 · Syed, Mahal, Schumm, Dachman — Pancreas size and volume on computed tomography in normal adults + Kreel et al. 1977 — Computed tomography of the normal pancreas", "faixas": [] }, { "id": "tc_abdome.8", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Adrenal glands — body and limb thickness", "valor": "corpo ≤ 10 · ramos ≤ 5", "unidade": "mm", "nota": "CT measurements in a population without adrenal disease: maximum body width 6.1 mm on the right and 7.9 mm on the left; medial and lateral limbs 2.8–3.3 mm. The practical limits of 10 mm (body) and 5 mm (limbs) correspond to mean + 2 SD. The left gland is normally larger than the right — mild asymmetry is not a finding. Diffuse thickening with preserved contour suggests hyperplasia; a focal nodule enters the HU/washout algorithm (most adrenal nodules are adenomas).", "fonte": "Clinical Radiology 1994 · Vincent JM, Morrison ID, Armstrong P, Reznek RH — The size of normal adrenal glands on computed tomography", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "corpo ≤10 mm e ramos ≤5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "diffuse thickening", "valor": ">10 mm com contorno e forma preservados", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "focal nodule — characterize", "valor": "protrusão nodular focal de qualquer tamanho; medir UH sem contraste", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.9", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Adrenal nodule — unenhanced attenuation", "valor": "≤ 10", "unidade": "UH", "nota": "A homogeneous lesion ≤10 HU on unenhanced CT characterizes a lipid-rich adenoma and needs no further imaging. Between 11 and 20 HU it is indeterminate: proceed to chemical-shift MRI or further assessment. Above 20 HU in a heterogeneous lesion, multidisciplinary discussion. Size is an axis INDEPENDENT of attenuation: a lesion ≥4 cm enters surgical discussion because of adrenocortical carcinoma risk even with low attenuation — and is never downgraded by favorable washout. Measure with an ROI covering at least two-thirds of the lesion, avoiding calcification, necrosis and macroscopic fat. Every incidentaloma requires hormonal workup.", "fonte": "ESE/ENSAT 2023 · European Journal of Endocrinology 189:G1 · Fassnacht et al. — Management of adrenal incidentalomas", "faixas": [ { "status": "green", "rotulo": "lipid-rich adenoma", "valor": "≤10 UH, homogêneo, <4 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate", "valor": "11–20 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious or surgical management", "valor": ">20 UH em lesão heterogênea; ou lesão ≥4 cm de qualquer atenuação (discussão multidisciplinar)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.10", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Adrenal — absolute percentage washout (APW)", "valor": "≥ 60", "unidade": "%", "nota": "APW = 100 × (HUportal − HUdelayed) / (HUportal − HUunenhanced). Requires all three acquisitions: unenhanced, 60 s (portal) and 15 min (delayed), with the same ROI on all three; a delayed phase earlier than 15 min underestimates washout. ROI misplacement is the main source of error. Guideline caveat: ESE/ENSAT 2023 assigns CT washout only moderate value and does not treat it as a decisive test — use it as supporting data. Clinical pitfall: pheochromocytoma and some adrenocortical carcinomas and hypervascular metastases also wash out fast — favorable washout does NOT downgrade a large, heterogeneous or growing lesion.", "fonte": "Radiology 2002;222:629 · Caoili et al. — Adrenal masses: characterization with combined unenhanced and delayed enhanced CT (+ Korobkin et al., Radiology 1998) — origem dos cortes; ESE/ENSAT 2023 · Eur J Endocrinol 189:G1 · Fassnacht et al. — ressalva sobre o valor apenas moderado do washout", "faixas": [ { "status": "green", "rotulo": "likely adenoma", "valor": "≥60% em lesão homogênea <4 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "do not downgrade on washout alone", "valor": "≥60% mas lesão ≥4 cm, heterogênea ou em crescimento", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely non-adenoma", "valor": "<60%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.11", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Adrenal — relative percentage washout (RPW)", "valor": "≥ 40", "unidade": "%", "nota": "RPW = 100 × (HUportal − HUdelayed) / HUportal. Used when no unenhanced series is available. Only moderate performance: in a dedicated series, the 40% cutoff flagged malignancy in about one third of proven benign lesions. Prefer repeating with a full adrenal protocol when the decision is surgical.", "fonte": "Radiology 2002;222:629 · Caoili et al. (fórmulas) + Schloetelburg et al. — \"Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses\" + ESE/ENSAT 2023 · Eur J Endocrinol 189:G1", "faixas": [ { "status": "green", "rotulo": "likely adenoma", "valor": "≥40% em lesão homogênea <4 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "reduced reliability", "valor": "sem fase pré-contraste ou lesão heterogênea", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely non-adenoma", "valor": "<40%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.12", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Kidneys — pole-to-pole length on CT", "valor": "direito 108,5 ± 12,2 · esquerdo 111,3 ± 12,6", "unidade": "mm", "nota": "Series of 1,040 asymptomatic patients on 64-slice MDCT. Parenchymal width 15.4 mm on the right and 15.9 mm on the left; cortical width 6.6 ± 1.9 mm. Independent predictors: body size, BMI, age and sex — in men, length increases until the fifth decade and then declines. The left kidney is normally larger. Always compare both sides and cortical thickness before reporting a small kidney or chronic nephropathy.", "fonte": "BMC Urology 2009 · Glodny et al. — Normal kidney size and its influencing factors: a 64-slice MDCT study of 1,040 asymptomatic patients", "faixas": [] }, { "id": "tc_abdome.13", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Renal mass — what counts as enhancement on CT", "valor": "≥ 20 UH de aumento", "unidade": "UH", "nota": "Bosniak v2019 defines enhancement as a ≥20 HU rise between unenhanced and post-contrast images, in the same ROI. A rise ≤10 HU is considered no enhancement, and intermediate values (11–19 HU) are indeterminate — resolve with MRI or follow-up, never report \"probable enhancement\". The protocol requires unenhanced and nephrographic phases with thin sections; without them, do not assign a Bosniak class.", "fonte": "Bosniak v2019 · Radiology 2019 · Silverman SG, Pedrosa I, Ellis JH et al. — Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment", "faixas": [ { "status": "green", "rotulo": "no enhancement", "valor": "≤10 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate", "valor": "11–19 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "enhancement present", "valor": "≥20 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.14", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Simple renal cyst on CT", "valor": "−9 a 20", "unidade": "UH", "nota": "Bosniak I: well-defined mass, thin (≤2 mm) smooth wall, homogeneous content of −9 to 20 HU, no septa, no calcification, no enhancing tissue. Bosniak II additionally allows a homogeneous mass ≥70 HU on unenhanced CT (hemorrhagic/proteinaceous cyst) and a homogeneous mass of 21–30 HU on portal venous phase. Only call it a simple cyst when the protocol allowed assessment of enhancement — on a single portal venous phase, describe it and suggest characterization.", "fonte": "Bosniak v2019 · Radiology 2019 · Silverman et al.", "faixas": [ { "status": "green", "rotulo": "simple cyst (Bosniak I)", "valor": "−9 a 20 UH, homogêneo, parede ≤2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "benign complicated cyst (Bosniak II)", "valor": "≥70 UH sem contraste ou 21–30 UH na fase portal, homogêneo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "requires full Bosniak classification", "valor": "heterogêneo, septos espessos, nódulo ou realce ≥20 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.15", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Abdominal aorta — diameter and aneurysm threshold", "valor": "< 3,0 normal · ≥ 3,0 aneurisma", "unidade": "cm", "nota": "Measure the largest outer diameter perpendicular to the vessel axis — in a tortuous aorta use reformats, since the raw axial slice overestimates. Besides the fixed 3.0 cm cutoff, focal dilatation ≥1.5× the adjacent normal segment is also aneurysmal (relevant in small-framed patients). Elective repair is recommended from 5.5 cm in men at acceptable surgical risk; in women, 5.0–5.4 cm is considered. Saccular morphology and rapid expansion are repair indications independent of absolute diameter.", "fonte": "SVS 2018 · J Vasc Surg · Chaikof et al. — The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm", "faixas": [ { "status": "green", "rotulo": "normal caliber", "valor": "<3,0 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "aneurysm under surveillance", "valor": "3,0–5,4 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "elective repair threshold", "valor": "≥5,5 cm (homem) ou ≥5,0 cm (mulher)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.16", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Abdominal aortic aneurysm — surveillance interval by diameter", "valor": "3,0–3,9 cm: 3 anos · 4,0–4,9 cm: 12 meses · 5,0–5,4 cm: 6 meses", "unidade": "intervalo", "nota": "SVS 2018 recommendation (grade 2, level C). Initial diameter 2.5–2.9 cm: rescreening in 10 years. Below 2.5 cm there is no surveillance recommendation. Writing the interval in the report is what actually makes follow-up happen — the radiologist closes the loop here.", "fonte": "SVS 2018 · J Vasc Surg · Chaikof et al. — diretriz de AAA", "faixas": [ { "status": "green", "rotulo": "long rescreening", "valor": "2,5–2,9 cm → 10 anos", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "periodic surveillance", "valor": "3,0–3,9 cm → 3 anos; 4,0–4,9 cm → 12 meses", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "short surveillance / surgical assessment", "valor": "5,0–5,4 cm → 6 meses; ≥5,5 cm → cirurgia vascular", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.17", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Common bile duct on CT", "valor": "≤ 6 (até 50 anos) · ≤ 8 (>50 anos) · ≤ 10 (pós-colecistectomia)", "unidade": "mm", "nota": "In 604 adults assessed with 64-slice CT, the mean largest diameter of the normal CBD was 4.77 ± 1.81 mm, rising to 7.28 ± 2.37 mm after cholecystectomy; caliber increases significantly with age. Dilatation without an identified cause on CT warrants MRCP. What changes management is the presence of an obstruction level and intrahepatic duct dilatation, not the isolated number.", "fonte": "Eur J Radiol 2012 · Şentürk et al. — Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "≤6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline by age or prior surgery", "valor": "7–8 mm acima dos 50 anos; até 10 mm pós-colecistectomia", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "relevant dilatation", "valor": ">8 mm sem contexto benigno; >10 mm pós-colecistectomia", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.18", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Appendix — outer diameter on CT", "valor": "≤ 6", "unidade": "mm", "nota": "The classic 6 mm cutoff is highly sensitive and poorly specific: a normal appendix distended by gas or a fecalith frequently exceeds 6 mm. In a dedicated series, a 6.75 mm cutoff yielded 87.5% sensitivity and 100% specificity. Never diagnose appendicitis on diameter alone — require at least one secondary sign (fat stranding, wall thickening, periappendiceal fluid). The converse also holds: fat stranding with a normal-caliber appendix should raise an alternative diagnosis (right-sided diverticulitis, epiploic appendagitis, terminal ileitis, mesenteric adenitis, adnexal disease).", "fonte": "Cureus 2023 · Wazzan et al. — Up-to-Date Diagnostic CT Standards for Acute Appendicitis + World J Gastroenterol 2014 · Park et al. — Stratified computed tomography findings improve diagnostic accuracy for appendicitis", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "≤6 mm sem sinais secundários", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline / indeterminate", "valor": ">6 e ≤6,75 mm sem sinal secundário; ou qualquer calibre com sinal secundário isolado", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely appendicitis", "valor": ">6,75 mm com pelo menos um sinal secundário", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.19", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Appendix — intraluminal fluid thickness", "valor": "≥ 2,25", "unidade": "mm", "nota": "Maximum thickness of the intraluminal fluid column. Sensitivity 96.4% and specificity 67% — its value is in EXCLUSION: an appendix with intraluminal air and no fluid column argues strongly against appendicitis. On an equivocal CT, this is the criterion that most helps avoid a negative appendectomy.", "fonte": "Cureus 2023 · Wazzan et al. — Up-to-Date Diagnostic CT Standards for Acute Appendicitis: Wall Thickness and Intraluminal Fluid Thickness", "faixas": [ { "status": "green", "rotulo": "against appendicitis", "valor": "<2,25 mm com ar intraluminal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "isolated, poorly specific", "valor": "≥2,25 mm sem sinal secundário", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely appendicitis", "valor": "≥2,25 mm com densificação da gordura ou parede espessada", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.20", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Bowel wall thickness on CT", "valor": "delgado ≤ 3 · cólon ≤ 3 distendido (até 5 colabado)", "unidade": "mm", "nota": "Measure only with the loop distended: a collapsed loop mimics thickening and is the leading source of false positives in the acute abdomen. Above 4 mm in the small bowel and above 5 mm in the colon and stomach is considered abnormal; 3 to 4 mm in the small bowel is borderline and should not be reported as thickening without another finding. Beyond the number, describe the pattern (halo/target, submucosal fat, stratified versus homogeneous enhancement), extent and symmetry — these separate inflammatory from ischemic and neoplastic disease.", "fonte": "AJR 2001;176:1105 · Macari & Balthazar — CT of Bowel Wall Thickening: Significance and Pitfalls of Interpretation + RadioGraphics 1991 · CT evaluation of wall thickening in the alimentary tract", "faixas": [ { "status": "green", "rotulo": "normal with distended loop", "valor": "delgado ≤3 mm; cólon ≤3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline / not measurable / pseudothickening", "valor": "delgado >3 e ≤4 mm; alça colabada; cólon até 5 mm sem distensão", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "true thickening", "valor": ">4 mm no delgado ou >5 mm no cólon/estômago com alça distendida", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.21", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Bowel obstruction — calibers on CT", "valor": "delgado ≥ 2,5–3,0 cm · cólon > 6 cm · ceco > 9 cm", "unidade": "regra 3–6–9", "nota": "Measure outer wall to outer wall. Dilatation alone does NOT establish obstruction: a transition point is required, with proximal dilated bowel giving way to distal collapsed bowel. Without a transition, consider adynamic ileus or enteritis. The practical 3–6–9 rule (small bowel, colon, cecum) is the on-call reference standard.", "fonte": "Radiology 2015 · Paulson & Thompson — Review of Small-Bowel Obstruction: The Diagnosis and When to Worry + RadioGraphics 2001 · CT Evaluation of Small Bowel Obstruction", "faixas": [ { "status": "green", "rotulo": "normal caliber", "valor": "delgado <2,5 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "dilatation without transition", "valor": "delgado 2,5–3,0 cm sem ponto de transição", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "likely obstruction", "valor": "delgado >3 cm com transição; cólon >6 cm; ceco >9 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.22", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Abdominal lymph nodes — short axis by station", "valor": "retrocrural 6 · gastro-hepático 8 · hilo hepático 7 · para-aórtico superior 9 · portocava 10 · para-aórtico inferior 11", "unidade": "mm", "nota": "Upper limits of short-axis diameter determined by CT in 130 patients without nodal disease. Short axis is what counts, and the limit changes by station: using 10 mm for everything overestimates the retrocrural station and underestimates the lower para-aortic one. Morphology (central necrosis, spiculated contour, loss of the fatty hilum, conglomeration) outweighs the isolated millimeter.", "fonte": "Radiology 1991 · Dorfman RE, Alpern MB, Gayler BW, Sandler MA — Upper abdominal lymph nodes: criteria for normal size determined with CT", "faixas": [ { "status": "green", "rotulo": "within station limit", "valor": "≤ limite da estação, hilo gorduroso preservado", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "above limit, benign morphology", "valor": "> limite da estação, isolado, com hilo gorduroso preservado", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious", "valor": "> limite com perda do hilo, necrose central ou conglomerado", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.23", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Lymph node in oncologic context (RECIST 1.1)", "valor": "< 10 não patológico · 10–14,9 não-alvo · ≥ 15 alvo", "unidade": "mm (eixo curto)", "nota": "For staging and response assessment, RECIST 1.1 measures lymph nodes by SHORT AXIS: <10 mm is non-pathological, 10 to <15 mm counts as a non-target lesion, and ≥15 mm may be a measurable target lesion. Complete response requires target nodes to return to <10 mm. Keep the same plane and the same reader across serial studies.", "fonte": "RECIST 1.1 · European Journal of Cancer 2009;45:228 · Eisenhauer et al.", "faixas": [ { "status": "green", "rotulo": "non-pathological", "valor": "<10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "non-target lesion", "valor": "10–14,9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "measurable target lesion", "valor": "≥15 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_abdome.24", "grupo": "tc_abdome", "ruleId": null, "rotulo": "Portal vein — bland versus tumor thrombus (LR-TIV)", "valor": "tecido que realça dentro da veia + expansão do calibre = trombo tumoral", "unidade": "qualitativo", "nota": "In a patient at risk for HCC, unequivocal soft tissue within the vein — enhancing in the arterial phase, expanding the caliber and contiguous with the tumor — defines LR-TIV (tumor in vein) and changes staging and treatment, even without an evident parenchymal mass. Bland thrombus does not enhance, usually does not expand the vessel and occurs in a prothrombotic context. Always describe extent (branch, main trunk, superior mesenteric vein, splenic vein) and the presence of cavernous transformation.", "fonte": "ACR LI-RADS v2018 CT/MRI · Radiology 2018 · Chernyak V et al. — LI-RADS Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients", "faixas": [ { "status": "green", "rotulo": "patent vein", "valor": "sem falha de enchimento", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "likely bland thrombus", "valor": "falha de enchimento sem realce, vaso não expandido", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "tumor thrombus (LR-TIV)", "valor": "tecido que realça, vaso expandido, contiguidade com o tumor", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "tc_abdome.c0", "grupo": "tc_abdome", "nome": "Bosniak v2019 — cystic renal masses on CT", "nota": null, "fonte": "Bosniak v2019 · Radiology 2019 · Silverman SG, Pedrosa I, Ellis JH et al. — An update proposal and needs assessment; aplicação prática em RadioGraphics 2021 · A Pictorial Guide to Clinical Use", "colunas": [ "Class", "CT criteria", "Malignancy risk", "Management" ], "linhas": [ { "status": null, "celulas": [ "Pré-requisitos", "Massa cística = menos de 25% do volume composto por tecido que realça. Protocolo com fase sem contraste e fase nefrográfica, cortes finos. Realce = aumento ≥20 UH; ≤10 UH = sem realce; 11–19 UH = indeterminado. \"Espesso\" = ≥4 mm. \"Irregular\" = protrusões convexas ≤3 mm com margens obtusas.", "—", "Sem protocolo adequado, descrever e sugerir caracterização — não atribuir classe." ] }, { "status": null, "celulas": [ "I", "Parede fina (≤2 mm) e lisa; conteúdo homogêneo de −9 a 20 UH; sem septos e sem tecido que realce. A parede pode realçar.", "≈ 0%", "Nenhum seguimento." ] }, { "status": null, "celulas": [ "II", "Parede fina (≤2 mm) e lisa; até 3 septos finos (≤2 mm), que podem realçar; qualquer padrão de calcificação. Inclui massas homogêneas ≥70 UH sem contraste e massas homogêneas de 21–30 UH na fase portal.", "< 1%", "Nenhum seguimento." ] }, { "status": null, "celulas": [ "IIF", "≥4 septos finos (≤2 mm) que realçam, OU parede/septos lisos minimamente espessados (3 mm) que realçam.", "Baixo; a maioria não progride", "Seguimento por imagem; progressão para III/IV eleva muito a chance de malignidade." ] }, { "status": null, "celulas": [ "III", "Parede OU septos espessados (≥4 mm) e lisos que realçam, OU parede/septos irregulares que realçam.", "≈ 50%", "Tratamento ou seguimento individualizado, conforme comorbidades e preferência." ] }, { "status": null, "celulas": [ "IV", "Nódulo que realça: protrusão convexa de QUALQUER tamanho com margens agudas, OU protrusão convexa ≥4 mm com margens obtusas.", "≈ 90%", "Tratar quando as condições clínicas permitirem." ] }, { "status": null, "celulas": [ "Regra de segurança", "Calcificação densa, hiperatenuação (≥70 UH) e estabilidade NÃO rebaixam massa que já tem descritor suspeito (nódulo, parede/septo ≥4 mm ou irregular). Classifique primeiro pelos descritores.", "—", "Descritor suspeito sempre vence." ] } ] }, { "id": "tc_abdome.c1", "grupo": "tc_abdome", "nome": "Adrenal CT washout — formulas and cutoffs", "nota": null, "fonte": "Radiology 2002;222:629 · Caoili et al. (protocolo sem contraste + tardia e cortes de washout; ver também Korobkin et al., Radiology 1998) + ESE/ENSAT 2023 · European Journal of Endocrinology 189:G1 · Fassnacht et al. (algoritmo de manejo, corte de 10 UH, limiar de 4 cm e ressalva sobre o valor apenas moderado do washout) + Schloetelburg et al. — \"Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses\"", "colunas": [ "Step", "Formula / threshold", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "1 — TC sem contraste", "Atenuação ≤ 10 UH em lesão homogênea", "Adenoma rico em lipídio: encerra a investigação de IMAGEM. O tamanho é eixo independente — lesão ≥4 cm segue para discussão multidisciplinar." ] }, { "status": null, "celulas": [ "2 — Zona indeterminada", "11–20 UH", "Seguir para RM em fase oposta ou avaliação adicional; nesta faixa o valor absoluto não decide." ] }, { "status": null, "celulas": [ "3 — Washout absoluto (APW)", "APW = 100 × (UHportal − UHtardio) / (UHportal − UHsem contraste); adenoma se ≥ 60%", "Requer as três fases. É o mais confiável dos dois — mas o ESE/ENSAT 2023 lhe atribui valor apenas moderado e não o trata como teste decisório." ] }, { "status": null, "celulas": [ "4 — Washout relativo (RPW)", "RPW = 100 × (UHportal − UHtardio) / UHportal; adenoma se ≥ 40%", "Usar só quando não houver fase sem contraste; desempenho apenas moderado." ] }, { "status": null, "celulas": [ "5 — Técnica", "Sem contraste + 60 s (portal) + 15 min (tardia); mesma ROI nas três fases, cobrindo ≥2/3 da lesão, evitando calcificação, necrose e gordura", "ROI mal posicionada e fase tardia antes de 15 min são as principais causas de washout falso." ] }, { "status": null, "celulas": [ "Armadilhas", "Feocromocitoma, parte dos carcinomas adrenocorticais e metástases hipervasculares também lavam rápido; hemorragia, cisto e mielolipoma têm padrões próprios", "Washout favorável NÃO exclui malignidade — pesar tamanho, heterogeneidade, crescimento e história oncológica." ] }, { "status": null, "celulas": [ "Limiar cirúrgico", "Lesão ≥ 4 cm (mesmo com atenuação baixa ou washout favorável), lesão heterogênea, ou > 20 UH sem contraste", "Discussão multidisciplinar com cirurgia, independentemente do washout." ] }, { "status": null, "celulas": [ "Avaliação funcional", "Todo incidentaloma adrenal exige investigação hormonal (ao menos hipercortisolismo; feocromocitoma e hiperaldosteronismo conforme quadro)", "Imagem sozinha não conclui incidentaloma adrenal." ] } ] }, { "id": "tc_abdome.c2", "grupo": "tc_abdome", "nome": "Acute pancreatitis — CT severity index (Balthazar CTSI and MCTSI)", "nota": null, "fonte": "AJR 2004;183:1261 · Mortele KJ et al. — A Modified CT Severity Index for Evaluating Acute Pancreatitis: Improved Correlation with Patient Outcome (inclui o CTSI original de Balthazar); momento da TC conforme a Classificação de Atlanta revisada · Gut 2013 · Banks et al.", "colunas": [ "Component", "CT finding", "Points" ], "linhas": [ { "status": null, "celulas": [ "CTSI — grau", "A: pâncreas normal", "0" ] }, { "status": null, "celulas": [ "CTSI — grau", "B: aumento focal ou difuso, contorno irregular, atenuação heterogênea, dilatação ductal, pequenas coleções intrapancreáticas — sem alteração peripancreática", "1" ] }, { "status": null, "celulas": [ "CTSI — grau", "C: alterações pancreáticas + densificação inflamatória da gordura peripancreática", "2" ] }, { "status": null, "celulas": [ "CTSI — grau", "D: coleção líquida única mal definida", "3" ] }, { "status": null, "celulas": [ "CTSI — grau", "E: duas ou mais coleções mal definidas, ou gás no pâncreas / ao redor dele", "4" ] }, { "status": null, "celulas": [ "CTSI — necrose", "ausente / < 30% / 30–50% / > 50%", "0 / 2 / 4 / 6" ] }, { "status": null, "celulas": [ "CTSI — total (0–10)", "leve 0–3 · moderada 4–6 · grave 7–10", "0–10" ] }, { "status": null, "celulas": [ "MCTSI — inflamação pancreática", "pâncreas normal / alterações intrínsecas ± inflamação peripancreática / coleção pancreática ou peripancreática ou necrose gordurosa peripancreática", "0 / 2 / 4" ] }, { "status": null, "celulas": [ "MCTSI — necrose pancreática", "ausente / ≤ 30% / > 30%", "0 / 2 / 4" ] }, { "status": null, "celulas": [ "MCTSI — complicações extrapancreáticas", "derrame pleural, ascite, complicações vasculares, complicações do trato gastrointestinal", "2" ] }, { "status": null, "celulas": [ "MCTSI — total (0–10)", "leve 0–2 · moderada 4–6 · grave 8–10", "0–10" ] }, { "status": null, "celulas": [ "Momento da TC", "A TC com contraste deve ser feita após 72–96 h do início da dor: antes disso a necrose é subestimada e o índice, falsamente baixo", "—" ] }, { "status": null, "celulas": [ "Desempenho", "O MCTSI correlaciona-se melhor que o CTSI com falência orgânica e tempo de internação, e é mais simples de aplicar", "—" ] } ] }, { "id": "tc_abdome.c3", "grupo": "tc_abdome", "nome": "LI-RADS v2018 — CT/MRI in patients at risk for HCC", "nota": null, "fonte": "ACR LI-RADS v2018 CT/MRI · Radiology 2018 · Chernyak V, Fowler KJ, Kamaya A et al. — Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients", "colunas": [ "Category", "Criteria on multiphase CT/MRI", "Meaning / management" ], "linhas": [ { "status": null, "celulas": [ "População elegível", "Adultos com cirrose, hepatite B crônica sem cirrose, ou CHC atual ou prévio (incluindo tratado por ressecção, ablação ou transplante). NÃO aplicar em cirrose por doença vascular ou fibrose hepática congênita, nem fora do grupo de risco (nesses casos, laudar como nódulo hepático comum).", "Fora dessa população o algoritmo não vale e a categoria não deve ser emitida." ] }, { "status": null, "celulas": [ "Características maiores", "APHE não em anel (realce arterial não periférico, maior que o fígado); washout não periférico (queda de atenuação/intensidade na fase portal ou tardia — com agente hepatobiliar, só na fase portal); cápsula que realça (borda lisa e uniforme); crescimento limiar = aumento ≥50% do maior diâmetro em ≤6 meses.", "São as quatro variáveis que alimentam a tabela; medir sempre o maior diâmetro externo." ] }, { "status": null, "celulas": [ "LR-1 / LR-2", "Definitivamente benigno / provavelmente benigno: cisto, hemangioma típico, alteração perfusional, nódulo de regeneração com comportamento benigno.", "Retorna ao rastreamento semestral." ] }, { "status": null, "celulas": [ "LR-3", "Sem APHE e <20 mm com nenhuma ou uma característica adicional; sem APHE e ≥20 mm sem característica adicional; COM APHE não em anel e <20 mm sem nenhuma característica adicional.", "Probabilidade intermediária de malignidade — repetir ou alternar método em 3–6 meses." ] }, { "status": null, "celulas": [ "LR-4", "Sem APHE e ≥20 mm com ≥1 adicional; sem APHE e <20 mm com ≥2 adicionais; com APHE e <10 mm com ≥1 adicional; com APHE, 10–19 mm, tendo apenas a cápsula como característica adicional; com APHE e ≥20 mm sem nenhuma adicional.", "Provavelmente CHC — discussão multidisciplinar, seguimento curto ou biópsia." ] }, { "status": null, "celulas": [ "LR-5", "APHE não em anel + 10–19 mm + washout não periférico; APHE não em anel + 10–19 mm + crescimento limiar; APHE não em anel + 10–19 mm + ≥2 características adicionais; APHE não em anel + ≥20 mm + ≥1 característica adicional. Observação <10 mm nunca é LR-5. Só emitir LR-5 se a observação não preencher LR-M nem LR-TIV. Conferir a tabela diagnóstica do ACR CORE v2018 antes do primeiro uso clínico.", "Definitivamente CHC — dispensa confirmação histológica; encaminhar para tratamento." ] }, { "status": null, "celulas": [ "LR-M", "Malignidade provável ou definitiva, não específica para CHC: aparência em alvo (realce em anel, washout periférico, restrição periférica), crescimento infiltrativo, necrose acentuada.", "Investigar colangiocarcinoma, CHC-CCA e metástase; costuma exigir biópsia. Precede LR-5." ] }, { "status": null, "celulas": [ "LR-TIV", "Tecido de partes moles inequívoco dentro da veia, com ou sem massa parenquimatosa associada.", "Trombo tumoral — muda estadiamento e elegibilidade para transplante/ressecção. Precede LR-5." ] }, { "status": null, "celulas": [ "LR-NC", "Não categorizável por limitação técnica: artefato de movimento, ausência de fase essencial, contraste inadequado.", "Repetir ou complementar o exame; não forçar categoria." ] } ] }, { "id": "tc_abdome.c4", "grupo": "tc_abdome", "nome": "Acute diverticulitis — modified Hinchey on CT", "nota": null, "fonte": "Hinchey et al. 1978 (original); modificação de Wasvary et al. 1999 (inclusão do estágio 0); adaptação para TC de Kaiser AM et al. 2005 · Am J Gastroenterol — The management of complicated diverticulitis and the role of computed tomography", "colunas": [ "Stage", "CT finding", "Usual management" ], "linhas": [ { "status": null, "celulas": [ "0", "Diverticulite clinicamente leve: divertículos com ou sem espessamento da parede colônica, sem coleção nem ar extraluminal.", "Tratamento clínico; antibiótico de forma seletiva." ] }, { "status": null, "celulas": [ "Ia", "Fleimão pericólico com densificação inflamatória da gordura, sem coleção líquida organizada.", "Tratamento clínico." ] }, { "status": null, "celulas": [ "Ib", "Abscesso pericólico CONFINADO, adjacente ao segmento acometido — qualquer diâmetro (o estágio é definido pela topografia, não pelo tamanho).", "Antibiótico se ≤4 cm; drenagem percutânea se >4 cm ou sem resposta clínica." ] }, { "status": null, "celulas": [ "II", "Abscesso PÉLVICO, retroperitoneal ou entre alças, isto é, distante do segmento acometido — qualquer diâmetro.", "Drenagem percutânea guiada por imagem + antibiótico (sobretudo se >4 cm)." ] }, { "status": null, "celulas": [ "III", "Peritonite purulenta generalizada: líquido livre difuso, ar extraluminal distante do segmento acometido, sem contraste entérico extravasando.", "Cirurgia de urgência (lavagem/ressecção)." ] }, { "status": null, "celulas": [ "IV", "Peritonite fecal: perfuração livre com extravasamento de conteúdo entérico.", "Cirurgia de urgência." ] }, { "status": null, "celulas": [ "Nota sobre os 4 cm", "O diâmetro de 4 cm é limiar de CONDUTA (antibiótico × drenagem percutânea), não critério de estadiamento — vale tanto no Ib quanto no II.", "Não usar o tamanho para trocar o estágio; usar para indicar a drenagem." ] }, { "status": null, "celulas": [ "O que descrever sempre", "Segmento e extensão do acometimento; ar extraluminal (localizado × distante); tamanho, topografia e via de acesso percutâneo do abscesso; obstrução associada; fístula e seu trajeto (colovesical, colovaginal, coloentérica).", "É o detalhe que muda a conduta na prática — o número do estágio sozinho não guia o cirurgião." ] } ] }, { "id": "tc_abdome.c5", "grupo": "tc_abdome", "nome": "Acute appendicitis — CT criteria", "nota": null, "fonte": "World J Gastroenterol 2014 · Park et al. — Stratified computed tomography findings improve diagnostic accuracy for appendicitis + Cureus 2023 · Wazzan et al. — Up-to-Date Diagnostic CT Standards for Acute Appendicitis: Wall Thickness and Intraluminal Fluid Thickness", "colunas": [ "Criterion", "CT finding", "Diagnostic weight" ], "linhas": [ { "status": null, "celulas": [ "Contexto dos percentuais", "Os percentuais das linhas abaixo vêm de coortes com TC estratificada/duvidosa, não da apendicite em geral", "Em TC de rotina, densificação da gordura periapendicular é achado frequente na apendicite — os percentuais aqui NÃO devem ser lidos como prevalência geral do sinal." ] }, { "status": null, "celulas": [ "Diâmetro externo", "> 6 mm (corte clássico); 6,75 mm em série dedicada", "6 mm é muito sensível e pouco específico; 6,75 mm rendeu sensibilidade de 87,5% e especificidade de 100%. Nunca usar isolado." ] }, { "status": null, "celulas": [ "Líquido intraluminal", "Espessura da coluna líquida ≥ 2,25 mm", "Sensibilidade 96,4% e especificidade 67% — excelente critério de EXCLUSÃO: apêndice com ar e sem líquido fala contra apendicite." ] }, { "status": null, "celulas": [ "Espessura da parede", "≥ 2–3 mm", "Isolada, não discriminou apendicite de não-apendicite em série de 2014 (78,1% × 67,4%; p = 0,175) — não usar como critério único." ] }, { "status": null, "celulas": [ "Densificação da gordura periapendicular", "Estriamento / borramento adjacente", "Na coorte estratificada de 2014: 34,1% dos casos de apendicite × 8,9% dos controles (p = 0,001). Com apêndice de calibre normal, densificação isolada aponta para diagnóstico alternativo." ] }, { "status": null, "celulas": [ "Ausência de ar intraluminal", "Lúmen sem gás", "Na mesma coorte: 67,6% × 48,9% (p = 0,024) — apoia o diagnóstico em TC duvidosa." ] }, { "status": null, "celulas": [ "Combinação de achados", "≥ 2 dos achados acima", "OR 6,8 (IC 95% 3,0–15,5; p < 0,001) — é a combinação, não o milímetro, que fecha o diagnóstico." ] }, { "status": null, "celulas": [ "Apendicite complicada", "Ar extraluminal, abscesso, fleimão, defeito da parede apendicular, líquido livre espesso, apendicolito extraluminal", "Muda o tratamento (drenagem/cirurgia × antibiótico) e deve ser explicitada na impressão diagnóstica." ] }, { "status": null, "celulas": [ "Diagnósticos alternativos", "Apendagite epiploica, diverticulite direita, ileíte terminal, adenite mesentérica, patologia anexial na mulher", "Apêndice normal identificado e causa alternativa encontrada devem ser afirmados no laudo." ] } ] }, { "id": "tc_abdome.c6", "grupo": "tc_abdome", "nome": "Bowel obstruction — structured CT reading", "nota": null, "fonte": "Radiology 2015 · Paulson EK & Thompson WM — Review of Small-Bowel Obstruction: The Diagnosis and When to Worry + RadioGraphics 2001 · CT Evaluation of Small Bowel Obstruction", "colunas": [ "Item", "CT criterion", "Why it matters" ], "linhas": [ { "status": null, "celulas": [ "Delgado dilatado", "≥ 2,5–3,0 cm, medido de parede externa a parede externa", "Sem dilatação não se firma obstrução de delgado." ] }, { "status": null, "celulas": [ "Cólon e ceco dilatados", "Cólon > 6 cm; ceco > 9 cm (regra prática 3–6–9)", "Define obstrução colônica e o segmento de maior tensão parietal." ] }, { "status": null, "celulas": [ "Ponto de transição", "Alça dilatada proximal cedendo a alça colabada distal, com afilamento ou angulação abrupta", "É o que separa obstrução de íleo adinâmico e localiza o nível — deve constar do laudo." ] }, { "status": null, "celulas": [ "Grau", "Alta/completa: alças distais e cólon vazios. Parcial: passagem de gás ou conteúdo além da transição.", "Obstrução alta tende a exigir intervenção mais precoce." ] }, { "status": null, "celulas": [ "Alça fechada", "Duas transições adjacentes, alça em C ou em U, vasos mesentéricos convergindo para o mesmo ponto, rotação do mesentério", "Alta chance de estrangulamento — sinal de urgência mesmo sem isquemia estabelecida." ] }, { "status": null, "celulas": [ "Sofrimento isquêmico", "Redução ou ausência de realce parietal, espessamento parietal, pneumatose intestinal, gás no sistema porta, ingurgitamento e turvamento do mesentério, líquido livre", "Indica necessidade de cirurgia urgente — deve abrir a impressão diagnóstica." ] }, { "status": null, "celulas": [ "Causa", "Aderência (transição abrupta sem massa nem hérnia), hérnia (parede, interna, incisional), neoplasia, intussuscepção, íleo biliar, corpo estranho, doença inflamatória", "A causa define via de tratamento; aderência é diagnóstico de exclusão por imagem." ] } ] } ] }, { "metodo": "CT", "chave": "tc_msk_coluna", "slug": "tc-msk-coluna", "nome": "CT — Musculoskeletal and Spine", "temPaginaPublica": false, "medidas": [ { "id": "tc_msk_coluna.0", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Quantitative CT (QCT) BMD — lumbar spine", "valor": "> 120", "unidade": "mg/cm³", "nota": "QCT measures volumetric trabecular BMD (mg/cm³) at L1-L2/L3 and uses ABSOLUTE cut-offs — a QCT T-score is not equivalent to DXA and should not be reported under WHO criteria. Requires a calibration phantom (or asynchronous internal calibration).", "fonte": "American College of Radiology — ACR–SPR–SSR Practice Parameter for the Performance of Musculoskeletal QCT (rev. 2018) · ISCD Official Positions · ACR Appropriateness Criteria® Osteoporosis and BMD: 2022 Update (JACR)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "> 120 mg/cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Low bone mass (osteopenia)", "valor": "80-120 mg/cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Osteoporosis", "valor": "< 80 mg/cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.1", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "L1 trabecular attenuation — opportunistic osteoporosis screening at CT", "valor": "> 160", "unidade": "UH (HU)", "nota": "Oval ROI in the anterior trabecular portion of the L1 body on an axial slice, avoiding cortex, basivertebral vein and bone islands. Measure on the NON-contrast series: IV contrast raises attenuation. Tube voltage other than 120 kV (80/100/140) shifts attenuation and invalidates the cut-offs.", "fonte": "Pickhardt et al., Ann Intern Med 2013;158:588-595 (≤ 160 UH 90% sensível; 110 UH > 90% específico; VPP ≥ 68% abaixo de 100 UH; VPN 99% acima de 200 UH) · valores normativos em > 20.000 adultos: Pickhardt et al., Radiology 2019 · efeito do kV: AJR 2017 (Variation in Attenuation in L1 Trabecular Bone at Different Tube Voltages)", "faixas": [ { "status": "green", "rotulo": "Osteoporosis unlikely (90%-sensitive threshold; > 200 HU carries 99% NPV)", "valor": "> 160 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Indeterminate zone — consider DXA/QCT if risk factors present", "valor": "> 110-160 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Probable osteoporosis (> 90% specific; < 100 HU carries PPV ≥ 68%)", "valor": "≤ 110 UH", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Flag in the report when an associated vertebral fracture is present (97% of patients with fracture had L1 ≤ 145 HU)", "valor": "≤ 110 UH + fratura", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.2", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Cervical spinal canal AP (sagittal) diameter (C3-C7)", "valor": "> 13", "unidade": "mm", "nota": "Measure from the posterior vertebral body margin to the spinolaminar line on the mid-sagittal plane. The thresholds come from lateral RADIOGRAPHS (10-20% magnification): the same canal measures less on CT, so applying the raw number over-calls stenosis — state the method. Developmental stenosis (short pedicles) differs from acquired stenosis (osteophytes, OPLL, ligamentum flavum hypertrophy) — describe both. Space available for the cord is the parameter that correlates with symptoms.", "fonte": "Edwards & LaRocca, Spine 1983;8:20-27", "faixas": [ { "status": "green", "rotulo": "No developmental stenosis (> 17 mm: capacious canal)", "valor": "> 13 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Narrow canal — reduced reserve for spondylosis; myelopathy risk with little degeneration", "valor": "10-13 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Absolute stenosis — associated with myelopathy", "valor": "< 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.3", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Torg-Pavlov ratio (canal ÷ vertebral body)", "valor": "≥ 0,80", "unidade": null, "nota": "The ratio cancels radiographic magnification but over-calls stenosis in athletes with large vertebral bodies (the classic false positive in football players). On CT, prefer the absolute diameter and space available for the cord; use the ratio mainly to compare with prior radiographs.", "fonte": "Pavlov et al., Radiology 1987;164:771-775 · corte de 0,70: Aebli et al., Spine J 2013;13:605-612", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "≥ 0,80", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — below 0.80 is Torg's original developmental narrowing cut-off", "valor": "0,70-0,79", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Developmental stenosis — risk of cord injury after minor trauma", "valor": "< 0,70", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.4", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Lumbar spinal canal AP diameter (midline)", "valor": "> 12", "unidade": "mm", "nota": "Measured from the posterior body/disc margin to the base of the spinous process. The thresholds are radiograph/myelogram-derived — CT values tend to be lower. The criterion does not adjust for body size, pedicle length or interlaminar angle — always correlate with dural sac cross-sectional area, which is the more sensitive parameter.", "fonte": "Verbiest, J Bone Joint Surg Br 1954;36:230-237", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "> 12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Relative stenosis (Verbiest) — symptomatic when combined with osteophyte, listhesis or facet hypertrophy", "valor": "> 10-12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Absolute stenosis — neural compression even without other factors", "valor": "≤ 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.5", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Dural sac cross-sectional area (narrowest level)", "valor": "> 100", "unidade": "mm²", "nota": "Trace on the axial plane parallel to the disc, at the narrowest point. Slices oblique to the disc overestimate the area. On CT myelography the area is dynamic: it increases in flexion and decreases in extension.", "fonte": "Schönström, Bolender & Spengler, Spine 1985;10:806-811 · Hamanishi et al., J Spinal Disord 1994;7:388-393", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "> 100 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Relative / moderate stenosis", "valor": "76-100 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Absolute / severe stenosis", "valor": "≤ 75 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.6", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Lumbar lateral recess (height, depth and angle)", "valor": "> 3", "unidade": "mm (altura)", "nota": "Recess height = distance between the most anterior point of the superior articular process and the posterior vertebral body margin, on the axial slice at pedicle level. Recess angle is formed between roof and floor. Classic cause of radicular pain with a normal-caliber central canal — and of failed back surgery.", "fonte": "Ciric et al., J Neurosurg 1980;53:433-443 · Mikhael et al., Radiology 1981;140:97-107", "faixas": [ { "status": "green", "rotulo": "Normal (recess angle ≥ 30°)", "valor": "> 3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Suspicious for lateral recess stenosis", "valor": "> 2-3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Lateral recess stenosis (height ≤ 2 mm, depth ≤ 3 mm or angle < 30°)", "valor": "≤ 2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.7", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Cobb angle on coronal reformat", "valor": "< 10", "unidade": "graus", "nota": "Scoliosis requires a Cobb angle ≥ 10° WITH vertebral rotation. CT is supine and underestimates the curve relative to standing full-spine radiographs — follow-up Cobb angles and surgical decisions belong on upright films. On CT, state the end vertebrae used so measurements are comparable.", "fonte": "Cobb, AAOS Instructional Course Lectures 1948 · definição de escoliose (Cobb ≥ 10°): Scoliosis Research Society (SRS) terminology", "faixas": [ { "status": "green", "rotulo": "Does not meet the definition of scoliosis", "valor": "< 10°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Mild scoliosis", "valor": "10-25°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Moderate to severe scoliosis (surgical discussion typically from ~45-50° in AIS)", "valor": "> 25°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.8", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Atlantodental interval (ADI) in adults — CT", "valor": "< 2", "unidade": "mm", "nota": "On CT the adult 95th percentile is ~2 mm, tighter than the 3 mm inherited from radiography — do not carry the radiographic threshold to CT. In children the interval is physiologically larger; use pediatric-specific values and the condyle-C1 interval.", "fonte": "Rojas et al., AJNR Am J Neuroradiol 2007;28:1819-1823 (95% da população com ADI < 2 mm na TC) · pediátrico: AJR 2009 (Evaluation of the Pediatric Craniocervical Junction on MDCT)", "faixas": [ { "status": "green", "rotulo": "Normal on CT (95th percentile)", "valor": "< 2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — 3 mm was the accepted radiographic limit", "valor": "2-3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Atlantoaxial instability (consider trauma, rheumatoid arthritis, Down and Morquio syndromes)", "valor": "> 3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.9", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Basion-dens interval (BDI) on CT", "valor": "< 8,5", "unidade": "mm", "nota": "Harris' 12 mm rule (BDI and BAI) was derived from radiographs; on CT the 95th percentile BDI falls to ~8.5 mm. A BDI that is 'normal by radiographic standards' may already be abnormal on CT. In children the condyle-C1 interval is more reliable than BDI.", "fonte": "Rojas et al., AJNR 2007;28:1819-1823 (95% da população com BDI < 8,5 mm na TC) · regra dos 12: Harris et al., AJR Am J Roentgenol 1994", "faixas": [ { "status": "green", "rotulo": "Normal on CT (95th percentile)", "valor": "< 8,5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline by CT standards, still within the radiographic 'rule of 12'", "valor": "8,5-12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Atlanto-occipital dissociation — emergency", "valor": "> 12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.10", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Structural sacroiliitis on CT — data-driven definition (disease criterion, not a normal value)", "valor": "Erosões em mais de uma região das porções média e/ou dorsal, e/ou anquilose (parcial ou completa)", "unidade": null, "nota": "Best-performing definition: 67.6% sensitivity, 96.3% specificity (LR+ 18.3; LR− 0.34). Critical points: (1) do NOT count isolated sclerosis — the authors conclude sclerosis is not useful on CT and should no longer define structural damage; (2) do NOT count VENTRAL-third erosions — common in non-diseased subjects from biomechanical loading; (3) a single eroded region is insufficient. CT is the reference standard for cortical erosion, outperforming radiography.", "fonte": "RMD Open 2022 — 'What amount of structural damage defines sacroiliitis: a CT study' (PMID 35064092) · contexto: ASAS/OMERACT MRI working group, definições de lesões estruturais", "faixas": [] }, { "id": "tc_msk_coluna.11", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Acetabular roof arc angle and CT subchondral arc", "valor": "≥ 45", "unidade": "graus", "nota": "Matta's rule: 45° applies to ALL THREE arcs — medial (AP), anterior (obturator oblique) and posterior (iliac oblique). The CT equivalent is the subchondral arc: the superior 10 mm of the acetabular articular surface; involvement of those slices corresponds to a roof arc < 45°. The alternative 25° (anterior) and 70° (posterior) cut-offs come from the Vrahas et al. biomechanical study (JBJS Am 1999) and are NOT Matta's rule — state which criterion was used. The rule does not apply to both-column or posterior wall fractures.", "fonte": "Matta et al., Clin Orthop Relat Res 1986 · arco subcondral na TC: Olson & Matta, J Orthop Trauma 1993 · cortes biomecânicos anterior 25° / posterior 70°: Vrahas et al., J Bone Joint Surg Am 1999;81:966-974", "faixas": [ { "status": "green", "rotulo": "Fracture line spares the weight-bearing dome on all three views (AP, obturator and iliac oblique)", "valor": "≥ 45°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Fracture line crosses the weight-bearing dome — potentially unstable, consider fixation", "valor": "< 45° em qualquer incidência", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.12", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Tibial plateau articular depression", "valor": "≤ 2", "unidade": "mm", "nota": "There is no single consecrated threshold: Schatzker's original 1979 paper defines MORPHOLOGY (types I-VI), not a millimetre cut-off. Contemporary surgical series use ≥ 4 mm (posterolateral approaches / Gerdy tubercle osteotomy) and > 10 mm (subchondral raft), and a post-operative step-off ≥ 2.5 mm is associated with worse WOMAC. Measure on coronal AND sagittal reformats (posterolateral depression is missed on coronal alone). Also report plateau widening and articular step-off. Experimental osteoarthritis develops once the step-off exceeds articular cartilage thickness.", "fonte": "Schatzker, McBroom & Bruce, Clin Orthop Relat Res 1979;138:94-104 (classificação morfológica; não define limiar em mm) · Markhardt et al., RadioGraphics 2009;29:585-597 · limiares milimétricos: séries cirúrgicas contemporâneas (depressão ≥ 4 mm e > 10 mm; degrau ≥ 2,5 mm com pior WOMAC)", "faixas": [ { "status": "green", "rotulo": "Depression without stand-alone surgical indication in most adults", "valor": "≤ 2 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Decision zone — step-off ≥ 2.5 mm is associated with worse functional scores; young/athletic patients tolerate less", "valor": "> 2-4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Significant depression in most surgical series (≥ 4 mm; > 10 mm in subchondral raft/graft series)", "valor": "> 4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.13", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Alpha angle (femoral head-neck junction) — cam morphology", "valor": "< 55", "unidade": "graus", "nota": "Nötzli's original work is MRI-based and proposed no formal cut-off: mean 42° in controls versus 74° in symptomatic hips (p < 0.001); the 50-55° thresholds used in practice derive from that, with 60° as the more specific cut-off. Measure on radial reformats oblique to the neck (the peak is usually anterosuperior, 1-2 o'clock). Isolated cam morphology is common in asymptomatic subjects — the Warwick Agreement requires the triad of symptoms + signs + imaging to diagnose FAI syndrome.", "fonte": "Nötzli et al., J Bone Joint Surg Br 2002;84:556-560 · Warwick Agreement on femoroacetabular impingement syndrome, Br J Sports Med 2016 (Griffin et al.)", "faixas": [ { "status": "green", "rotulo": "No cam morphology", "valor": "< 55°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — meaningful only with symptoms and clinical signs", "valor": "55-60°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Cam morphology (more specific cut-off used in recent series)", "valor": "> 60°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.14", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Femoral anteversion (torsion) on CT", "valor": "8-14", "unidade": "graus (média do adulto)", "nota": "CT series report an adult mean around 8° in men and 14° in women, with a wide normal range. Values fall with growth: ~31° at birth, ~26° at 5 years, ~21° at 9 years, ~15° at 16 years — do not call an age-appropriate value excessive. Femoral internal torsion > 25° is the proposed threshold for axial correction in patellofemoral instability. The number depends on technique: proximal-neck methods (Murphy) yield higher values than distal-neck methods, mean difference ~6° — state the method in the report.", "fonte": "valores por idade: Fabry, MacEwen & Shands, J Bone Joint Surg Am 1973 · método por TC: Murphy et al., J Bone Joint Surg Am 1987;69:1169-1176 · comparação de métodos: J Comput Assist Tomogr 1998 (PMID 9676454) · limiar > 25°: Journal of ISAKOS 2024", "faixas": [] }, { "id": "tc_msk_coluna.15", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "External tibial torsion on CT", "valor": "≈ 30-35", "unidade": "graus", "nota": "CT series report a mean of 30-35° of external torsion, with wide dispersion. Most authors use > 30° as the cut-off for rotational osteotomy in anterior knee pain / refractory patellofemoral instability. The value shifts with the distal reference (bony transmalleolar axis vs. posterior bicondylar talar axis) — standardize and state it. Increased external torsion is mainly an infratuberositary deformity and does NOT imply a lateralized tibial tubercle.", "fonte": "Journal of ISAKOS 2024 (limiares: torção interna femoral > 25° e/ou torção externa tibial > 30° por TC) · Knee Surg Sports Traumatol Arthrosc 2021 (torção externa aumentada como deformidade infratuberositária)", "faixas": [] }, { "id": "tc_msk_coluna.16", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "TT-TG (tibial tuberosity to trochlear groove) distance on CT", "valor": "< 15", "unidade": "mm", "nota": "Superimpose the axial slice at the trochlear groove (proximal, full cartilage) on the tibial tubercle slice and measure between perpendiculars to the posterior bicondylar axis. Knee extended, quadriceps relaxed — flexion reduces TT-TG. Only 3.4% of controls exceed 20 mm versus 56% of objectively unstable knees.", "fonte": "Dejour et al., Knee Surg Sports Traumatol Arthrosc 1994;2:19-26", "faixas": [ { "status": "green", "rotulo": "Normal (Dejour controls: 12.7 ± 3.4 mm)", "valor": "< 15 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — meaningful only with trochlear dysplasia, patella alta and clinical instability", "valor": "15 a < 20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Pathological (Dejour unstable group: 19.8 ± 1.6 mm) — consider tubercle medialization", "valor": "≥ 20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.17", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "TT-TG — CT versus MRI (not interchangeable)", "valor": "RM ≈ 2,2 mm menor que a TC (3,8 mm no subgrupo cirúrgico)", "unidade": "mm", "nota": "In the same cohort, mean TT-TG was 16.9 mm on CT versus 14.7 mm on MRI; within the subgroup with CT TT-TG ≥ 20 mm (osteotomy candidates) the gap rises to 3.80 mm (p < .001), 22.5 mm on CT versus 18.7 mm on MRI. Practical consequence: applying the CT 20 mm threshold to an MRI value under-calls surgical candidates. Always state the modality.", "fonte": "Camp et al., Am J Sports Med 2013;41:1835-1840 (PMID 23857884)", "faixas": [] }, { "id": "tc_msk_coluna.18", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Trochlear sulcus angle", "valor": "< 145", "unidade": "graus", "nota": "Measure on the most cranial axial slice where the trochlea is still complete; more distal slices give falsely lower angles. The 145° cut-off is the one in common use; a strict statistical rule (mean + 2 SD) would place the limit near 150°, so 145-150° values require correlation with the other criteria. Trochlear depth < 3 mm is an additional dysplasia criterion. CT depicts bone only — the bony angle may overstate dysplasia compared with MRI.", "fonte": "Merchant et al., J Bone Joint Surg Am 1974;56:1391-1396 · profundidade troclear < 3 mm: Pfirrmann et al., Radiology 2000;216:858-864", "faixas": [ { "status": "green", "rotulo": "Normal trochlea (mean 138° ± 6°)", "valor": "< 145°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Trochlear dysplasia (shallow/flat trochlea) — risk factor for patellar dislocation", "valor": "≥ 145°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.19", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Lateral patellofemoral angle (Laurin) and patellar tilt", "valor": "Aberto lateralmente", "unidade": null, "nota": "QUALITATIVE criterion: drawn between the lateral patellar facet and the line joining the anterior trochlear margins; it opens laterally in the normal knee and becomes parallel or opens medially with tilt. Do not report a numeric degree range for this angle — the original paper defines none. Merchant's congruence angle (mean ≈ −6°, upper limit of normal near +16°) is complementary. Note: Laurin and Merchant are axial RADIOGRAPHIC measurements with the knee flexed; CT is acquired in extension with a relaxed quadriceps, and tilt may be underestimated relative to dynamic CT with contraction — state the method.", "fonte": "Laurin et al., J Bone Joint Surg Am 1978;60:55-60 · ângulo de congruência: Merchant et al., J Bone Joint Surg Am 1974", "faixas": [ { "status": "green", "rotulo": "Normal — angle opens laterally (the pattern in ~97% of normal knees)", "valor": "aberto lateralmente", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Parallel lines — borderline lateral tilt", "valor": "≈ 0°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Angle opening medially — lateral patellar tilt/subluxation", "valor": "aberto medialmente", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_msk_coluna.20", "grupo": "tc_msk_coluna", "ruleId": null, "rotulo": "Patellar height — Insall-Salvati index on sagittal reformat", "valor": "0,8-1,2", "unidade": null, "nota": "Ratio of patellar tendon length to greatest patellar length. Its advantage: it is a ratio between two fixed structures, described as independent of knee flexion angle (~20-70°) and of weight-bearing — it can be measured on supine, extended-knee CT without correction. It is Caton-Deschamps and Blackburne-Peel, which reference the tibial plateau, that vary with flexion and loading: for those, prefer a 30° lateral radiograph. Measure on a strict sagittal reformat in the plane of the tendon.", "fonte": "Insall & Salvati, Radiology 1971;101:101-104", "faixas": [ { "status": "green", "rotulo": "Normal patellar height", "valor": "0,8-1,2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Patella alta — risk factor for patellofemoral instability", "valor": "> 1,2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Patella baja — post-surgical, post-traumatic or arthrofibrosis", "valor": "< 0,8", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "tc_msk_coluna.c0", "grupo": "tc_msk_coluna", "nome": "Meyerding grading of spondylolisthesis", "nota": null, "fonte": "Meyerding, Surg Gynecol Obstet 1932 · revisão: 'Classification in Brief: The Meyerding Classification System of Spondylolisthesis', Clin Orthop Relat Res 2020 (PMID 32282463)", "colunas": [ "Grade", "Slip", "Clinical reading" ], "linhas": [ { "status": null, "celulas": [ "I", "0-25%", "Baixo grau — habitualmente conduta conservadora" ] }, { "status": null, "celulas": [ "II", "25-50%", "Baixo grau" ] }, { "status": null, "celulas": [ "III", "50-75%", "Alto grau — avaliar instabilidade e indicação cirúrgica" ] }, { "status": null, "celulas": [ "IV", "75-100%", "Alto grau" ] }, { "status": null, "celulas": [ "V", "> 100% (espondiloptose)", "Deslocamento completo do corpo vertebral" ] } ] }, { "id": "tc_msk_coluna.c1", "grupo": "tc_msk_coluna", "nome": "Genant semiquantitative vertebral fracture grading", "nota": null, "fonte": "Genant et al., J Bone Miner Res 1993;8:1137-1148 · aplicação em reformatação sagital de TC: International Osteoporosis Foundation, vertebral fracture assessment", "colunas": [ "Grade", "Height reduction", "Deformity" ], "linhas": [ { "status": null, "celulas": [ "0 — normal", "< 20%", "Sem deformidade" ] }, { "status": null, "celulas": [ "1 — leve", "≈ 20-25%", "Cunha, bicôncava ou compressão (esmagamento)" ] }, { "status": null, "celulas": [ "2 — moderada", "≈ 25-40%", "Cunha, bicôncava ou compressão" ] }, { "status": null, "celulas": [ "3 — grave", "≥ 40%", "Cunha, bicôncava ou compressão" ] } ] }, { "id": "tc_msk_coluna.c2", "grupo": "tc_msk_coluna", "nome": "TT-TG — reference ranges and CT/MRI equivalence", "nota": null, "fonte": "Dejour et al., Knee Surg Sports Traumatol Arthrosc 1994;2:19-26 · Camp et al., Am J Sports Med 2013;41:1835-1840", "colunas": [ "Range", "TT-TG on CT", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "Normal", "< 15 mm", "Alinhamento do aparelho extensor dentro do esperado (controles: 12,7 ± 3,4 mm)" ] }, { "status": null, "celulas": [ "Limítrofe", "15 a < 20 mm", "Só valorizar com displasia troclear, patela alta e instabilidade objetiva" ] }, { "status": null, "celulas": [ "Patológico", "≥ 20 mm", "Lateralização significativa (instáveis: 19,8 ± 1,6 mm) — considerar medialização da tuberosidade" ] }, { "status": null, "celulas": [ "Medido por RM", "≈ 2,2 mm menor que a TC (3,8 mm nos casos ≥ 20 mm)", "Não aplicar o corte de 20 mm da TC a medidas de RM" ] } ] }, { "id": "tc_msk_coluna.c3", "grupo": "tc_msk_coluna", "nome": "Letournel-Judet acetabular fracture classification", "nota": null, "fonte": "Judet, Judet & Letournel, J Bone Joint Surg Am 1964 · Letournel & Judet, Fractures of the Acetabulum, 2ª ed., 1993 · aplicação em TC/3D: Scheinfeld et al., RadioGraphics 2015 ('Acetabular Fractures: What Radiologists Should Know and How 3D CT Can Aid Classification')", "colunas": [ "Group", "Pattern", "CT key" ], "linhas": [ { "status": null, "celulas": [ "Elementar", "Parede posterior", "Fragmento posterior com quadrilátero e linhas íntegras; pesquisar luxação e fragmentos intra-articulares. Padrão elementar mais frequente" ] }, { "status": null, "celulas": [ "Elementar", "Parede anterior", "Fragmento anterior com coluna anterior íntegra" ] }, { "status": null, "celulas": [ "Elementar", "Coluna posterior", "Interrupção da linha ilioisquiática e do forame obturatório" ] }, { "status": null, "celulas": [ "Elementar", "Coluna anterior", "Interrupção da linha ileopectínea" ] }, { "status": null, "celulas": [ "Elementar", "Transversa", "Traço único separando ílio (segmento superior) do segmento inferior; ambas as linhas rompidas — única elementar que atravessa as duas colunas" ] }, { "status": null, "celulas": [ "Associada", "Ambas as colunas (both-column)", "Padrão associado MAIS frequente (~23% na série de Letournel). Nenhum fragmento articular permanece conectado ao esqueleto axial; sinal do esporão na incidência obturatriz" ] }, { "status": null, "celulas": [ "Associada", "Transversa + parede posterior", "Segundo padrão associado mais frequente (~20%)" ] }, { "status": null, "celulas": [ "Associada", "Em T", "Transversa com traço vertical adicional no quadrilátero/obturatório" ] }, { "status": null, "celulas": [ "Associada", "Coluna posterior + parede posterior", "" ] }, { "status": null, "celulas": [ "Associada", "Coluna anterior (ou parede anterior) + hemitransversa posterior", "" ] } ] }, { "id": "tc_msk_coluna.c4", "grupo": "tc_msk_coluna", "nome": "Schatzker tibial plateau fracture classification", "nota": null, "fonte": "Schatzker, McBroom & Bruce, Clin Orthop Relat Res 1979;138:94-104 (classificação morfológica; não define limiar milimétrico de depressão) · avaliação por TC/RM: Markhardt et al., RadioGraphics 2009;29:585-597 · revisão: Injury 2018 ('Revisiting the Schatzker classification')", "colunas": [ "Type", "Morphology", "CT note" ], "linhas": [ { "status": null, "celulas": [ "I", "Cisalhamento (split) do planalto lateral, sem afundamento", "Osso jovem; pesquisar lesão meniscal lateral" ] }, { "status": null, "celulas": [ "II", "Split do planalto lateral com afundamento", "Quantificar o afundamento nas reformatações coronal e sagital" ] }, { "status": null, "celulas": [ "III", "Afundamento puro — lateral (IIIA) ou central (IIIB)", "Frequentemente só caracterizado na TC" ] }, { "status": null, "celulas": [ "IV", "Fratura do planalto medial", "Alta energia — pesquisar luxação do joelho e lesão neurovascular" ] }, { "status": null, "celulas": [ "V", "Bicondilar com continuidade entre epífise e diáfise", "" ] }, { "status": null, "celulas": [ "VI", "Bicondilar com dissociação metafisodiafisária", "Maior risco de síndrome compartimental e de lesão de partes moles" ] } ] }, { "id": "tc_msk_coluna.c5", "grupo": "tc_msk_coluna", "nome": "AO Spine thoracolumbar injury classification (+ TL AOSIS)", "nota": null, "fonte": "Vaccaro et al., Spine 2013;38:2028-2037 (AOSpine Thoracolumbar Spine Injury Classification System) · algoritmo cirúrgico e TL AOSIS: Vaccaro/Kepler et al., Eur Spine J 2016 · revisão: 'Classifications in Brief: AO Thoracolumbar Classification System', Clin Orthop Relat Res 2020", "colunas": [ "Element", "Category", "Description" ], "linhas": [ { "status": null, "celulas": [ "Morfologia", "A0", "Sem fratura ou fratura de processo transverso/espinhoso" ] }, { "status": null, "celulas": [ "Morfologia", "A1", "Impactação em cunha de um platô, sem envolvimento da parede posterior" ] }, { "status": null, "celulas": [ "Morfologia", "A2", "Split (pinça) envolvendo ambos os platôs, sem parede posterior" ] }, { "status": null, "celulas": [ "Morfologia", "A3", "Burst incompleta — um platô com envolvimento da parede posterior" ] }, { "status": null, "celulas": [ "Morfologia", "A4", "Burst completa — ambos os platôs com envolvimento da parede posterior" ] }, { "status": null, "celulas": [ "Morfologia", "B1", "Falha óssea transóssea da banda de tensão posterior (fratura de Chance)" ] }, { "status": null, "celulas": [ "Morfologia", "B2", "Falha da banda de tensão posterior (óssea e/ou ligamentar), em geral com lesão tipo A associada" ] }, { "status": null, "celulas": [ "Morfologia", "B3", "Hiperextensão — falha da banda de tensão anterior" ] }, { "status": null, "celulas": [ "Morfologia", "C", "Translação/deslocamento em qualquer plano (lesão mais grave da escala)" ] }, { "status": null, "celulas": [ "Estado neurológico", "N0 a N4, NX", "N0 intacto · N1 déficit transitório · N2 radiculopatia · N3 lesão incompleta ou cauda equina · N4 lesão completa · NX não avaliável" ] }, { "status": null, "celulas": [ "Modificadores", "M1 / M2", "M1 lesão indeterminada da banda de tensão posterior (tipicamente pela RM) · M2 comorbidade específica do paciente (ex.: espondilite anquilosante, DISH, queimadura)" ] } ] }, { "id": "tc_msk_coluna.c6", "grupo": "tc_msk_coluna", "nome": "Structural sacroiliitis — modified New York grading and CT definition", "nota": null, "fonte": "van der Linden, Valkenburg & Cats, Arthritis Rheum 1984;27:361-368 (critérios de Nova York modificados) · definição estrutural por TC: RMD Open 2022, 'What amount of structural damage defines sacroiliitis: a CT study' (PMID 35064092) · contexto de lesões estruturais: ASAS/OMERACT MRI working group", "colunas": [ "Grade / criterion", "Finding", "CT application" ], "linhas": [ { "status": null, "celulas": [ "0", "Normal", "—" ] }, { "status": null, "celulas": [ "1", "Alterações suspeitas", "Não caracteriza sacroiliíte" ] }, { "status": null, "celulas": [ "2", "Anormalidade mínima — pequenas áreas de erosão ou esclerose, sem alteração da largura articular", "Contar apenas erosões das porções média e dorsal" ] }, { "status": null, "celulas": [ "3", "Anormalidade inequívoca — erosões, esclerose, alargamento, estreitamento ou anquilose parcial", "TC é o padrão de referência para erosão cortical" ] }, { "status": null, "celulas": [ "4", "Anquilose total", "Anquilose parcial ou completa, uni ou bilateral, é critério positivo" ] }, { "status": null, "celulas": [ "Critério mNY (radiográfico)", "Grau ≥ 2 bilateral OU grau ≥ 3 unilateral", "Define sacroiliíte estrutural para classificação de espondiloartrite axial" ] }, { "status": null, "celulas": [ "Definição por TC (data-driven)", "Erosões em mais de uma região das porções média e/ou dorsal, e/ou anquilose", "Sensibilidade 67,6% · especificidade 96,3% (RV+ 18,3 · RV− 0,34). Excluir esclerose isolada e erosões do terço ventral" ] } ] } ] }, { "metodo": "CT", "chave": "tc_protocolo", "slug": "tc-protocolo", "nome": "CT — Technique, dose and contrast", "temPaginaPublica": false, "medidas": [ { "id": "tc_protocolo.0", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "k factor — adult head (DLP → effective dose)", "valor": "0,0021", "unidade": "mSv/(mGy·cm)", "nota": "Assumes the 16 cm head dosimetry phantom. Use 0.0031 for head-and-neck and 0.0059 for neck alone; paediatric values are far higher (0.011 in the newborn).", "fonte": "AAPM Report No. 96 (2008), Tabela 3 — AAPM Task Group 23: CT Dosimetry", "faixas": [] }, { "id": "tc_protocolo.1", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "k factor — adult chest", "valor": "0,014", "unidade": "mSv/(mGy·cm)", "nota": "32 cm body phantom. Same factor the AAPM uses to estimate effective dose in lung cancer screening CT.", "fonte": "AAPM Report No. 96 (2008), Tabela 3 — AAPM Task Group 23: CT Dosimetry", "faixas": [] }, { "id": "tc_protocolo.2", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "k factor — adult abdomen and pelvis", "valor": "0,015", "unidade": "mSv/(mGy·cm)", "nota": "Same value for trunk (0.015). In the newborn it is 0.049, more than threefold higher — never apply the adult k to a child.", "fonte": "AAPM Report No. 96 (2008), Tabela 3 — AAPM Task Group 23: CT Dosimetry", "faixas": [] }, { "id": "tc_protocolo.3", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Head k factor recomputed with ICRP 103 tissue weighting factors", "valor": "2,4", "unidade": "µSv/(mGy·cm)", "nota": "With ICRP 103 weights, head effective dose rises ~11% and chest ~20% versus ICRP 60, while pelvis falls ~25% (neck and abdomen show no marked change); body examinations fall between 14 and 20 µSv/(mGy·cm). Always state which weighting set was used.", "fonte": "Huda W, Magill D, He W. Med Phys 2011;38(3):1261–1265", "faixas": [] }, { "id": "tc_protocolo.4", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Maximum CTDIvol for lung cancer screening CT", "valor": "≤ 3,0", "unidade": "mGy", "nota": "Measured on the 32 cm phantom for a standard-size patient (170 cm, 70 kg, BMI ≈ 24). Some form of patient-size output adjustment (AEC and/or automatic kV) is mandatory.", "fonte": "AAPM CT Protocols — Lung Cancer Screening CT, v6.0 (09/11/2023)", "faixas": [ { "status": "green", "rotulo": "Within requirement", "valor": "≤ 3,0 mGy", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above requirement — review protocol", "valor": "> 3,0 mGy", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.5", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Maximum DLP for lung cancer screening CT", "valor": "≤ 75", "unidade": "mGy·cm", "nota": "For an idealized standard-size patient and 25 cm scan length. Multiplied by the chest k (0.014) it corresponds to an effective dose ≤ 1.0 mSv — a population metric, not to be reported for an individual.", "fonte": "AAPM CT Protocols — Lung Cancer Screening CT, v6.0 (09/11/2023)", "faixas": [ { "status": "green", "rotulo": "Within requirement", "valor": "≤ 75 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above requirement", "valor": "> 75 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.6", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "NDRL — head CT for acute stroke, CTDIvol", "valor": "47", "unidade": "mGy", "nota": "An NDRL is a protocol audit trigger derived from the 75th percentile of the national distribution, not a limit for an individual patient. Compare your department's median, not a single examination.", "fonte": "UKHSA — National Diagnostic Reference Levels (NDRLs), TC de adulto, GOV.UK (página atualizada em 11/12/2025; valores de TC adotados em 2022)", "faixas": [ { "status": "green", "rotulo": "Local median within the NDRL", "valor": "≤ 47 mGy", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Local median above the NDRL — investigate", "valor": "> 47 mGy", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.7", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "NDRL — head CT for acute stroke, DLP", "valor": "790", "unidade": "mGy·cm", "nota": "Value for the complete examination, summing all sequences. Multiphase stroke protocols (perfusion and angiography) add to the total DLP and need their own reference level.", "fonte": "UKHSA — National Diagnostic Reference Levels (NDRLs), TC de adulto, GOV.UK (página atualizada em 11/12/2025; valores de TC adotados em 2022)", "faixas": [ { "status": "green", "rotulo": "Within the NDRL", "valor": "≤ 790 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the NDRL", "valor": "> 790 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.8", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "NDRL — chest CT (lung cancer), DLP", "valor": "290", "unidade": "mGy·cm", "nota": "Corresponding CTDIvol is 8.5 mGy. High-resolution chest CT for interstitial lung disease has its own NDRL: 8 mGy and 300 mGy·cm.", "fonte": "UKHSA — National Diagnostic Reference Levels (NDRLs), TC de adulto, GOV.UK (página atualizada em 11/12/2025; valores de TC adotados em 2022)", "faixas": [ { "status": "green", "rotulo": "Within the NDRL", "valor": "≤ 290 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the NDRL", "valor": "> 290 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.9", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "NDRL — CT pulmonary angiography (PE), DLP", "valor": "310", "unidade": "mGy·cm", "nota": "Corresponding CTDIvol is 9.1 mGy. Additional phases (e.g. lower-limb venography) are not covered by this level.", "fonte": "UKHSA — National Diagnostic Reference Levels (NDRLs), TC de adulto, GOV.UK (página atualizada em 11/12/2025; valores de TC adotados em 2022)", "faixas": [ { "status": "green", "rotulo": "Within the NDRL", "valor": "≤ 310 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the NDRL", "valor": "> 310 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.10", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "NDRL — abdomen and pelvis CT (abscess), DLP", "valor": "530", "unidade": "mGy·cm", "nota": "Corresponding CTDIvol is 10 mGy. The stone (KUB) protocol is much lower — 6.3 mGy and 290 mGy·cm — so do not use a full abdominal protocol for renal colic.", "fonte": "UKHSA — National Diagnostic Reference Levels (NDRLs), TC de adulto, GOV.UK (página atualizada em 11/12/2025; valores de TC adotados em 2022)", "faixas": [ { "status": "green", "rotulo": "Within the NDRL", "valor": "≤ 530 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the NDRL", "valor": "> 530 mGy·cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.11", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "US DRL — chest CT, CTDIvol (water-equivalent diameter 26–30 cm)", "valor": "9", "unidade": "mGy", "nota": "75th percentile (DRL); the median (achievable dose) in the same band is 6 mGy, with DLP 231 mGy·cm (P50) and 310 mGy·cm (P75). Unlike the European model, the ACR registry stratifies by size: above 30 cm the P75 rises to 12 mGy. Table values not re-verified line by line in this audit (full text not open access).", "fonte": "Kanal KM, Butler PF, Sengupta D et al. Radiology 2017;284(1):120–133 (ACR Dose Index Registry)", "faixas": [] }, { "id": "tc_protocolo.12", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "European paediatric DRL — head CT over 6 years, DLP", "valor": "650", "unidade": "mGy·cm", "nota": "Corresponding CTDIvol 50 mGy. By age: 0–3 months 24 mGy / 300 mGy·cm; 3 months–1 year 28 / 385; 1–6 years 40 / 505. Paediatric body DRLs are defined by weight band, not by age. Values not re-verified in this audit (document unavailable at query time).", "fonte": "European Commission, Radiation Protection No. 185 — European Guidelines on DRLs for Paediatric Imaging (2018)", "faixas": [] }, { "id": "tc_protocolo.13", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Iodine load per examination — renal mass protocol", "valor": "35–52,5", "unidade": "g de iodo", "nota": "Equivalent to 100–150 mL of a 350 mgI/mL agent. Use low-osmolar or iso-osmolar contrast. Weight-based dosing is an accepted alternative. SAR document not retrieved in this audit — re-check against the institutional protocol.", "fonte": "Society of Abdominal Radiology, DFP on Renal Cell Carcinoma — CT renal mass protocols v1.0", "faixas": [] }, { "id": "tc_protocolo.14", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Iodinated contrast injection rate", "valor": "2–5", "unidade": "mL/s", "nota": "Range from the renal mass protocol. Higher rates favour arterial phases; lower rates suit small peripheral access. Always record route, site, agent, volume and rate.", "fonte": "Society of Abdominal Radiology, DFP on Renal Cell Carcinoma — CT renal mass protocols v1.0", "faixas": [] }, { "id": "tc_protocolo.15", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Weight-adjusted iodine dose (hepatic and aortic enhancement)", "valor": "518", "unidade": "mgI/kg", "nota": "Delivered over a fixed 25 s injection in a multiphase protocol for hypervascular HCC. Moderate-concentration contrast (300 mgI/mL) injected rapidly outperformed high concentration at the same iodine load for hypervascular HCC detection.", "fonte": "Awai K, Inoue M, Yagyu Y et al. Radiology 2004 — Moderate versus high concentration of contrast material at multi-detector row CT", "faixas": [] }, { "id": "tc_protocolo.16", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Weight-based volume in portal venous phase with fixed injection duration", "valor": "1,22", "unidade": "mL/kg (iohexol 350)", "nota": "With a fixed 35 s duration, mean hepatic enhancement was 54.8 ± 11 HU versus 50.0 ± 12 HU with a fixed 3 mL/s rate (p = 0.001). Inter-patient variability did not differ between protocols.", "fonte": "Costa AF, Peet K. Abdom Radiol (NY) 2021", "faixas": [] }, { "id": "tc_protocolo.17", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "eGFR — CA-AKI risk threshold for intravenous contrast", "valor": "< 30", "unidade": "mL/min/1,73 m²", "nota": "Same threshold applies to intra-arterial injection with second-pass renal exposure. Use 2009 CKD-EPI in adults and revised Schwartz in children. Obtain eGFR within 7 days in acute or inpatient settings and within 3 months otherwise. ESUR adopted the term CA-AKI (formerly PC-AKI) in 2025, aligning with the 2020 ACR/NKF consensus.", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025 (limiares) · Davenport MS et al., Kidney Med 2020;2(1):85–93 (risco por faixa)", "faixas": [ { "status": "green", "rotulo": "No increased risk for IV contrast", "valor": "≥ 45", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Caution zone — optional prophylaxis in high-risk cases", "valor": "30–44", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "At risk — preventive hydration and risk-benefit weighing", "valor": "< 30", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.18", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "eGFR — threshold for intra-arterial injection with first-pass renal exposure", "valor": "< 45", "unidade": "mL/min/1,73 m²", "nota": "First-pass means contrast reaching the renal arteries essentially undiluted (left heart, thoracic and suprarenal aorta, renal arteries). The same threshold applies to ICU patients. If eGFR cannot be obtained in an emergency, follow the protocol for the corresponding threshold.", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025", "faixas": [] }, { "id": "tc_protocolo.19", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Preventive hydration with 0.9% saline", "valor": "1", "unidade": "mL/kg/h", "nota": "For 3–4 h before and 4–6 h after contrast (IV and second-pass intra-arterial). Alternative: 1.4% sodium bicarbonate (154 mmol/L) at 3 mL/kg/h for 1 h before — saline and bicarbonate have similar efficacy. For first-pass intra-arterial injection the bicarbonate regimen adds 1 mL/kg/h for 4–6 h afterwards. Oral hydration alone is not recommended. Individualise in NYHA 3–4 heart failure and eGFR < 15.", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025", "faixas": [] }, { "id": "tc_protocolo.20", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Contrast volume / eGFR ratio (first-pass intra-arterial injection)", "valor": "< 3,0", "unidade": "mL por mL/min/1,73 m² (contraste a 350 mgI/mL)", "nota": "Equivalent criterion: iodine mass (g) divided by absolute eGFR (mL/min) below 1.1. Intended to cap dose in catheter-based arterial procedures, not in routine IV CT.", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025", "faixas": [ { "status": "green", "rotulo": "Within the recommended cap", "valor": "< 3,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the cap — reduce volume", "valor": "≥ 3,0", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.21", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "CA-AKI definition (contrast-associated acute kidney injury)", "valor": "> 0,3 mg/dL ou > 1,5× o basal", "unidade": "creatinina sérica, em 48–72 h", "nota": "Equivalent to a rise > 26.5 µmol/L. In at-risk patients measure eGFR 48 h after contrast; if CA-AKI occurs, follow clinically for at least 30 days with serial eGFR. No pharmacological prophylaxis has shown consistent protection. ESUR retired the term PC-AKI in 2025 in favour of CA-AKI.", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025 · consenso ACR/NKF 2020", "faixas": [ { "status": "green", "rotulo": "No CA-AKI", "valor": "Δ ≤ 0,3 mg/dL e < 1,5× o basal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "CA-AKI", "valor": "Δ > 0,3 mg/dL ou ≥ 1,5× o basal em 48–72 h", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "tc_protocolo.22", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Intramuscular adrenaline for contrast anaphylaxis (adult)", "valor": "0,5", "unidade": "mg IM (0,5 mL de 1:1.000), repetível", "nota": "Single adult dose for any anaphylaxis: shock, stridor, laryngeal oedema with hypoxia, and deteriorating bronchospasm — ESUR 2025 does NOT retain a 0.1–0.3 mg tier. Give in the lateral upper thigh, repeat as needed guided by heart rate, with O2 10–15 L/min via non-rebreathing mask and a repeatable 500 mL crystalloid IV bolus over 10 min. The guideline's injectable H1-antihistamine is chlorphenamine 20 mg or clemastine 2 mg IV. Bradycardia with hypotension is vasovagal: atropine and fluids, not adrenaline. Observation: ≥30 min if mild, 4–6 h if greater but non-life-threatening, admission if life-threatening. Paediatric dosing: follow the guideline's paediatric chapter.", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025, 'Management of hypersensitivity reactions'", "faixas": [] }, { "id": "tc_protocolo.23", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Metformin — continue or hold", "valor": "manter se eGFR > 30", "unidade": "mL/min/1,73 m²", "nota": "With eGFR > 30 and no AKI, for IV or second-pass intra-arterial contrast, metformin continues unchanged. Hold it when eGFR < 30, for first-pass intra-arterial injection, or in AKI: recheck eGFR at 48 h and restart if renal function has not changed significantly. No special precaution with gadolinium (CA-AKI risk extremely low, no reported lactic acidosis in this setting).", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025, 'Safe use of contrast agents in patients with diabetes mellitus taking metformin'", "faixas": [] }, { "id": "tc_protocolo.24", "grupo": "tc_protocolo", "ruleId": null, "rotulo": "Premedication for a previous reactor", "valor": "ESUR 2025 (emergência): prednisolona 50 mg IV + clemastina 2 mg IV, ≥ 30 min antes", "unidade": null, "nota": "Classic 13-hour elective regimen (Greenberger 1991): oral prednisone 50 mg at 13 h, 7 h and 1 h before plus diphenhydramine 50 mg 1 h before; immediate generalised reaction rate fell to 0.5% versus 9.1% with conventional media. ESUR 2025 no longer rejects premedication: it says to consider it (citing EAACI) and gives an emergency protocol — prednisolone 50 mg IV (or 40 mg methylprednisolone, 8 mg dexamethasone, 200 mg hydrocortisone) plus clemastine 2 mg IV, both ≥ 30 min beforehand. Priorities remain switching the culprit agent, rapid response team nearby, IV access with ≥30 min observation, and readiness to treat. Premedication never abolishes breakthrough reactions; recurrence mandates allergy referral.", "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025, 'Prevention of recurrent hypersensitivity reactions' · Greenberger PA, Patterson R. J Allergy Clin Immunol 1991;87(4):867–872", "faixas": [] } ], "classificacoes": [ { "id": "tc_protocolo.c0", "grupo": "tc_protocolo", "nome": "Diagnostic reference levels (NDRL) — adult CT", "nota": null, "fonte": "UK Health Security Agency (UKHSA) — National Diagnostic Reference Levels (NDRLs), Tabela 1 (TC de adulto), publicada no GOV.UK. Página atualizada em 11/12/2025; os valores de TC foram adotados em 2022 e os de angio-TC coronária em 2018. São o terceiro quartil (percentil 75) da distribuição nacional.", "colunas": [ "Examination", "Clinical indication / technique", "CTDIvol per sequence (mGy)", "DLP per complete examination (mGy·cm)" ], "linhas": [ { "status": null, "celulas": [ "Crânio", "AVC agudo", "47", "790" ] }, { "status": null, "celulas": [ "Seios paranasais", "Doença sinusal", "12", "160" ] }, { "status": null, "celulas": [ "Coluna cervical", "Fratura", "16", "400" ] }, { "status": null, "celulas": [ "Pescoço, tórax, abdome e pelve", "Câncer", "—", "850" ] }, { "status": null, "celulas": [ "Tórax", "Câncer de pulmão", "8,5", "290" ] }, { "status": null, "celulas": [ "Tórax e abdome", "Câncer de pulmão", "—", "470" ] }, { "status": null, "celulas": [ "Tórax de alta resolução (TCAR)", "Doença pulmonar intersticial", "8", "300" ] }, { "status": null, "celulas": [ "Tórax, abdome e pelve", "Câncer", "—", "660" ] }, { "status": null, "celulas": [ "Angio-TC de artérias pulmonares", "Tromboembolismo pulmonar", "9,1", "310" ] }, { "status": null, "celulas": [ "Abdome e pelve", "Abscesso", "10", "530" ] }, { "status": null, "celulas": [ "Colonoscopia virtual", "Pólipos / tumor", "—", "690" ] }, { "status": null, "celulas": [ "Rins, ureteres e bexiga (KUB)", "Cálculo / cólica", "6,3", "290" ] }, { "status": null, "celulas": [ "Urografia por TC", "Tumor / cálculo / cólica", "—", "890" ] }, { "status": null, "celulas": [ "Angio-TC coronária", "Prospectiva, sem padding", "—", "170" ] }, { "status": null, "celulas": [ "Angio-TC coronária", "Prospectiva, com padding", "—", "280" ] }, { "status": null, "celulas": [ "Angio-TC coronária", "Retrospectiva, com gating", "—", "380" ] } ] }, { "id": "tc_protocolo.c1", "grupo": "tc_protocolo", "nome": "CT display windows (width and level)", "nota": null, "fonte": "Lev MH et al., Radiology 1999;213:150–155 (encéfalo 80/20 e janela estreita 8/32 no AVC) · Stern EJ, Frank MS, Godwin JD, Invest Radiol 1995;30(9):517–521 (pulmão 1500/−600 e mediastino 350/40, preferência de radiologistas torácicos) · Mayo-Smith WW et al., Radiology 1999 (utilidade da janela hepática) · Pomerantz SM et al., AJR 2000 (janelas hepática e óssea adicionais). Percentuais das duas últimas referências não reconferidos nesta auditoria.", "colunas": [ "Window", "Width (W, HU)", "Level (L, HU)", "When to use" ], "linhas": [ { "status": null, "celulas": [ "Encéfalo — parênquima", "80", "20", "Leitura padrão do crânio; base sobre a qual se procura o AVC precoce" ] }, { "status": null, "celulas": [ "AVC agudo — janela estreita variável", "8", "32", "Isquemia hiperaguda: elevou a sensibilidade de 57% para 71% mantendo especificidade de 100%; o leitor ajusta a partir de 8/32 para acentuar o contraste substância cinzenta/branca" ] }, { "status": null, "celulas": [ "Pulmão", "1500", "−600", "Parênquima pulmonar: enfisema, nódulo, vidro fosco, bronquiectasia" ] }, { "status": null, "celulas": [ "Mediastino", "350", "40", "Linfonodos, vasos, derrame, partes moles do tórax" ] }, { "status": null, "celulas": [ "Fígado (janela estreita adicional)", "sem valor consensual publicado — usar preset do serviço", "—", "Revisão adicional em janela hepática detectou lesão nova em 3,1% dos abdomes e mudou o diagnóstico em 1,7%; janelas hepática e óssea adicionais melhoraram conspicuidade em 67% dos achados alterados e tiveram impacto diagnóstico em 18% dos casos, com custo de ~40 s por exame" ] } ] }, { "id": "tc_protocolo.c2", "grupo": "tc_protocolo", "nome": "Iodinated contrast phases and timing", "nota": null, "fonte": "ACR LI-RADS v2018 CT/MRI (definição de fase arterial tardia pelo realce e fase tardia 2–5 min) · Society of Abdominal Radiology — Disease Focused Panel on Renal Cell Carcinoma, CT renal mass protocols v1.0 (Wang ZJ, Davenport MS, Silverman SG et al.). Atenção: o documento da SAR não pôde ser recuperado nesta auditoria; os atrasos das fases renais seguem convenção de serviço e devem ser reconferidos contra o protocolo institucional.", "colunas": [ "Phase", "Delay (from start of injection)", "Hallmark / main use" ], "linhas": [ { "status": null, "celulas": [ "Arterial (mapa arterial pré-nefrectomia parcial ou pré-ablação)", "30 s", "Artérias renais e seus ramos e a relação com a massa" ] }, { "status": null, "celulas": [ "Arterial tardia (abdome)", "40–50 s", "Metástases hipervasculares hepáticas e pancreáticas" ] }, { "status": null, "celulas": [ "Corticomedular", "40–70 s", "Diferenciação córtex/medula renal; ajuda na subtipagem do carcinoma de células renais" ] }, { "status": null, "celulas": [ "Portal (venosa)", "60–90 s", "Melhor equilíbrio entre parênquima, alças e vasos; vigilância oncológica" ] }, { "status": null, "celulas": [ "Nefrográfica", "100–120 s", "Fase de escolha para caracterizar e medir massa renal" ] }, { "status": null, "celulas": [ "Excretora", "7–10 min", "Urotélio, divertículo calicinal, cisto parapiélico vs hidronefrose, lesão do sistema coletor" ] }, { "status": null, "celulas": [ "Arterial tardia hepática (LI-RADS)", "definida pelo realce, não pelo relógio", "Artéria hepática e seus ramos plenamente realçados com veias hepáticas ainda não realçadas — é a fase arterial exigida, preferida à arterial precoce" ] }, { "status": null, "celulas": [ "Tardia hepática (LI-RADS)", "2–5 min", "Veias porta e hepáticas ainda realçadas, porém menos que na fase portal; washout e cápsula" ] } ] }, { "id": "tc_protocolo.c3", "grupo": "tc_protocolo", "nome": "k factor: DLP → effective dose conversion (mSv per mGy·cm)", "nota": null, "fonte": "AAPM Report No. 96 (2008), Tabela 3 — Report of AAPM Task Group 23: The Measurement, Reporting, and Management of Radiation Dose in CT. Fatores de cabeça/pescoço e pediátricos assumem o fantoma de 16 cm; os demais, o fantoma de corpo de 32 cm. Fatores derivados de pesos de tecido da ICRP 60.", "colunas": [ "Body region", "0 year", "1 year", "5 years", "10 years", "Adult" ], "linhas": [ { "status": null, "celulas": [ "Cabeça e pescoço", "0,013", "0,0085", "0,0057", "0,0042", "0,0031" ] }, { "status": null, "celulas": [ "Cabeça", "0,011", "0,0067", "0,0040", "0,0032", "0,0021" ] }, { "status": null, "celulas": [ "Pescoço", "0,017", "0,012", "0,011", "0,0079", "0,0059" ] }, { "status": null, "celulas": [ "Tórax", "0,039", "0,026", "0,018", "0,013", "0,014" ] }, { "status": null, "celulas": [ "Abdome e pelve", "0,049", "0,030", "0,020", "0,015", "0,015" ] }, { "status": null, "celulas": [ "Tronco", "0,044", "0,028", "0,019", "0,014", "0,015" ] } ] }, { "id": "tc_protocolo.c4", "grupo": "tc_protocolo", "nome": "Acute contrast reaction — classification and first-line management (ESUR 2025)", "nota": null, "fonte": "ESUR Contrast Media Safety Committee — Guidelines 2025 (publicadas em dezembro de 2025, sucedendo a versão 10.0), seções 'Categories of immediate hypersensitivity reactions' e 'Management of hypersensitivity reactions'. A gradação de gravidade segue a classificação radiológica do ACR, com equivalência aos graus de Ring & Messmer, ambas endossadas pelo CMSC.", "colunas": [ "Severity (ACR classification)", "Clinical picture", "Ring & Messmer", "First-line treatment" ], "linhas": [ { "status": null, "celulas": [ "Leve", "Congestão nasal, espirros, conjuntivite, rinorreia, urticária e prurido limitados, edema cutâneo, prurido leve de garganta", "Grau 1", "Tranquilizar e observar os sinais vitais até a resolução (mínimo 30 min); não retirar o acesso venoso durante a observação. Considerar anti-H1 não sedante (desloratadina 5 mg VO ou cetirizina 10 mg VO) e ondansetrona 4 mg IV no vômito prolongado" ] }, { "status": null, "celulas": [ "Moderada — urticária ou eritema difusos", "Urticária e prurido difusos, eritema difuso sem hipotensão", "Grau 1", "Clorfenamina 20 mg ou clemastina 2 mg IV. Se houver hipotensão associada, tratar como anafilaxia" ] }, { "status": null, "celulas": [ "Moderada — edema facial sem estridor", "Edema facial ou rouquidão sem dispneia", "Grau 1", "O2 10–15 L/min em máscara não reinalante + clorfenamina 20 mg ou clemastina 2 mg IV. Se o edema for intenso, próximo às vias aéreas, ou surgir estridor, tratar como anafilaxia" ] }, { "status": null, "celulas": [ "Moderada — broncoespasmo leve", "Broncoespasmo leve sem hipóxia", "Grau 2", "Salbutamol 2–4 jatos de 100 µg inalados (repetíveis a cada 20 min) ou nebulização, até melhora clínica. Se houver deterioração, adrenalina 0,5 mg IM e acionar o time de resposta rápida, repetindo 0,5 mg guiado pela frequência cardíaca" ] }, { "status": null, "celulas": [ "Grave — anafilaxia ou estridor", "Edema difuso ou facial com dispneia, eritema difuso com hipotensão, edema laríngeo com hipóxia, broncoespasmo grave com hipóxia, choque anafilático", "Graus 2–3", "Acionar o time de resposta rápida; O2 10–15 L/min em máscara não reinalante; adrenalina 0,5 mg IM na face lateral da coxa, repetível conforme necessário e guiada pela frequência cardíaca; bolus de cristaloide 500 mL IV em 10 min, repetível; salbutamol 2–10 jatos de 100 µg; clorfenamina 20 mg ou clemastina 2 mg IV; considerar corticoide (prednisolona 50 mg IV ou equivalente); dosar triptase sérica em até 4 h do início" ] }, { "status": null, "celulas": [ "Grave — parada cardíaca ou respiratória", "Parada cardiopulmonar", "Grau 4", "Acionar o time de PCR e iniciar RCP imediatamente" ] }, { "status": null, "celulas": [ "Reação vasovagal (não é hipersensibilidade)", "Bradicardia acentuada com hipotensão, palidez, sudorese", "—", "Manter deitado com as pernas elevadas, O2 e expansão volêmica IV; atropina se a bradicardia for acentuada. NÃO é indicação de adrenalina — confundir vasovagal com anafilaxia leva a tratamento errado nos dois sentidos" ] } ] }, { "id": "tc_protocolo.c5", "grupo": "tc_protocolo", "nome": "Contrast-associated AKI (CA-AKI) risk by eGFR band", "nota": null, "fonte": "Davenport MS, Perazella MA, Yee J et al. Use of Intravenous Iodinated Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med 2020;2(1):85–93 (publicação simultânea em Radiology 2020). Os percentuais são de CA-AKI (qualquer LRA coincidente à administração do contraste, independentemente de causalidade) e são bem maiores que o risco de CI-AKI atribuível ao contraste. Adotado pela ESUR CMSC a partir de 2025.", "colunas": [ "eGFR (mL/min/1.73 m²)", "CA-AKI risk (KDIGO stage 1 creatinine criterion)", "Management" ], "linhas": [ { "status": null, "celulas": [ "≥ 60", "~5%", "Sem profilaxia; não retardar nem negar exame bem indicado" ] }, { "status": null, "celulas": [ "45–59", "~10%", "Sem profilaxia indicada" ] }, { "status": null, "celulas": [ "30–44", "~15%", "Profilaxia pode ser considerada em situações individuais de alto risco (múltiplos fatores de risco, LRA recente, eGFR limítrofe), a critério do médico solicitante" ] }, { "status": null, "celulas": [ "< 30, sem diálise de manutenção, ou LRA em curso", "~30%", "Expansão volêmica com soro fisiológico IV; ponderar risco de adiar o diagnóstico" ] }, { "status": null, "celulas": [ "Em diálise de manutenção", "—", "Não iniciar nem reprogramar diálise apenas por causa do contraste iodado. Exceção importante: o dialítico NÃO anúrico, com função renal residual (diurese > 100 mL/dia), é tratado como eGFR < 30 / LRA — considerar expansão volêmica para preservar a diurese residual" ] } ] }, { "id": "tc_protocolo.c6", "grupo": "tc_protocolo", "nome": "CT artifacts — categories, recognition and avoidance", "nota": null, "fonte": "Barrett JF, Keat N. Artifacts in CT: recognition and avoidance. RadioGraphics 2004;24(6):1679–1691", "colunas": [ "Category", "Typical artifacts", "How to reduce" ], "linhas": [ { "status": null, "celulas": [ "Físicos (processo de aquisição)", "Endurecimento do feixe (cupping e estrias entre estruturas densas), efeito de volume parcial, penúria de fótons (estrias em ombros e pelve), subamostragem/aliasing", "Filtros de forma e correção de endurecimento do feixe, cortes mais finos, aumento do produto corrente-tempo ou modulação automática, kV mais alto em pacientes grandes, reconstrução iterativa" ] }, { "status": null, "celulas": [ "Relacionados ao paciente", "Movimento (borramento e estrias duplas), material metálico (estrias intensas), estruturas fora do campo de visão", "Imobilização e treino de apneia, menor tempo de rotação, retirada de metal removível, campo de visão que inclua todo o corpo, algoritmos de redução de artefato metálico" ] }, { "status": null, "celulas": [ "Relacionados ao equipamento", "Artefato em anel por detector descalibrado ou defeituoso", "Calibração periódica do detector e manutenção preventiva" ] }, { "status": null, "celulas": [ "Helicoidais e multicorte (reconstrução)", "Artefato em cata-vento (windmill), efeito degrau nas reformatações, artefato de feixe cônico", "Reduzir o pitch, usar colimação e espessura de corte menores, algoritmos de reconstrução dedicados a feixe cônico" ] } ] }, { "id": "tc_protocolo.c7", "grupo": "tc_protocolo", "nome": "ASPECTS — non-contrast CT in middle cerebral artery stroke", "nota": null, "fonte": "Barber PA, Demchuk AM, Zhang J, Buchan AM (ASPECTS Study Group). Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 2000;355(9216):1670–1674", "colunas": [ "Item", "Description" ], "linhas": [ { "status": null, "celulas": [ "Pontuação", "Começa em 10; subtrai-se 1 ponto para cada região com alteração isquêmica precoce" ] }, { "status": null, "celulas": [ "Regiões avaliadas (10)", "Caudado, lentiforme, cápsula interna, fita insular e os territórios corticais M1 a M6, em dois cortes axiais padronizados" ] }, { "status": null, "celulas": [ "≥ 8", "Maior chance de desfecho funcional independente" ] }, { "status": null, "celulas": [ "< 8 (ou seja, ≤ 7)", "Maior probabilidade de mau desfecho funcional; pode apoiar decisões de transferência e de terapia" ] }, { "status": null, "celulas": [ "O que o estudo original mostrou", "O ASPECTS basal predisse desfecho funcional (p < 0,001) E hemorragia intracerebral sintomática (p = 0,012; sensibilidade 0,90, especificidade 0,62), e correlacionou-se inversamente com o NIHSS (r = −0,56). Concordância interobservador boa (kappa 0,71–0,89)" ] }, { "status": null, "celulas": [ "Limites do escore", "Validado sobretudo em pacientes elegíveis a reperfusão; a literatura posterior é menos consistente quanto a predizer resposta ao tratamento. O escore isolado não deve negar terapia de reperfusão" ] }, { "status": null, "celulas": [ "Como ler", "Use a janela estreita de AVC (W 8 / L 32) sobre a janela de encéfalo (W 80 / L 20) para não subestimar a hipoatenuação precoce" ] } ] }, { "id": "tc_protocolo.c8", "grupo": "tc_protocolo", "nome": "Estimated effective dose from DLP — k factors by region", "nota": null, "fonte": "AAPM Report 96 (2008) · Deak PD et al., Radiology 2010;257(1):158-66 · ICRP 103 (2007)", "colunas": [ "Region", "k factor (mSv·mGy⁻¹·cm⁻¹)", "Reading" ], "linhas": [ { "status": null, "celulas": [ "Crânio", "0,0021", "O menor fator do corpo: 1000 mGy·cm de crânio equivalem a ≈ 2,1 mSv." ] }, { "status": null, "celulas": [ "Pescoço", "0,0059", "Tireoide é o órgão crítico; proteção e colimação pesam mais que o número." ] }, { "status": null, "celulas": [ "Tórax", "0,014", "Mama e pulmão dominam a dose efetiva na mulher jovem." ] }, { "status": null, "celulas": [ "Abdome", "0,015", "Fator praticamente igual ao da pelve; use o mesmo em abdome-pelve." ] }, { "status": null, "celulas": [ "Pelve", "0,015", "Gônadas e medula óssea entram com peso alto no cálculo." ] }, { "status": null, "celulas": [ "Coluna", "0,015", "Aplique por segmento examinado, não ao exame inteiro quando houver múltiplas séries." ] } ] } ] }, { "metodo": "RM", "chave": "rm_neuro", "slug": "rm-neuro", "nome": "MRI — Neuroradiology (brain)", "temPaginaPublica": false, "medidas": [ { "id": "rm_neuro.0", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Pituitary gland height — adult upper limit", "valor": "♂ < 8,0 · ♀ < 9,0", "unidade": "mm", "nota": "Measure on midsagittal T1, from sellar floor to gland apex. In the original series (213 subjects, ages 0–69) no subject of any age reached 8.0 mm (men) or 9.0 mm (women) — including adolescents, who had the highest mean. The paper itself warns that the midsagittal measurement UNDERESTIMATES the gland in the elderly because of the frequent upward concavity. Physiological hypertrophy in pregnancy and postpartum raises the ceiling (literature consensus, not data from this series): a convex, homogeneous, uniformly enhancing gland in those settings is not an adenoma.", "fonte": "Suzuki et al., J Comput Assist Tomogr 1990;14(1):36-9 (PMID 2298994; n=213, 0–69 anos) · faixas normativas modernas: Kobrow et al., Sci Rep 2024;14(1):4492 (PMID 38396059; n=1.924)", "faixas": [ { "status": "green", "rotulo": "Within the healthy reference range", "valor": "< 7,1 mm (♂) / < 8,1 mm (♀)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — correlate age, sex and hormonal status", "valor": "7,1–7,9 mm (♂) / 8,1–8,9 mm (♀)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the normal range — evaluate hyperplasia or mass", "valor": "≥ 8,0 mm (♂) / ≥ 9,0 mm (♀)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.1", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Pituitary gland height — median in healthy adults", "valor": "♀ 5,1 (2,2–8,1) · ♂ 4,6 (1,9–7,1)", "unidade": "mm", "nota": "Normative data from 1,924 population-based healthy adults on T1, with values stratified by body mass index (the BMI association exists but with small regression slopes: 0.0001 to 0.05). Useful to define what is normal in the general population before calling hyperplasia.", "fonte": "Kobrow R, Gross S, Fleischmann R, Baldauf J, Langner S, et al., Sci Rep 2024;14(1):4492 (PMID 38396059; doi 10.1038/s41598-024-54975-0)", "faixas": [] }, { "id": "rm_neuro.2", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Pituitary stalk (infundibulum) — diameter", "valor": "3,25 ± 0,56 no quiasma · 1,91 ± 0,40 na inserção", "unidade": "mm", "nota": "Retrospective series of 58 patients. The normal stalk tapers progressively downward and enhanced entirely in all cases after contrast. Loss of that taper (cylindrical or nodular stalk) matters more than the absolute number and is what raises hypophysitis, histiocytosis, germinoma and sarcoidosis. A central non-enhancing area within an otherwise uniform stalk is a normal variant depending on the size of the infundibular recess — do not mistake it for a lesion.", "fonte": "Simmons GE, Suchnicki JE, Rak KM, Damiano TR. AJR Am J Roentgenol 1992;159(2):375-7 (PMID 1632360; n=58)", "faixas": [ { "status": "green", "rotulo": "Normal, taper preserved", "valor": "≤ 3,8 mm no quiasma e ≤ 2,3 mm na inserção (≈ média + 1 DP)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — reassess with thin slices and contrast", "valor": "> 3,8 e ≤ 4,4 mm no quiasma", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Thickening (above mean + 2 SD) or loss of taper", "valor": "> 4,4 mm no quiasma", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.3", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Tonsillar ectopia — Chiari I threshold in adults", "valor": "> 5 (convenção pragmática — ver nota)", "unidade": "mm abaixo do forame magno", "nota": "SOURCE CAVEAT: the 5 mm cutoff is an established pragmatic convention, NOT the cutoff of the original paper. Barkovich et al. (1986) measured 200 normal subjects and 25 Chiari I: in normals the mean tonsillar position was 1 mm ABOVE the foramen magnum (range 8 mm above to 5 mm below), and 14% of normals already had tonsils slightly below it; in Chiari I the mean was 13 mm below (range 3–29 mm). The authors proposed 2 mm below (100% sensitivity, 98.5% specificity) or 3 mm below (96% sensitivity, 99.5% specificity), and concluded that ectopia of less than 2 mm probably has no clinical significance in the absence of syringomyelia. So the 3–5 mm range is genuine overlap between normal and Chiari, not a safe zone. Measure perpendicular to the basion–opisthion line down to the lowest tonsillar pole on midsagittal images. Isolated ectopia without syringomyelia, peg-shaped tonsils or effaced retrocerebellar cisterns is often asymptomatic — report the measurement and the context, not just the label.", "fonte": "Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol 1986;7(5):795-9 (PMID 3096099; n=200 normais + 25 Chiari I) · ajuste etário: Mikulis et al., Radiology 1992;183(3):725-8 (PMID 1584927)", "faixas": [ { "status": "green", "rotulo": "No isolated clinical significance (source: < 2 mm)", "valor": "Acima do forame magno ou até 2 mm abaixo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "True overlap zone with normals — read by age and look for syrinx", "valor": "> 2 e ≤ 5 mm abaixo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Consistent with Chiari I malformation by the usual convention", "valor": "> 5 mm abaixo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.4", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Tonsillar ectopia — decade-adjusted threshold", "valor": "1ª década 6 · 2ª–3ª 5 · 4ª–8ª 4 · 9ª 3", "unidade": "mm abaixo do forame magno", "nota": "The tonsils ascend with age (221 subjects, 5 months to 89 years). The values are those lying more than 2 standard deviations outside the normal range for each decade. A single 5 mm cutoff overcalls Chiari in the elderly and undercalls it in children — the authors concluded verbatim that a single reference standard is inappropriate unless age is considered.", "fonte": "Mikulis DJ, Diaz O, Egglin TK, Sanchez R. Radiology 1992;183(3):725-8 (PMID 1584927; n=221)", "faixas": [] }, { "id": "rm_neuro.5", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Evans index", "valor": "≥ 0,30", "unidade": "razão", "nota": "Maximal frontal horn width divided by maximal internal skull diameter on the same axial slice. It flags ventriculomegaly, not hydrocephalus: cortical atrophy raises it too. Never diagnose NPH on Evans alone — read it alongside the callosal angle and the DESH pattern. The converse also holds: the Japanese guideline accepts POSSIBLE iNPH even with an Evans index < 0.30 when the callosal angle is < 90°, z-Evans > 0.42, BVR is abnormal and/or the temporal horn is dilated.", "fonte": "Evans WA Jr. Am J Dis Child 1942 (índice original, por pneumoencefalografia) · adotado como critério nas diretrizes japonesas de HPN idiopática: Nakajima et al., Neurol Med Chir (Tokyo) 2021;61(2):63-97 (PMID 33455998)", "faixas": [ { "status": "green", "rotulo": "No ventriculomegaly by this criterion", "valor": "< 0,30", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Ventriculomegaly — separate hydrocephalus from atrophy", "valor": "≥ 0,30", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.6", "grupo": "rm_neuro", "ruleId": null, "rotulo": "z-Evans index (craniocaudal Evans)", "valor": "> 0,42", "unidade": "razão", "nota": "Height of the frontal horns of the lateral ventricles along the z-axis divided by the midline internal skull diameter on coronal images. It captures the disproportionate vertical enlargement typical of iNPH, which the classic axial Evans index misses — the guideline states that for this purpose z-Evans is superior to Evans > 0.30.", "fonte": "Nakajima et al., Neurol Med Chir (Tokyo) 2021;61(2):63-97 (PMID 33455998) — diretriz japonesa de HPN idiopática, 3ª edição", "faixas": [] }, { "id": "rm_neuro.7", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Brain/Ventricle Ratio (BVR)", "valor": "< 1,0 na comissura anterior · < 1,5 na comissura posterior", "unidade": "razão", "nota": "DEFINITION CAVEAT: it is WIDTH over WIDTH, not thickness over height. BVR = maximum width of the brain just above the lateral ventricles ÷ maximum width of the lateral ventricles, measured on the SAME reference coronal plane — one through the anterior commissure perpendicular to the AC–PC line, another through the posterior commissure. Useful as a supporting marker when the Evans index is borderline or even normal.", "fonte": "Nakajima et al., Neurol Med Chir (Tokyo) 2021;61(2):63-97 (PMID 33455998)", "faixas": [] }, { "id": "rm_neuro.8", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Callosal angle", "valor": "< 90°", "unidade": "graus", "nota": "Measure on the coronal plane through the posterior commissure, perpendicular to the AC–PC plane. Original means: iNPH 66 ± 14°, Alzheimer disease 104 ± 15°, controls 112 ± 11°. The 90° cutoff is the control group mean − 2 SD; at that cutoff it separated iNPH from AD with 97% sensitivity, 88% specificity, 93% accuracy. The measurement plane is decisive — an off-axis coronal changes the angle.", "fonte": "Ishii K, Kanda T, Harada A, et al. Eur Radiol 2008;18(11):2678-83 (PMID 18500524)", "faixas": [ { "status": "green", "rotulo": "Normal elderly / atrophy range", "valor": "> 100°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Overlap zone — weigh DESH and z-Evans", "valor": "90–100°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Acute angle — suggests iNPH", "valor": "< 90°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.9", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Optic nerve sheath diameter on MRI", "valor": "♀ 4,3 (2,8–5,9) · ♂ 4,6 (3,6–5,7)", "unidade": "mm", "nota": "Median and reference interval in 1,924 healthy adults, with values stratified by body mass index. In isolation the diameter has low specificity for idiopathic intracranial hypertension, because the normal range is wide and extends to almost 6 mm — the number alone discriminates poorly. NOTE the contrast with the other signs: in the same study, optic nerve head protrusion, empty sella and transverse sinus occlusion were RARE in healthy subjects, and the authors conclude that this rarity REINFORCES their value as imaging markers regardless of BMI. In short: discount the sheath diameter, do not discount papillary protrusion or empty sella.", "fonte": "Kobrow R, Gross S, Fleischmann R, Baldauf J, Langner S, et al., Sci Rep 2024;14(1):4492 (PMID 38396059; n=1.924)", "faixas": [] }, { "id": "rm_neuro.10", "grupo": "rm_neuro", "ruleId": null, "rotulo": "ADC — ischemic core threshold", "valor": "≤ 620", "unidade": "×10⁻⁶ mm²/s", "nota": "Voxel-wise threshold derived from 14 patients in the DEFUSE study (51,045 DWI-positive voxels), comparing baseline DWI lesion with 30-day FLAIR infarct (69% sensitivity, 78% specificity, by the Youden index). It is an automated segmentation criterion for thrombectomy triage, not a standalone diagnostic measure, and the sample is small. Core overestimation on baseline MRI is well described, especially very early after onset.", "fonte": "Purushotham A, Campbell BCV, Straka M, et al. Int J Stroke 2015;10(3):348-53 (PMID 23802548; n=14 pacientes / 51.045 voxels)", "faixas": [ { "status": "red", "rotulo": "Ischemic core (likely irreversible tissue)", "valor": "≤ 620 ×10⁻⁶ mm²/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "DWI-bright with ADC above threshold — potentially salvageable", "valor": "> 620 ×10⁻⁶ mm²/s", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.11", "grupo": "rm_neuro", "ruleId": null, "rotulo": "ADC — pyogenic abscess vs cystic/necrotic tumor", "valor": "Abscesso piogênico 0,65 ± 0,16 · tumor cístico/necrótico 2,70 ± 0,31", "unidade": "×10⁻³ mm²/s", "nota": "Small series (11 abscesses, 10 of them pyogenic, and 15 cystic/necrotic tumors; 1.5 T, b=1000). DWI separated the two groups with 93.3% sensitivity and 90.9% specificity (ROC area 0.92 versus 0.44 for post-contrast T1). Restriction reflects pus viscosity, not the enhancing rim — and it is not pathognomonic. TWO EXCEPTIONS FROM THE SAME SERIES, which are the real traps: the toxoplasmosis abscess did NOT restrict (ADC ~1.9 ×10⁻³, DWI-hypointense) and one low-grade fibrillary astrocytoma did restrict (0.44 ×10⁻³). Add to that metastases (particularly lung) and lymphoma, which can restrict and mimic abscess. Always read with SWI (a complete hypointense rim favors abscess), enhancement pattern and clinical context.", "fonte": "Chang SC, Lai PH, Chen WL, et al. Clin Imaging 2002;26(4):227-36 (PMID 12140151; n=11 abscessos + 15 tumores) · ressalva: \"Restricted diffusion within ring enhancement is not pathognomonic for brain abscess\", AJNR Am J Neuroradiol 2001;22:1738-42", "faixas": [] }, { "id": "rm_neuro.12", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Cho/NAA ratio — glioma grading", "valor": "> 1,60 (critério de erro C1) · > 0,75 (critério de erro C2)", "unidade": "razão", "nota": "Thresholds derived from 160 primary gliomas, measured at TE 144 ms. PAIRING CAVEAT: the study published TWO thresholds per metabolite, corresponding to different error-cost criteria — 1.60 (Cho/NAA) and 1.56 (Cho/Cr) minimize C1 error; 0.75 (Cho/NAA) and 1.08 (Cho/Cr) minimize C2 error. Do not mix the pairs: using Cho/NAA 1.60 together with Cho/Cr 1.08 combines different criteria and shifts performance. Elevated ratios also occur in tumefactive demyelination, abscess and radiation necrosis with residual tumor — spectroscopy grades, it does not diagnose alone. Intermediate TE (135–144 ms) yields more reproducible ratios for this purpose.", "fonte": "Law M, Yang S, Wang H, et al. AJNR Am J Neuroradiol 2003;24(10):1989-98 (PMID 14625221; n=160)", "faixas": [] }, { "id": "rm_neuro.13", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Cho/Cr ratio — glioma grading", "valor": "> 1,08 (critério de erro C2) · > 1,56 (critério de erro C1)", "unidade": "razão", "nota": "Same cohort of 160 gliomas, same TE of 144 ms, same pairing caveat as the previous item: 1.08 goes with Cho/NAA 0.75, and 1.56 goes with Cho/NAA 1.60. Combined with rCBV and Cho/NAA, the three measures together reached 93.3% sensitivity, 60.0% specificity, 87.5% PPV and 75.0% NPV — sensitive but not specific: useful to avoid missing high grade, not to exclude it.", "fonte": "Law M, Yang S, Wang H, et al. AJNR Am J Neuroradiol 2003;24(10):1989-98 (PMID 14625221; n=160)", "faixas": [] }, { "id": "rm_neuro.14", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Maximal rCBV (DSC perfusion) — glioma grading", "valor": "> 1,75", "unidade": "razão normalizada pela substância branca contralateral", "nota": "Best single performer in the study (160 gliomas): 95.0% sensitivity, 57.5% specificity, 87.0% PPV, 79.3% NPV — well above conventional MRI in the same cohort (72.5% / 65.0% / 86.1% / 44.1%). Low specificity is the caveat — low-grade oligodendroglioma and active demyelinating plaques can hyperperfuse. Measure at the region of maximum perfusion. Requires contrast preload and T1 leakage correction to avoid underestimation in blood–brain barrier breakdown.", "fonte": "Law M, Yang S, Wang H, et al. AJNR Am J Neuroradiol 2003;24(10):1989-98 (PMID 14625221; n=160)", "faixas": [ { "status": "green", "rotulo": "Favors low grade", "valor": "≤ 1,75", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Favors high grade", "valor": "> 1,75", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.15", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Proton spectroscopy — metabolite peak positions", "valor": "NAA 2,0 · Cr 3,0 · Cho 3,2 · mio-inositol 3,5–3,6 · lactato 1,33 (dupleto) · lipídios 0,9–1,3", "unidade": "ppm", "nota": "Short TE (~30 ms) shows myo-inositol, glutamate/glutamine and lipids; long TE (135–144 ms) cleans the spectrum and inverts the lactate doublet below baseline — pick TE by the clinical question. NAA falls with neuronal loss, choline rises with membrane turnover, myo-inositol rises in gliosis and Alzheimer disease, lactate and lipids mark necrosis and anaerobic metabolism.", "fonte": "Oz G, Alger JR, Barker PB, et al (MRS Consensus Group). Radiology 2014;270(3):658-79 (PMID 24568703) · razões diagnósticas: Law et al., AJNR 2003;24:1989-98", "faixas": [] }, { "id": "rm_neuro.16", "grupo": "rm_neuro", "ruleId": null, "rotulo": "MR Parkinsonism Index (MRPI)", "valor": "PSP 19,42 · DP 9,40 · AMS-P 6,53 · controles 9,21 (medianas)", "unidade": "índice adimensional", "nota": "MRPI = (pons area ÷ midbrain area) × (middle cerebellar peduncle width ÷ superior cerebellar peduncle width), by manual planimetry on midsagittal and coronal images. In the original series (33 PSP, 108 PD, 19 MSA-P, 50 controls) there was no overlap between PSP and the other groups and no PSP was misclassified — but the paper did NOT publish a cutoff value. CRITICAL READING: the index is HIGH in PSP and LOW in MSA-P (6.53, below controls themselves), so a low MRPI does not exclude atypical parkinsonism — it only argues against PSP. The ≥13 cutoff used here comes from a study of PSP versus VASCULAR parkinsonism (12 PSP vs 17 VP, retrospective), a different population from the one usually at issue; the most cited cutoff for PSP vs PD is 13.55. A later meta-analysis found, for PSP vs MSA specifically, pooled sensitivity 79.2% and specificity 91.2%, with no single validated cutoff and high risk of bias — the measure is highly operator- and technique-dependent.", "fonte": "Quattrone A, Nicoletti G, Messina D, et al. Radiology 2008 (PMID 17991785; n=33 PSP, 108 DP, 19 AMS-P, 50 controles; sem corte publicado) · corte ≥13 derivado de PSP vs parkinsonismo vascular: Mostile et al., Neurol Sci 2016;37(4):591-5 (PMID 26820655; n=12 PSP vs 17 VP) · desempenho agrupado PSP vs AMS: Heim B, Krismer F, Seppi K. J Neural Transm (Vienna) 2021;128(10):1497-505 (PMID 34105000)", "faixas": [ { "status": "green", "rotulo": "Does not favor PSP — caution: does NOT exclude atypical parkinsonism (MSA-P has a lower MRPI than controls)", "valor": "< 13", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Favors progressive supranuclear palsy", "valor": "≥ 13", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_neuro.17", "grupo": "rm_neuro", "ruleId": null, "rotulo": "DWI–FLAIR mismatch (unknown-onset stroke)", "valor": "Lesão visível em DWI e ainda não visível em FLAIR → provável início < 4,5 h", "unidade": null, "nota": "Performance in the PRE-FLAIR study (543 patients, multicenter observational): 62% sensitivity, 78% specificity, 83% PPV, 54% NPV. Interobserver agreement for FLAIR lesion visibility was only moderate (κ 0.569) — the judgement is not trivial. It was the selection criterion of the WAKE-UP trial (503 randomized), which showed functional benefit of thrombolysis in wake-up and unknown-onset stroke, with numerically more intracranial hemorrhages in the alteplase arm. In acute stroke reports, state explicitly whether the DWI lesion is already visible on FLAIR — that sentence changes management.", "fonte": "Thomalla G, Cheng B, Ebinger M, et al. Lancet Neurol 2011;10(11):978-86 (PRE-FLAIR, PMID 21978972; n=543) · Thomalla G, Simonsen CZ, Boutitie F, et al. N Engl J Med 2018;379(7):611-22 (WAKE-UP, PMID 29766770; n=503)", "faixas": [] }, { "id": "rm_neuro.18", "grupo": "rm_neuro", "ruleId": null, "rotulo": "SWI vs T2* gradient-echo — microbleed detection", "valor": "GRE 2D convencional de corte espesso detectou 33% (103/310) dos microssangramentos vistos em SWI de cortes finos", "unidade": null, "nota": "Comparison performed in patients with probable cerebral amyloid angiopathy, varying sequence (GRE vs SWI), section thickness (1.2–1.5 mm vs 5 mm) and field strength (1.5 T vs 3 T). The direct 103/310 count comes from only 3 subjects who underwent both protocols in the same session — the number shows the direction of the effect, not a stable estimate. Because microbleed burden feeds cerebral amyloid angiopathy criteria and anticoagulation decisions, the report must state which susceptibility-sensitive sequence was used and at what slice thickness — otherwise cross-institution comparison is meaningless.", "fonte": "Nandigam RN, Viswanathan A, Delgado P, et al. AJNR Am J Neuroradiol 2009;30(2):338-43 (PMID 19001544; contagem direta em n=3)", "faixas": [] }, { "id": "rm_neuro.19", "grupo": "rm_neuro", "ruleId": null, "rotulo": "MS protocol — 3D-FLAIR as core sequence", "valor": "3D-FLAIR = sequência-núcleo do encéfalo; gadolínio de uso criterioso", "unidade": null, "nota": "Joint MAGNIMS–CMSC–NAIMS consensus. 3D-FLAIR improves diagnostic accuracy and detection of new lesions on follow-up; the spinal cord should be included in the diagnostic MRI. With comparable 3D-FLAIR across studies, contrast can be omitted in many follow-up MRIs — a decision that also addresses gadolinium deposition concerns. The consensus extends its recommendations to childhood, pregnancy and the postpartum period.", "fonte": "Wattjes MP, Ciccarelli O, Reich DS, et al. Lancet Neurol 2021;20(8):653-70 (PMID 34139157) — consenso MAGNIMS-CMSC-NAIMS", "faixas": [] }, { "id": "rm_neuro.20", "grupo": "rm_neuro", "ruleId": null, "rotulo": "Scheltens MTA score — age-specific abnormality cutoff", "valor": "< 65 anos ≥ 1,0 · 65–74 anos ≥ 1,5 · 75–84 anos ≥ 2,0 · ≥ 85 anos ≥ 2,0", "unidade": null, "nota": "SOURCE-MODALITY CAVEAT: these age cutoffs were validated on COMPUTED TOMOGRAPHY (832 Alzheimer patients, mean age 81.8, versus 333 subjective cognitive impairment controls, mean age 71.8), not on MRI — transfer to MRI is established practice, not direct validation. The score is the average of both sides. Sensitivity/specificity by band: 83.3%/86.4%; 73.7%/84.6%; 73.7%/76.2%; 84.0%/62.5%. Medial temporal atrophy rises with age in BOTH groups, patients and controls, to a similar degree. Above 85 the cutoff loses practical value (62.5% specificity) — medial temporal atrophy is nearly the rule at that age and should not alone become a report of Alzheimer disease.", "fonte": "Claus JJ, Staekenborg SS, Holl DC, et al. Eur Radiol 2017;27(8):3147-55 (PMID 28083697; validação em TC, n=832 + 333) · escala original em RM: Scheltens et al., J Neurol Neurosurg Psychiatry 1992;55(10):967-72 (PMID 1431963)", "faixas": [ { "status": "green", "rotulo": "Below the age-specific cutoff", "valor": "MTA médio < corte da faixa", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "At the cutoff — correlate with cognition and other markers", "valor": "MTA médio = corte da faixa", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the cutoff — medial temporal atrophy beyond age expectation", "valor": "MTA médio > corte da faixa", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "rm_neuro.c0", "grupo": "rm_neuro", "nome": "2024 McDonald criteria — multiple sclerosis", "nota": null, "fonte": "Montalban X, Lebrun-Frénay C, Oh J, et al. Lancet Neurol 2025;24(10):850-65 — \"Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria\" (PMID 40975101) · leitura radiológica: Rai P, Bathla G, Chan VEY, et al. AJR Am J Roentgenol 2026;226(4):e2533997 (PMID 41439773) · qualificação da regra das 4–5 topografias (\"selected patients with highly characteristic clinical and imaging features\"): Arun T, et al. Pract Neurol 2026 (PMID 42178152) e Cobo-Calvo Á, Rovira À, Tintore M. Rev Neurol (Paris) 2026;182(5):335-43 (PMID 41927390) · protocolo: Wattjes et al., Lancet Neurol 2021;20:653-70 (PMID 34139157)", "colunas": [ "Element", "2024 revision rule" ], "linhas": [ { "status": null, "celulas": [ "Topografias do SNC (disseminação no espaço)", "Periventricular, cortical/justacortical, infratentorial, medula espinhal e nervo óptico — o nervo óptico passou a ser a 5ª topografia, principal novidade de 2024 (documentável por RM, potencial evocado visual ou OCT)" ] }, { "status": null, "celulas": [ "Disseminação no espaço (DIS) mínima", "Lesões típicas em pelo menos 2 das 5 topografias, sintomáticas ou não" ] }, { "status": null, "celulas": [ "4 ou 5 topografias acometidas", "Permite fechar o diagnóstico SEM demonstrar disseminação no tempo (DIT) — mas apenas EM CONTEXTO CLÍNICO APROPRIADO, em pacientes selecionados com quadro clínico e de imagem altamente característicos. Não é regra automática" ] }, { "status": null, "celulas": [ "2 a 3 topografias", "Exige um elemento de suporte: DIT na RM, LCR positivo (bandas oligoclonais ou índice kFLC) ou sinal da veia central pela regra Select 6" ] }, { "status": null, "celulas": [ "1 topografia", "Exige DIT na RM ou LCR positivo E, adicionalmente, sinal da veia central ou pelo menos 1 lesão com anel paramagnético" ] }, { "status": null, "celulas": [ "Sinal da veia central (SCV) — regra Select 6", "≥ 6 lesões da substância branca com veia central, distribuídas em ao menos 2 topografias; se houver menos de 10 lesões avaliáveis, a maioria delas deve ser SCV positiva" ] }, { "status": null, "celulas": [ "Lesão com anel paramagnético (PRL)", "≥ 1 PRL no encéfalo já conta como positivo — marcador de lesão cronicamente ativa, avaliado em sequências sensíveis a suscetibilidade (SWI/QSM)" ] }, { "status": null, "celulas": [ "Líquor", "O índice de cadeias leves kappa (kFLC) é intercambiável com as bandas oligoclonais restritas ao LCR, e pode substituir a demonstração de DIT" ] }, { "status": null, "celulas": [ "Síndrome radiologicamente isolada (RIS)", "Pode ser classificada como EM com ≥ 2 topografias mais DIT na RM, LCR positivo ou Select 6 — permite diagnóstico antes do primeiro sintoma" ] }, { "status": null, "celulas": [ "≥ 50 anos, cefaleia/enxaqueca, fatores de risco vascular ou CRIANÇAS", "Limiar mais rígido para evitar sobrediagnóstico: exigir elemento adicional — lesão medular, LCR positivo (bandas oligoclonais ou kFLC) ou sinal da veia central" ] }, { "status": null, "celulas": [ "Papel do gadolínio", "Realce continua útil para DIT em uma única RM (lesões realçantes e não realçantes simultâneas), mas deixou de ser condição obrigatória do diagnóstico" ] } ] }, { "id": "rm_neuro.c1", "grupo": "rm_neuro", "nome": "Fazekas scale — white matter hyperintensities", "nota": null, "fonte": "Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149(2):351-6 (PMID 3496763; n=12 Alzheimer, 4 demência multi-infarto, 9 controles)", "colunas": [ "Grade", "Periventricular (PVH)", "Deep white matter (DWMH)" ], "linhas": [ { "status": null, "celulas": [ "0", "Ausente", "Ausente" ] }, { "status": null, "celulas": [ "1", "\"Caps\" frontais/occipitais ou linha fina revestindo os ventrículos", "Focos puntiformes" ] }, { "status": null, "celulas": [ "2", "Halo liso periventricular", "Início de confluência" ] }, { "status": null, "celulas": [ "3", "Halo irregular estendendo-se à substância branca profunda", "Áreas confluentes extensas" ] }, { "status": null, "celulas": [ "Observação de uso", "A escala original é QUALITATIVA e não define cortes em milímetros para nenhum grau — cortes métricos atribuídos a Fazekas circulam na prática mas não estão no artigo de 1987", "Idem: a graduação da DWMH é por padrão de confluência, não por tamanho medido" ] } ] }, { "id": "rm_neuro.c2", "grupo": "rm_neuro", "nome": "Scheltens medial temporal atrophy (MTA) scale", "nota": null, "fonte": "Scheltens P, Leys D, Barkhof F, et al. J Neurol Neurosurg Psychiatry 1992;55(10):967-72 (PMID 1431963; escala original, em RM, n=21 Alzheimer + 21 controles) · cortes de anormalidade por idade validados em TC: Claus JJ, et al. Eur Radiol 2017;27(8):3147-55 (PMID 28083697)", "colunas": [ "Score", "Choroidal fissure", "Temporal horn", "Hippocampal height" ], "linhas": [ { "status": null, "celulas": [ "0", "Normal", "Normal", "Normal" ] }, { "status": null, "celulas": [ "1", "Alargamento discreto", "Normal", "Normal" ] }, { "status": null, "celulas": [ "2", "Alargamento moderado", "Alargamento discreto", "Redução discreta" ] }, { "status": null, "celulas": [ "3", "Alargamento acentuado", "Alargamento moderado", "Redução moderada" ] }, { "status": null, "celulas": [ "4", "Alargamento acentuado", "Alargamento acentuado", "Redução acentuada" ] } ] }, { "id": "rm_neuro.c3", "grupo": "rm_neuro", "nome": "Imaging markers of normal pressure hydrocephalus (DESH and indices)", "nota": null, "fonte": "Nakajima M, Yamada S, Miyajima M, et al. Neurol Med Chir (Tokyo) 2021;61(2):63-97 (PMID 33455998) — diretriz japonesa de HPN idiopática, 3ª edição · ângulo calososseptal: Ishii K, et al. Eur Radiol 2008;18(11):2678-83 (PMID 18500524)", "colunas": [ "Marker", "How to measure", "Cutoff" ], "linhas": [ { "status": null, "celulas": [ "Índice de Evans", "Maior largura dos cornos frontais ÷ maior diâmetro interno do crânio, no mesmo corte axial", "≥ 0,30" ] }, { "status": null, "celulas": [ "z-Evans index", "Altura dos cornos frontais no eixo z ÷ diâmetro interno mediano do crânio, no coronal", "> 0,42 (superior ao Evans axial para HPN idiopática)" ] }, { "status": null, "celulas": [ "Ângulo calososseptal", "Ângulo entre os tetos/paredes mediais dos ventrículos laterais no coronal que passa pela comissura posterior, perpendicular ao plano CA–CP", "< 90° (idoso normal 112 ± 11°; Alzheimer 104 ± 15°; HPN idiopática 66 ± 14°)" ] }, { "status": null, "celulas": [ "Brain/Ventricle Ratio (BVR)", "Maior LARGURA do parênquima logo acima dos ventrículos laterais ÷ maior LARGURA dos ventrículos laterais, no mesmo plano coronal (não é altura ventricular)", "< 1,0 no nível da comissura anterior; < 1,5 no nível da comissura posterior" ] }, { "status": null, "celulas": [ "DESH", "Tríade: ventriculomegalia + sulcos apertados na alta convexidade e na linha média + fissuras silvianas alargadas", "Padrão completo presente — alto valor preditivo positivo e baixo valor preditivo negativo; melhor resposta à derivação" ] }, { "status": null, "celulas": [ "Evans normal não exclui", "Mesmo com Evans < 0,30, a diretriz aceita HPN idiopática POSSÍVEL quando ângulo calososseptal < 90°, z-Evans > 0,42, BVR alterado e/ou dilatação do corno temporal estão presentes", "Não descartar HPN só porque o Evans está abaixo de 0,30" ] }, { "status": null, "celulas": [ "Armadilha a excluir", "Índice de Evans elevado com sulcos da convexidade ALARGADOS (e não apertados) e ângulo calososseptal obtuso", "Padrão de atrofia, não de HPN — não indicar derivação por Evans isolado" ] } ] }, { "id": "rm_neuro.c4", "grupo": "rm_neuro", "nome": "Neuro MRI sequences — when to use and what only they deliver", "nota": null, "fonte": "Wattjes et al., Lancet Neurol 2021;20(8):653-70 (PMID 34139157) · Purushotham et al., Int J Stroke 2015;10:348-53 (PMID 23802548) · Chang et al., Clin Imaging 2002;26:227-36 (PMID 12140151) · Thomalla et al., Lancet Neurol 2011;10:978-86 (PMID 21978972) e N Engl J Med 2018;379:611-22 (PMID 29766770) · Nandigam et al., AJNR 2009;30:338-43 (PMID 19001544) · Law et al., AJNR 2003;24:1989-98 (PMID 14625221) · Oz et al., Radiology 2014;270:658-79 (PMID 24568703)", "colunas": [ "Sequence", "When to use", "What only it delivers" ], "linhas": [ { "status": null, "celulas": [ "DWI / mapa de ADC", "AVC agudo, abscesso vs tumor, epidermoide vs cisto aracnoide, doença de Creutzfeldt-Jakob, estimativa de celularidade tumoral", "Núcleo do infarto (ADC ≤ 620 ×10⁻⁶ mm²/s); abscesso piogênico ~0,65 vs tumor cístico/necrótico ~2,70 ×10⁻³ mm²/s — lembrando que abscesso não-piogênico pode não restringir" ] }, { "status": null, "celulas": [ "FLAIR — preferir 3D", "Esclerose múltipla, epilepsia, doença de pequenos vasos, hemorragia subaracnóidea, AVC de horário desconhecido", "Mismatch DWI–FLAIR estima início < 4,5 h (VPP 83%, VPN 54%); 3D-FLAIR é a sequência-núcleo do protocolo de EM" ] }, { "status": null, "celulas": [ "SWI / QSM", "Microssangramentos, angiopatia amiloide, cavernoma, trauma, calcificação vs hemorragia, sinal da veia central e PRL na EM", "GRE 2D de corte espesso mostrou apenas 33% dos microssangramentos vistos em SWI de cortes finos; é a sequência obrigatória para Select 6 e PRL nos critérios de 2024" ] }, { "status": null, "celulas": [ "Perfusão DSC (rCBV)", "Graduação de glioma, recidiva tumoral vs radionecrose, lesão indeterminada", "rCBV > 1,75 favorece alto grau (S 95%, E 57,5%) — exige pré-carga e correção de vazamento de T1" ] }, { "status": null, "celulas": [ "Espectroscopia de prótons", "Massa indeterminada, doença metabólica/leucodistrofia, infecção, avaliação pós-tratamento", "Pelo critério de erro C1 de Law 2003, Cho/NAA > 1,60 com Cho/Cr > 1,56 favorecem alto grau (não misturar com o par C2: Cho/NAA > 0,75 com Cho/Cr > 1,08); lactato (1,33 ppm) e lipídios (0,9–1,3 ppm) marcam necrose" ] }, { "status": null, "celulas": [ "Gadolínio", "RM diagnóstica de EM, tumor, infecção, suspeita de lesão ativa ou de quebra de barreira", "Uso criterioso: no seguimento de EM com 3D-FLAIR comparável entre exames, o contraste pode ser dispensado em boa parte dos casos" ] } ] } ] }, { "metodo": "RM", "chave": "rm_coluna_msk", "slug": "rm-coluna-msk", "nome": "MRI — Spine and Musculoskeletal", "temPaginaPublica": false, "medidas": [ { "id": "rm_coluna_msk.0", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Focal disc herniation — circumferential extent", "valor": "< 25%", "unidade": "% da circunferência do disco", "nota": "Fardon 2.0 defines herniation as LOCALIZED displacement of disc material — localized means less than 50% (180°) of the circumference. Below 25% the correct term is focal herniation. Always report the zone (central, subarticular, foraminal, extraforaminal) and the craniocaudal level.", "fonte": "NASS/ASSR/ASNR — Lumbar Disc Nomenclature version 2.0, 2014 · Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Spine J 2014;14(11):2525-45 (publicação simultânea: Spine 2014;39(24):E1448-65)", "faixas": [] }, { "id": "rm_coluna_msk.1", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Broad-based disc herniation", "valor": "25-50%", "unidade": "% da circunferência do disco", "nota": "Intermediate range: still a herniation (broad-based), because it remains a localized displacement (< 50%). NOTE the overlap: a bulge starts above 25%, so 25-50% is shared territory — the tiebreaker is morphological (displaced disc material with a definable base and identifiable apex = broad-based herniation; smooth generalized extension of the outer annular contour = bulge). What the consensus forbids is calling anything above 50% (180°) a herniation.", "fonte": "NASS/ASSR/ASNR — Lumbar Disc Nomenclature version 2.0, 2014 · Fardon DF et al. Spine J 2014;14(11):2525-45", "faixas": [] }, { "id": "rm_coluna_msk.2", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Disc bulge", "valor": "> 25% (> 90°)", "unidade": "% da circunferência do disco", "nota": "Outer annular contour extending (or appearing to extend) beyond the ring apophyses over more than 25% (90°) of the circumference, usually less than 3 mm beyond the vertebral body margins. By consensus definition it is NOT a herniation and must not be reported as one, at any extent. Above 50% (180°) the finding is 'generalized' — which only reinforces that it can never be called a herniation. May be a normal variant, adaptive (scoliosis, listhesis) or degenerative.", "fonte": "NASS/ASSR/ASNR — Lumbar Disc Nomenclature version 2.0, 2014 · Fardon DF et al. Spine J 2014;14(11):2525-45 (glossário: disco abaulado = deslocamento > 25% da circunferência; hérnia = deslocamento localizado, < 50%)", "faixas": [] }, { "id": "rm_coluna_msk.3", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Protrusion vs extrusion — the base rule", "valor": "Protrusão: maior distância entre as bordas do material herniado MENOR que a distância entre as bordas da base, em todos os planos. Extrusão: em pelo menos UM plano, essa distância é MAIOR que a da base.", "unidade": null, "nota": "The distinction is geometric, not size-based. A small herniation with a narrow neck is an extrusion; a bulky wide-based one is a protrusion. Assess in BOTH axial and sagittal planes — one positive plane is enough to call it an extrusion.", "fonte": "NASS/ASSR/ASNR — Lumbar Disc Nomenclature version 2.0, 2014 · Fardon DF et al. Spine J 2014;14(11):2525-45 / Spine 2014;39(24):E1448-65", "faixas": [] }, { "id": "rm_coluna_msk.4", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Sequestration and migration", "valor": "Sequestro: fragmento que PERDEU continuidade com o disco-mãe. Migração: deslocamento do material para longe do sítio de extrusão, sequestrado ou não.", "unidade": null, "nota": "Sequestration and migration are independent concepts: migrated material may remain in continuity (not sequestered). Every sequestration is, by definition, an extrusion. Report direction (cranial/caudal) and whether it is subligamentous or transligamentous.", "fonte": "NASS/ASSR/ASNR — Lumbar Disc Nomenclature version 2.0, 2014 · Fardon DF et al. Spine J 2014;14(11):2525-45", "faixas": [] }, { "id": "rm_coluna_msk.5", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Lumbar canal anteroposterior diameter", "valor": "> 12", "unidade": "mm", "nota": "Classic Verbiest criteria, originally myelographic: 12 mm = narrow canal (relative stenosis); 10 mm or less = absolute stenosis. Useful as a screen: in a congenitally narrow canal (short pedicles), a small herniation already decompensates. Supine MRI tends to overestimate the canal available when upright.", "fonte": "Critérios clássicos de Verbiest, sintetizados em Gopinathan P. \"Lumbar spinal canal stenosis — special features\". J Orthop 2015 (PMC4501532)", "faixas": [ { "status": "green", "rotulo": "No narrowing", "valor": "> 12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Relative stenosis", "valor": "10-12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Absolute stenosis", "valor": "≤ 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_coluna_msk.6", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Dural sac cross-sectional area (DSCA) at the narrowest level", "valor": "> 100", "unidade": "mm²", "nota": "Quantitative measurement on axial T2. It complements the Schizas grade rather than replacing it: the two methods classify different patients. Trace the dural sac contour (not the bony canal) at the tightest level. Note: < 76 mm² is the DESCRIPTIVE cut-off from this source; the < 75 mm² used below is a PROGNOSTIC cut-off (Mannion 2017) — different sources and purposes, not a measurement discrepancy.", "fonte": "Gopinathan P. \"Lumbar spinal canal stenosis — special features\". J Orthop 2015 (PMC4501532) · validação clínica de desfecho em Mannion AF, Fekete TF, Pacifico D, et al. Eur Spine J 2017;26(10):2552-64", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "> 100 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Moderate stenosis", "valor": "76-100 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Severe stenosis", "valor": "< 76 mm²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_coluna_msk.7", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "DSCA < 75 mm² or Schizas D — surgical prognostic value", "valor": "4 a 13× mais chance de atingir a mudança clinicamente mínima importante (MCIC) do COMI aos 12 meses da descompressão", "unidade": null, "nota": "Cohort of 157 patients (88 male, 69 female; mean age 72 ± 7) undergoing first-time surgery for lumbar central stenosis. Strong correlation between area and morphological grade (ρ = -0.69; p < 0.001). Neither area nor grade correlated with baseline COMI (p > 0.85), yet both predicted surgical benefit. Reinforces that radiological severity does not explain preoperative pain. The authors conclude the simpler morphological grade is preferable in routine practice.", "fonte": "Mannion AF, Fekete TF, Pacifico D, O'Riordan D, Nauer S, von Büren M, Schizas C. Eur Spine J 2017;26(10):2552-64 (PMID 28856447)", "faixas": [] }, { "id": "rm_coluna_msk.8", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Active sacroiliitis (ASAS) — classic bone marrow oedema counting rule", "valor": "≥ 1 lesão de edema medular em ≥ 2 cortes consecutivos OU > 1 lesão em um único corte", "unidade": null, "nota": "Rule from the 2009 ASAS definition. In the 2016 update this quantitative requirement moved out of the core definition into the \"guidelines for application\": what defines active sacroiliitis is clearly present subchondral bone marrow oedema WITH an appearance highly suggestive of spondyloarthritis. Isolated synovitis, enthesitis or capsulitis without bone marrow oedema does NOT meet the definition.", "fonte": "ASAS 2009 (Rudwaleit M et al., Ann Rheum Dis) · atualização: Lambert RGW, Bakker PAC, van der Heijde D, et al. \"Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group\". Ann Rheum Dis 2016;75(11):1958-63", "faixas": [] }, { "id": "rm_coluna_msk.9", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Definite ACTIVE sacroiliac lesion — ASAS quantitative cut-offs", "valor": "Edema medular em ≥ 4 quadrantes da sacroilíaca (qualquer localização) OU no MESMO local em ≥ 3 cortes consecutivos", "unidade": null, "nota": "Data-driven cut-offs from the ASAS Classification Cohort, selected for high specificity and PPV ≥ 95% for a follow-up rheumatologist diagnosis of axial spondyloarthritis. Each sacroiliac joint is divided into quadrants (iliac/sacral × anterior/posterior) per slice.", "fonte": "Maksymowych WP, Lambert RG, Baraliakos X, et al. (ASAS MRI group) \"Data-driven definitions for active and structural MRI lesions in the sacroiliac joint in spondyloarthritis and their predictive utility\". Rheumatology (Oxford) 2021;60(10):4778-89 (PMID 33523107)", "faixas": [] }, { "id": "rm_coluna_msk.10", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Definite STRUCTURAL sacroiliac lesion — ASAS quantitative cut-offs", "valor": "Qualquer um: erosão em ≥ 3 quadrantes · lesão gordurosa em ≥ 5 quadrantes · erosão no mesmo local em ≥ 2 cortes consecutivos · lesão gordurosa no mesmo local em ≥ 3 cortes consecutivos · lesão gordurosa profunda (> 1 cm)", "unidade": null, "nota": "Requires a non-fat-saturated T1 sequence for erosion and fat lesions. A deep fat lesion (> 1 cm depth) alone already qualifies. Structural damage strengthens confidence that the oedema is due to spondyloarthritis, but is not required by the active sacroiliitis definition.", "fonte": "Maksymowych WP, Lambert RG, Baraliakos X, et al. Rheumatology (Oxford) 2021;60(10):4778-89 · contexto: Lambert RGW et al., Ann Rheum Dis 2016;75(11):1958-63", "faixas": [] }, { "id": "rm_coluna_msk.11", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Medial meniscal extrusion (mid-coronal image)", "valor": "> 3", "unidade": "mm", "nota": "Series of 105 knees. Major extrusion (> 3 mm) was associated with marked meniscal degeneration, extensive/complex tears, large radial tears and especially root tears: root involvement in 42% (30/71) of knees with major extrusion versus 3% (1/34) with minor extrusion. Measure from the tibial plateau (excluding osteophytes) on the mid-coronal image.", "fonte": "Costa CR, Morrison WB, Carrino JA. \"Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear?\" AJR Am J Roentgenol 2004;183(1):17-23", "faixas": [ { "status": "green", "rotulo": "Minor extrusion", "valor": "≤ 3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Major extrusion — look for a root tear", "valor": "> 3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_coluna_msk.12", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Grade 3 meniscal signal (contact with the articular surface)", "valor": "94% (116/123) tinham rotura na cirurgia", "unidade": null, "nota": "Series of 277 menisci in 144 knees with surgical confirmation. Linear signal reaching the tibial or femoral articular surface. It is the only grade that licenses reporting a tear. Confirm on at least two slices or two planes to reduce false positives from partial volume and from meniscal vessels in young patients.", "fonte": "Crues JV 3rd, Mink J, Levy TL, Lotysch M, Stoller DW. \"Meniscal tears of the knee: accuracy of MR imaging\". Radiology 1987 (PMID 3602385)", "faixas": [] }, { "id": "rm_coluna_msk.13", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Grade 1 and 2 meniscal signal (does not reach the surface)", "valor": "89% (137/154) eram meniscos NORMAIS na cirurgia", "unidade": null, "nota": "Grade 1 = globular irregularly marginated signal (early mucoid degeneration). Grade 2 = linear signal NOT reaching the articular surface. Neither should be reported as a tear — describe as intrasubstance degenerative change. Counting only grade 3 as positive, MR and surgical findings agreed in 91.3% of menisci.", "fonte": "Crues JV 3rd, Mink J, Levy TL, Lotysch M, Stoller DW. Radiology 1987 (PMID 3602385)", "faixas": [] }, { "id": "rm_coluna_msk.14", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Tibial tubercle–trochlear groove (TT-TG) distance on MRI", "valor": "≤ 15,0", "unidade": "mm", "nota": "Optimal cut-off derived from MRI in 100 patients with patellar dislocation and 100 matched controls, with almost perfect interobserver reproducibility. In a paediatric cohort (215 MRIs, ages 5-18), TT-TG ≥ 13.5 mm was 76% sensitive and 76% specific for dislocation (AUC 0.806). Do not use CT cut-offs interchangeably with MRI.", "fonte": "Friedman MV, Hillen TJ, Misra S, Hildebolt CF, Rubin DA. \"Quantitative variable assessment of patellar instability: an MRI-based study\". AJR Am J Roentgenol 2020;215(5):1163-70 (PMID 32901564) · Mistovich RJ, Urwin JW, Fabricant PD, Lawrence JTR. Am J Sports Med 2018;46(14):3400-6 (PMID 30427701)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "≤ 15,0 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Associated with patellar instability", "valor": "> 15,0 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_coluna_msk.15", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Tibial tubercle–PCL (TT-PCL) distance on MRI", "valor": "≤ 21,3", "unidade": "mm", "nota": "Measures tibial tubercle lateralization independently of trochlear morphology (useful when dysplasia displaces the groove and contaminates TT-TG). Almost perfect reproducibility in the original series.", "fonte": "Friedman MV, Hillen TJ, Misra S, Hildebolt CF, Rubin DA. AJR Am J Roentgenol 2020;215(5):1163-70", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "≤ 21,3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Lateralized tubercle", "valor": "> 21,3 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_coluna_msk.16", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Trochlear groove depth on MRI (trochlear dysplasia)", "valor": "≥ 4,95", "unidade": "mm", "nota": "In the same series (100 cases vs 100 controls), trochlear dysplasia showed the strongest single association with patellar instability, and stronger still combined with an abnormal TT-TG. Patellar instability is multifactorial: report all three parameters together.", "fonte": "Friedman MV, Hillen TJ, Misra S, Hildebolt CF, Rubin DA. AJR Am J Roentgenol 2020;215(5):1163-70", "faixas": [ { "status": "green", "rotulo": "Normal trochlea", "valor": "≥ 4,95 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Trochlear dysplasia", "valor": "< 4,95 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_coluna_msk.17", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Hip alpha angle (cam morphology)", "valor": "> 55", "unidade": "graus", "nota": "Measured on the tilted oblique axial image through the femoral head centre, at the neck waist. NOTE the provenance: Nötzli 2002 reported MEANS of 74° in 39 symptomatic patients with a positive impingement test versus 42° in 35 asymptomatic controls (p < 0.001), with good reproducibility across 4 observers — the original paper does not set the cut-off; the > 55° threshold is a convention consolidated in later literature and should be reported as such. The Warwick Agreement requires the TRIAD of symptoms + clinical signs + imaging findings: an abnormal alpha angle alone, in an asymptomatic patient, is not FAI syndrome.", "fonte": "Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. J Bone Joint Surg Br 2002;84(4):556-60 (PMID 12043778) — médias 74° × 42° · corte de 55°: convenção da literatura posterior · Griffin DR et al. \"The Warwick Agreement on femoroacetabular impingement syndrome\". Br J Sports Med 2016;50(19):1169-76", "faixas": [ { "status": "green", "rotulo": "Normal (asymptomatic controls: mean 42°)", "valor": "< 50°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline (operational range, not from the original series) — depends on slice plane and rotation", "valor": "50-55°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Cam morphology", "valor": "> 55°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_coluna_msk.18", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Tangent sign (supraspinatus atrophy)", "valor": "Negativo em 100% (70/70) dos voluntários assintomáticos", "unidade": null, "nota": "Draw the tangent through the superior borders of the scapular spine and the coracoid process, on the parasagittal T1 image. A healthy supraspinatus crosses this line; if it does not, the sign is POSITIVE. Original series: 70 healthy volunteers, 30 patients with cuff tears and 10 with instability — the sign was negative in the healthy and positive in most medium and large tears. Cross-sectional areas discriminated tear stages; signal intensity did NOT.", "fonte": "Zanetti M, Gerber C, Hodler J. \"Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging\". Invest Radiol 1998;33(3):163-70 (PMID 9525755)", "faixas": [] }, { "id": "rm_coluna_msk.19", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "Rotator cuff tendon retraction (Patte, frontal plane)", "valor": "Estágio 1: coto proximal próximo à inserção óssea (retração < 1 cm) · Estágio 2: coto retraído até a altura da cabeça umeral · Estágio 3: coto retraído até a margem superior da glenoide ou mais medial", "unidade": null, "nota": "Assess on the oblique coronal plane. Patte's classification describes the tear in two dimensions (sagittal and frontal topography) and also incorporates muscle trophic quality and long head of biceps integrity. Stage 3 retraction combined with Goutallier ≥ 3 and a positive tangent sign characterizes a tear that is difficult to repair.", "fonte": "Patte D. \"Classification of rotator cuff lesions\". Clin Orthop Relat Res 1990 (PMID 2323151)", "faixas": [] }, { "id": "rm_coluna_msk.20", "grupo": "rm_coluna_msk", "ruleId": null, "rotulo": "SLAP lesions (Snyder) — four original types", "valor": "Tipo I: degeneração/fibrilação do lábio superior com âncora bicipital ÍNTEGRA · Tipo II: desinserção da âncora do bíceps e do lábio superior da glenoide · Tipo III: rotura em alça de balde do lábio superior com âncora bicipital íntegra · Tipo IV: alça de balde que se estende ao tendão da cabeça longa do bíceps", "unidade": null, "nota": "The lesion begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the biceps anchor. Most common mechanism in the original series: axial compression from a fall onto an outstretched arm with the shoulder abducted and slightly forward-flexed. The authors noted that no imaging test accurately defined the lesion preoperatively — MR arthrography is today's method of choice. Beware SLAP mimics: sublabral recess, sublabral foramen and Buford complex.", "fonte": "Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. \"SLAP lesions of the shoulder\". Arthroscopy 1990;6(4):274-9", "faixas": [] } ], "classificacoes": [ { "id": "rm_coluna_msk.c0", "grupo": "rm_coluna_msk", "nome": "Pfirrmann — lumbar disc degeneration on MRI", "nota": null, "fonte": "Pfirrmann CWA, Metzdorf A, Zanetti M, Hodler J, Boos N. \"Magnetic resonance classification of lumbar intervertebral disc degeneration\". Spine 2001;26(17):1873-8 — 300 discos, 60 pacientes; κ intraobservador 0,84-0,90 e interobservador 0,69-0,81; concordância completa em 83,8%", "colunas": [ "Grade", "Disc structure", "Nucleus vs annulus distinction", "T2 signal", "Disc height" ], "linhas": [ { "status": null, "celulas": [ "I", "Homogênea, branca", "Nítida", "Hiperintenso (isointenso ao LCR)", "Normal" ] }, { "status": null, "celulas": [ "II", "Não homogênea, com ou sem bandas horizontais", "Nítida", "Hiperintenso (isointenso ao LCR)", "Normal" ] }, { "status": null, "celulas": [ "III", "Não homogênea, acinzentada", "Indistinta", "Intermediário", "Normal a levemente reduzida" ] }, { "status": null, "celulas": [ "IV", "Não homogênea, de cinza a preta", "Perdida", "Intermediário a hipointenso", "Normal a moderadamente reduzida" ] }, { "status": null, "celulas": [ "V", "Não homogênea, preta", "Perdida", "Hipointenso", "Colapso do espaço discal" ] } ] }, { "id": "rm_coluna_msk.c1", "grupo": "rm_coluna_msk", "nome": "Modic — vertebral endplate and marrow changes", "nota": null, "fonte": "Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. \"Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging\". Radiology 1988;166(1 Pt 1):193-9 — 474 pacientes consecutivos; tipo 1 em 4% e tipo 2 em 16%, sempre com doença discal degenerativa no mesmo nível · tipo 3 (esclerose) consolidado em Modic MT, Ross JS. Radiology 2007 (PMID 17885180)", "colunas": [ "Type", "T1", "T2", "Histologic substrate", "Behaviour on follow-up" ], "linhas": [ { "status": null, "celulas": [ "1", "Hipointenso", "Hiperintenso", "Ruptura e fissuração dos platôs com tecido fibrovascular vascularizado", "Converteu para tipo 2 em 5 de 6 pacientes, entre 14 meses e 3 anos" ] }, { "status": null, "celulas": [ "2", "Hiperintenso", "Isointenso a levemente hiperintenso", "Substituição por medula amarela (gordura)", "Estável em 10 de 10 pacientes ao longo de 2-3 anos" ] }, { "status": null, "celulas": [ "3", "Hipointenso", "Hipointenso", "Esclerose óssea subcondral", "Descrito após a série original de 1988" ] } ] }, { "id": "rm_coluna_msk.c2", "grupo": "rm_coluna_msk", "nome": "Schizas — lumbar central stenosis by dural sac morphology", "nota": null, "fonte": "Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. \"Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images\". Spine 2010;35(21):1919-24 (PMID 20671589) — 95 pacientes (37 operados, 31 tratados conservadoramente, 27 com lombalgia); concordância intraobservador substancial (κ 0,65) e interobservador moderada (κ 0,44); graus C e D falharam mais no tratamento conservador; a área do saco dural isolada superdiagnosticou estenose em 35 e subdiagnosticou em 12 casos · validação de desfecho: Mannion AF et al., Eur Spine J 2017;26(10):2552-64 (ρ = -0,69 com a área do saco dural)", "colunas": [ "Grade", "Rootlet vs CSF relationship on axial T2", "Posterior epidural fat", "Reading" ], "linhas": [ { "status": null, "celulas": [ "A1", "LCR nitidamente visível; raízes dorsais ocupando MENOS da metade da área do saco dural", "Presente", "Sem estenose ou estenose mínima" ] }, { "status": null, "celulas": [ "A2", "LCR nitidamente visível; raízes dorsais em configuração de ferradura, tocando a dura", "Presente", "Sem estenose ou estenose mínima" ] }, { "status": null, "celulas": [ "A3", "LCR nitidamente visível; raízes dorsais ocupando MAIS da metade da área", "Presente", "Sem estenose ou estenose mínima" ] }, { "status": null, "celulas": [ "A4", "LCR nitidamente visível; raízes em posição CENTRAL ocupando a maior parte da área", "Presente", "Sem estenose ou estenose mínima" ] }, { "status": null, "celulas": [ "B", "Raízes ocupam todo o saco dural mas ainda são individualizáveis; ainda há LCR, com aspecto granulado", "Presente", "Estenose moderada" ] }, { "status": null, "celulas": [ "C", "Nenhuma raiz identificável; saco dural com sinal cinzento homogêneo, sem sinal de LCR", "Presente", "Estenose grave" ] }, { "status": null, "celulas": [ "D", "Nenhuma raiz identificável, como no grau C", "AUSENTE", "Estenose extrema" ] } ] }, { "id": "rm_coluna_msk.c3", "grupo": "rm_coluna_msk", "nome": "Goutallier — fatty infiltration of the rotator cuff muscles", "nota": null, "fonte": "Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. \"Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan\". Clin Orthop Relat Res 1994;(304):78-83 (PMID 8020238) — 63 pacientes no pré-operatório, 57 com seguimento (média 17,7 meses); a degeneração do infraespinal nunca regrediu no pós-operatório e influenciou negativamente o resultado do reparo do supraespinal (recidiva em 25% dos reparos de supraespinal) · adaptação para RM em T1: Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. J Shoulder Elbow Surg 1999 · corte de leitura: imagem parassagital mais lateral em que a espinha da escápula ainda toca o corpo escapular", "colunas": [ "Stage", "Finding (original CT, 1994)", "MRI reading (parasagittal T1)", "Severity" ], "linhas": [ { "status": null, "celulas": [ "0", "Músculo completamente normal, sem qualquer estria gordurosa", "Sem estrias gordurosas", "Normal" ] }, { "status": null, "celulas": [ "1", "Algumas estrias gordurosas", "Estrias gordurosas tênues", "Normal a leve" ] }, { "status": null, "celulas": [ "2", "Infiltração gordurosa importante, mas ainda há mais músculo que gordura", "Músculo > gordura", "Moderada" ] }, { "status": null, "celulas": [ "3", "Tanta gordura quanto músculo", "Músculo ≈ gordura", "Grave" ] }, { "status": null, "celulas": [ "4", "Mais gordura que músculo", "Gordura > músculo", "Grave" ] } ] }, { "id": "rm_coluna_msk.c4", "grupo": "rm_coluna_msk", "nome": "Outerbridge (modified) and ICRS — chondral lesion", "nota": null, "fonte": "Outerbridge RE, J Bone Joint Surg Br 1961 (descrição original para condromalácia patelar, com o divisor de área em meia polegada; estendida a todo o joelho e depois a outras articulações) · revisão de referência: Slattery C, Kweon CY. \"Classifications in Brief: Outerbridge Classification of Chondral Lesions\". Clin Orthop Relat Res 2018;476(10):2101-4 (PMID 29533246) · ICRS: International Cartilage Repair Society (escala de 5 categorias, com graduação por profundidade e dimensão)", "colunas": [ "Grade", "Outerbridge (arthroscopy, 1961)", "MRI correlate", "ICRS" ], "linhas": [ { "status": null, "celulas": [ "0", "Cartilagem normal", "Espessura e sinal cartilaginosos normais", "0 — normal" ] }, { "status": null, "celulas": [ "I", "Amolecimento e edema da cartilagem", "Alteração de sinal com superfície ainda íntegra", "1 — quase normal: amolecimento e/ou fissuras superficiais" ] }, { "status": null, "celulas": [ "II", "Fragmentação e fissuras em área de ≤ 1,3 cm de diâmetro (\"meia polegada\" no texto original = 1,27 cm)", "Defeito acometendo menos de 50% da espessura", "2 — anormal: defeito < 50% da espessura" ] }, { "status": null, "celulas": [ "III", "Fragmentação e fissuras em área > 1,3 cm de diâmetro", "Defeito ≥ 50% da espessura, sem exposição do osso", "3 — gravemente anormal: > 50% da espessura, até a camada calcificada / placa subcondral, sem atravessá-la" ] }, { "status": null, "celulas": [ "IV", "Erosão da cartilagem com exposição do osso subcondral", "Perda condral total, com alteração de sinal do osso subcondral", "4 — gravemente anormal: atravessa a placa subcondral" ] } ] }, { "id": "rm_coluna_msk.c5", "grupo": "rm_coluna_msk", "nome": "Fardon 2.0 — lumbar disc nomenclature (NASS/ASSR/ASNR)", "nota": null, "fonte": "NASS/ASSR/ASNR — Lumbar Disc Nomenclature version 2.0, 2014. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Spine J 2014;14(11):2525-45 (PMID 24768732) · publicação simultânea: Spine 2014;39(24):E1448-65 · substitui o documento de 2001 (Fardon & Milette)", "colunas": [ "Preferred term", "Definition", "How to recognize / what to report" ], "linhas": [ { "status": null, "celulas": [ "Abaulamento (bulge)", "Contorno do ânulo externo além dos anéis apofisários em MAIS de 25% (> 90°) da circunferência, em geral < 3 mm além das bordas apofisárias", "NÃO é hérnia, em nenhuma extensão. Acima de 50% (180°) é 'generalizado' — e por isso jamais pode ser chamado de hérnia. Não usar \"hérnia difusa\". Pode ser variante, adaptativo (escoliose, listese) ou degenerativo" ] }, { "status": null, "celulas": [ "Hérnia focal", "Deslocamento LOCALIZADO de material discal em MENOS de 25% da circunferência", "Relatar zona (central, subarticular, foraminal, extraforaminal) e nível craniocaudal" ] }, { "status": null, "celulas": [ "Hérnia de base larga", "Deslocamento localizado acometendo 25-50% da circunferência", "Ainda é hérnia (broad-based). Faixa que se sobrepõe à do abaulamento: desempatar pela morfologia (material deslocado com base definível = hérnia; contorno liso e generalizado do ânulo = abaulamento). Acima de 50% nunca é hérnia" ] }, { "status": null, "celulas": [ "Protrusão", "A maior distância entre as bordas do material herniado é MENOR que a distância entre as bordas da base, em TODOS os planos", "Base ampla em relação ao ápice; medir no axial e no sagital" ] }, { "status": null, "celulas": [ "Extrusão", "Em PELO MENOS UM plano, a distância entre as bordas do material é MAIOR que a da base", "Aspecto em cogumelo, colo estreito; basta um plano positivo" ] }, { "status": null, "celulas": [ "Sequestro", "Fragmento deslocado que PERDEU continuidade com o disco-mãe", "Todo sequestro é extrusão. Localizar o fragmento livre" ] }, { "status": null, "celulas": [ "Migração", "Deslocamento do material para longe do sítio de extrusão, sequestrado ou não", "Relatar sentido (cranial/caudal) e se é subligamentar ou transligamentar" ] }, { "status": null, "celulas": [ "Fissura anular", "Ruptura das fibras do ânulo (radial, concêntrica ou transversa)", "Preferir \"fissura\" a \"rasgo/tear\", que sugere trauma. Zona de alta intensidade (HIZ) é achado associado" ] } ] }, { "id": "rm_coluna_msk.c6", "grupo": "rm_coluna_msk", "nome": "Meyerding — spondylolisthesis grade", "nota": null, "fonte": "Meyerding HW, 1932 (descrição original, com quatro graus; o grau V/espondiloptose foi incorporado posteriormente) · revisão de referência: \"Classification in Brief: The Meyerding Classification System of Spondylolisthesis\", Clin Orthop Relat Res 2020 (PMID 32282463) — graduação sobre radiografia em perfil, ortostática e neutra", "colunas": [ "Grade", "Anterior slip", "Comment" ], "linhas": [ { "status": null, "celulas": [ "I", "0-25%", "Divide-se o platô superior da vértebra caudal em 4 quadrantes iguais" ] }, { "status": null, "celulas": [ "II", "25-50%", "O grau é o percentual do platô descoberto pelo escorregamento" ] }, { "status": null, "celulas": [ "III", "50-75%", "Instabilidade progressivamente mais provável" ] }, { "status": null, "celulas": [ "IV", "75-100%", "Frequentemente sintomática e com estenose associada" ] }, { "status": null, "celulas": [ "V", "> 100%", "Espondiloptose — deslocamento completo" ] } ] }, { "id": "rm_coluna_msk.c7", "grupo": "rm_coluna_msk", "nome": "Lee — lumbar foraminal stenosis on MRI", "nota": null, "fonte": "Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, Kang HS. \"A practical MRI grading system for lumbar foraminal stenosis\". AJR Am J Roentgenol 2010;194(4):1095-8 — 576 forames em 96 pacientes (L3-L4 a L5-S1); concordância inter e intraobservador quase perfeita (κ 0,80-1,00)", "colunas": [ "Grade", "Perineural fat obliteration (sagittal)", "Nerve root morphology", "Reading" ], "linhas": [ { "status": null, "celulas": [ "0", "Gordura perineural preservada", "Normal", "Sem estenose foraminal" ] }, { "status": null, "celulas": [ "1", "Obliteração em DUAS direções opostas — vertical OU transversa", "Normal", "Estenose foraminal leve" ] }, { "status": null, "celulas": [ "2", "Obliteração nas QUATRO direções — vertical E transversa", "Normal", "Estenose foraminal moderada" ] }, { "status": null, "celulas": [ "3", "—", "Colapso ou alteração morfológica da raiz", "Estenose foraminal grave" ] } ] } ] }, { "metodo": "RM", "chave": "rm_abdome", "slug": "rm-abdome", "nome": "MRI — Abdomen", "temPaginaPublica": false, "medidas": [ { "id": "rm_abdome.0", "grupo": "rm_abdome", "ruleId": null, "rotulo": "LI-RADS — minimum size for LR-5 (definite HCC)", "valor": "10 mm", "unidade": "mm", "nota": "A 10–19 mm observation with nonrim APHE plus nonperipheral washout is LR-5 in v2018; the same size range with APHE plus threshold growth is also LR-5. Below 10 mm the ceiling is LR-4. No observation can be LR-5 without nonrim APHE. v2018 removed the '-us' and '-g' qualifiers (LR-5us/LR-5g) and simplified threshold growth — note that the former antecedent-US visibility requirement applied to the GROWTH pathway (LR-5us), never to the washout pathway, which was always full LR-5.", "fonte": "ACR CT/MRI LI-RADS v2018 (ACR) · Chernyak et al., Radiology 2018;289(3):816-830 (PMID 30251931)", "faixas": [ { "status": "yellow", "rotulo": "< 10 mm — LR-4 at most", "valor": "< 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "10–19 mm with APHE + washout or threshold growth — LR-5", "valor": "10–19 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "≥ 20 mm with APHE + 1 additional major feature — LR-5", "valor": "≥ 20 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_abdome.1", "grupo": "rm_abdome", "ruleId": null, "rotulo": "LI-RADS — threshold growth", "valor": "≥ 50% de aumento em ≤ 6 meses", "unidade": null, "nota": "Simplified in v2018 to match OPTN. Any other increase is subthreshold growth and does NOT count as a major feature — a common error is treating 12-month growth as threshold growth.", "fonte": "ACR CT/MRI LI-RADS v2018 (ACR) · Chernyak et al., Radiology 2018;289(3):816-830 — alinhado à definição OPTN", "faixas": [] }, { "id": "rm_abdome.2", "grupo": "rm_abdome", "ruleId": null, "rotulo": "LI-RADS MRI — phase for washout assessment, by contrast agent", "valor": "Gadoxetato: somente fase portal · Extracelular e gadobenato: portal OU tardia", "unidade": null, "nota": "The restriction belongs to the agent, not the class. With extracellular gadolinium AND with gadobenate dimeglumine, washout counts on portal venous or delayed phase. Only with gadoxetate disodium is assessment restricted to the portal venous phase, because transitional- and hepatobiliary-phase hypointensity reflects parenchymal hepatocyte uptake rather than washout — using it overcalls the category. The mirror-image error is just as serious: discarding a legitimate delayed-phase washout by assuming every hepatobiliary agent follows the gadoxetate rule.", "fonte": "ACR CT/MRI LI-RADS v2018 (ACR) · Chernyak et al., Radiology 2018;289(3):816-830 (PMID 30251931)", "faixas": [] }, { "id": "rm_abdome.3", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Hepatobiliary phase — acquisition delay", "valor": "≈ 20 min (gadoxetato); 1–3 h (gadobenato)", "unidade": "min", "nota": "In the hepatobiliary phase the parenchyma is hyperintense relative to vessels with biliary excretion of contrast. Used as an ancillary feature (HBP hypointensity favors malignancy), never as a major feature. Gadobenate is a hepatobiliary agent but — unlike gadoxetate — imposes no phase restriction on washout assessment.", "fonte": "ACR CT/MRI LI-RADS v2018 — recomendações técnicas (ACR) · Chernyak et al., Radiology 2018;289(3):816-830", "faixas": [] }, { "id": "rm_abdome.4", "grupo": "rm_abdome", "ruleId": null, "rotulo": "PDFF — hepatic steatosis threshold (grade ≥ 1)", "valor": "6,4%", "unidade": "%", "nota": "High-specificity thresholds validated in an independent biopsy cohort (3 T, 89 adults): 6.4% → 86% sensitivity / 83% specificity. Do not confuse with the 5% histologic hepatocyte threshold — PDFF is a fat proton fraction, not a percentage of hepatocytes.", "fonte": "Tang et al., Radiology 2013;267(2):422-431 (PMID 23382291) · validação: Tang et al., Radiology 2015;274(2):416-425 (PMID 25247408)", "faixas": [ { "status": "green", "rotulo": "No steatosis", "valor": "< 6,4%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Grade 1 steatosis", "valor": "6,4–17,3%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Grade ≥ 2 steatosis", "valor": "≥ 17,4%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_abdome.5", "grupo": "rm_abdome", "ruleId": null, "rotulo": "PDFF — relative decline associated with histologic response (MASH/NASH)", "valor": "≥ 30% de redução relativa", "unidade": "%", "nota": "Meta-analysis of 7 trials (346 patients): a ≥30% PDFF decline yielded histologic response in 51% vs 14% (OR 6.98; 95% CI 2.38–20.43) and NASH resolution in 41% vs 7% (OR 5.45). This is a RELATIVE decline (e.g. 20% → 14%), not a 30-percentage-point drop.", "fonte": "Stine et al., Clin Gastroenterol Hepatol 2021;19(11):2274-2283 (PMID 32882428)", "faixas": [] }, { "id": "rm_abdome.6", "grupo": "rm_abdome", "ruleId": null, "rotulo": "MRE — liver stiffness for significant fibrosis (≥ F2)", "valor": "3,5 kPa", "unidade": "kPa", "nota": "Single thresholds proposed for most etiologies by the LI-RADS Quantitative Imaging Working Group and the SAR Liver Fibrosis panel: 3.0 (≥F1), 3.5 (≥F2), 4.0 (≥F3), 5.0 (F4). Raising stiffness WITHOUT fibrosis: acute inflammation/active hepatitis, elevated transaminases, cholestasis, hepatic congestion, portal hypertension, edema and the postprandial state. A rapid drop on antiviral therapy usually reflects reduced inflammation, not fibrosis regression.", "fonte": "Moura Cunha et al., Radiology 2024;310(3):e231220 (PMID 38470236) — LI-RADS QIWG / SAR Liver Fibrosis Disease Focus Panel", "faixas": [ { "status": "green", "rotulo": "Fibrosis unlikely (F0)", "valor": "< 3,0 kPa", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Mild to significant fibrosis (F1–F2)", "valor": "3,0–3,9 kPa", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Advanced fibrosis / cirrhosis (F3–F4)", "valor": "≥ 4,0 kPa", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_abdome.7", "grupo": "rm_abdome", "ruleId": null, "rotulo": "MRE — cirrhosis threshold (F4)", "valor": "5,0 kPa", "unidade": "kPa", "nota": "Above 5.0 kPa, report stiffness as a continuous variable rather than a category alone: in established cirrhosis histology lumps everyone into one stage, but the absolute value still stratifies risk.", "fonte": "Moura Cunha et al., Radiology 2024;310(3):e231220 (PMID 38470236)", "faixas": [] }, { "id": "rm_abdome.8", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Liver R2* at 1.5 T — healthy controls", "valor": "39,9 ± 2,8 Hz", "unidade": "Hz", "nota": "Mean (± SEM) of 13 controls at 1.5 T, corresponding to an estimated HIC of ≈1.2 mg/g dry weight. Reference valid only at 1.5 T — at 3 T R2* roughly doubles for the same iron burden.", "fonte": "Wood et al., Blood 2005;106(4):1460-1465 (PMID 15860670)", "faixas": [] }, { "id": "rm_abdome.9", "grupo": "rm_abdome", "ruleId": null, "rotulo": "R2* → hepatic iron concentration conversion (1.5 T)", "valor": "HIC (mg/g peso seco) = 0,0254 × R2* (Hz) + 0,202", "unidade": null, "nota": "Biopsy-validated calibration for HIC of 1.33–32.9 mg/g (r² ≥ 0.95). Extrapolation outside this range is unreliable. Combining R2 and R2* did not improve accuracy.", "fonte": "Wood et al., Blood 2005;106(4):1460-1465 (PMID 15860670)", "faixas": [] }, { "id": "rm_abdome.10", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Myocardial T2* — cardiac iron overload (cardiac MRI, adjunct to the iron-overload protocol)", "valor": "< 20 ms", "unidade": "ms", "nota": "A CARDIAC MRI measurement, included here because it belongs to the same iron-overload protocol as liver R2* — it is not an abdominal measurement. All patients with ventricular dysfunction had myocardial T2* < 20 ms. Cardiac iron is NOT predictable from serum ferritin or liver iron — hence it is an independent measurement.", "fonte": "Anderson et al., Eur Heart J 2001;22(23):2171-2179 (PMID 11913479)", "faixas": [ { "status": "green", "rotulo": "No detectable cardiac iron", "valor": "≥ 20 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Cardiac iron overload", "valor": "< 20 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_abdome.11", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Common bile duct — normal caliber (64-slice CT reference, extended to MRCP)", "valor": "até 6 mm", "unidade": "mm", "nota": "MIND THE MODALITY: the reference series is 64-slice CT (604 adults with gallbladder in situ), not MRCP. Mean largest diameter 4.77 ± 1.81 mm (range 1.8–11.8 mm), increasing significantly with age. A reasonable upper limit is 8 mm after age 50 and 10 mm after cholecystectomy (mean 7.28 ± 2.37 mm). Caliber alone does not establish obstruction: correlate with bilirubin, transition point and stone presence.", "fonte": "Senturk et al., Eur J Radiol 2012;81(1):39-42 (PMID 21144686) — série de TC de 64 canais", "faixas": [ { "status": "green", "rotulo": "Normal (gallbladder in situ)", "valor": "≤ 6 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline — acceptable if > 50 y (in situ) or post-cholecystectomy", "valor": "7–8 mm (in situ, > 50 anos) · 7–10 mm (pós-colecistectomia)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Dilated — investigate obstruction", "valor": "> 8 mm (in situ) · > 10 mm (pós-colecistectomia)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_abdome.12", "grupo": "rm_abdome", "ruleId": null, "rotulo": "MRCP — accuracy for choledocholithiasis", "valor": "Sensibilidade 93% / especificidade 96%", "unidade": "%", "nota": "Cochrane meta-analysis; the MRCP arm pooled 7 studies (996 participants; 361 cases): sensitivity 0.93 (95% CI 0.87–0.96), specificity 0.96 (95% CI 0.90–0.98), with no statistical difference from EUS (p = 0.5). Included studies were of poor methodological quality. A negative MRCP with persistent symptoms does not end the workup.", "fonte": "Giljaca et al., Cochrane Database Syst Rev 2015;2:CD011549 (PMID 25719224)", "faixas": [] }, { "id": "rm_abdome.13", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Main pancreatic duct — main-duct IPMN definition", "valor": "> 5 mm", "unidade": "mm", "nota": "MPD dilatation > 5 mm without another obstructive cause defines main-duct involvement. 5–9.9 mm is a worrisome feature; ≥ 10 mm is a high-risk stigma.", "fonte": "Ohtsuka et al., Kyoto guidelines, Pancreatology 2024;24(2):255-270 (PMID 38182527)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "< 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Worrisome feature", "valor": "5–9,9 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "High-risk stigma", "valor": "≥ 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_abdome.14", "grupo": "rm_abdome", "ruleId": null, "rotulo": "IPMN — enhancing mural nodule", "valor": "≥ 5 mm = high-risk stigma", "unidade": "mm", "nota": "An enhancing nodule ≥ 5 mm or a solid component is an absolute surgical indication in a fit patient; a nodule < 5 mm is a worrisome feature. Contrast MRI outperforms CT in separating a mural nodule from a mucin plug (non-enhancing, no restricted diffusion).", "fonte": "Ohtsuka et al., Kyoto guidelines, Pancreatology 2024;24(2):255-270 (PMID 38182527)", "faixas": [] }, { "id": "rm_abdome.15", "grupo": "rm_abdome", "ruleId": null, "rotulo": "IPMN — cyst growth rate", "valor": "≥ 2,5 mm/ano", "unidade": "mm/ano", "nota": "Threshold revised in the 2024 Kyoto guidelines (prior series ranged from 0.96 to 3.5 mm/year). In practice it replaces the old > 5 mm in 2 years criterion.", "fonte": "Ohtsuka et al., Kyoto guidelines, Pancreatology 2024;24(2):255-270 (PMID 38182527)", "faixas": [] }, { "id": "rm_abdome.16", "grupo": "rm_abdome", "ruleId": null, "rotulo": "IPMN — stopping surveillance", "valor": "Reavaliar após 5 anos estáveis", "unidade": null, "nota": "For a small unchanged BD-IPMN after 5 years of surveillance, Kyoto 2024 explicitly allows two options: stop surveillance, or continue because of the risk of concomitant pancreatic ductal adenocarcinoma (independent of the cyst).", "fonte": "Ohtsuka et al., Kyoto guidelines, Pancreatology 2024;24(2):255-270 (PMID 38182527)", "faixas": [] }, { "id": "rm_abdome.17", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Adrenal — signal intensity index (in/opposed phase)", "valor": "≥ 16,5%", "unidade": "%", "nota": "SII = [(in-phase SI − opposed-phase SI) / in-phase SI] × 100. Across 102 adrenal tumors there was no overlap BETWEEN ADENOMAS AND METASTASES using a cutoff between 11.2% and 16.5% (100% accuracy for that comparison). SII outperformed adrenal-to-spleen, adrenal-to-muscle and adrenal-to-liver ratios. SAFETY RULE: non-overlap was not shown for pheochromocytoma (9 cases in the series, outside that comparison), adrenocortical carcinoma or clear-cell renal carcinoma metastasis — all can contain lipid and drop signal. Signal drop does NOT downgrade a lesion with suspicious morphology, documented growth or an oncologic context. Additional caveat: hepatic steatosis invalidates the adrenal-to-liver ratio, and lipid-poor adenomas show no signal drop.", "fonte": "Fujiyoshi et al., AJR Am J Roentgenol 2003;180(6):1649-1657 (PMID 12760936)", "faixas": [ { "status": "green", "rotulo": "Signal drop consistent with lipid-rich adenoma — only if morphology is not suspicious", "valor": "≥ 16,5%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Study's intermediate zone", "valor": "11,2–16,4%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "No signal drop — not characterized as adenoma", "valor": "< 11,2%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_abdome.18", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Adrenal — size and malignancy risk", "valor": "≥ 4 cm com heterogeneidade ou HU > 20", "unidade": "cm", "nota": "ESE/ENSAT 2023 guideline: a homogeneous lesion with ≤ 10 HU on unenhanced CT is benign regardless of size and needs no further IMAGING (the previous 4 cm limitation was removed). Lesions ≥ 4 cm that are inhomogeneous or have HU > 20 carry a relevant malignancy risk and surgery is the usual management, preceded by multidisciplinary discussion; the rest go to multidisciplinary discussion. NOTE: 'no further imaging' is not 'no further workup' — hormonal assessment remains mandatory for EVERY adrenal incidentaloma (1 mg overnight dexamethasone suppression test plus metanephrines), including lesions judged benign on imaging.", "fonte": "Fassnacht et al., ESE/ENSAT clinical practice guidelines, Eur J Endocrinol 2023;189(1):G1-G42 (PMID 37318239)", "faixas": [] }, { "id": "rm_abdome.19", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Bosniak v2019 — wall and septal thickness", "valor": "≤ 2 mm / 3 mm / ≥ 4 mm", "unidade": "mm", "nota": "Smooth wall or septum ≤ 2 mm: Bosniak I/II. Smooth minimal thickening of 3 mm with enhancement, or ≥ 4 thin enhancing septa: IIF. Thick (≥ 4 mm) or irregular enhancing wall/septum: III. Measure at the thickest portion; enhancement must be unequivocal.", "fonte": "Silverman et al., Bosniak Classification version 2019 — An Update Proposal and Needs Assessment, Radiology 2019;292(2):475-488 (PMID 31210616)", "faixas": [] }, { "id": "rm_abdome.20", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Bosniak v2019 on MRI — hemorrhagic/proteinaceous cyst (class II)", "valor": "T1 sem contraste e SEM saturação de gordura ≈ 2,5 × o parênquima renal", "unidade": null, "nota": "MRI-only, sequence-dependent criterion: a homogeneously T1-hyperintense mass on unenhanced, NON-fat-saturated T1 with signal approximately 2.5 times normal renal parenchyma is Bosniak II. A HETEROGENEOUSLY hyperintense mass on unenhanced FAT-SATURATED T1, without higher-class features, falls into IIF. Measuring on the wrong sequence changes the class.", "fonte": "Silverman et al., Radiology 2019;292(2):475-488 (PMID 31210616)", "faixas": [] }, { "id": "rm_abdome.21", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Bosniak v2019 — enhancing nodule definition (class IV)", "valor": "≥ 4 mm com margem obtusa, ou qualquer tamanho com margem aguda", "unidade": "mm", "nota": "v2019 made the nodule a geometric, not subjective, definition: a focal convex protrusion with acute margins (any size) or with obtuse margins measuring ≥ 4 mm. Obtuse-margin protrusions ≤ 3 mm count as irregularity (class III), not as a nodule.", "fonte": "Silverman et al., Radiology 2019;292(2):475-488 (PMID 31210616)", "faixas": [] }, { "id": "rm_abdome.22", "grupo": "rm_abdome", "ruleId": null, "rotulo": "Liver diffusion — ADC in LR-3 nodules (NO validated cutoff)", "valor": "Sem corte validado — ADC médio: benigno 1,41 ± 0,31 × maligno 1,01 ± 0,15 (×10⁻³ mm²/s)", "unidade": "×10⁻³ mm²/s", "nota": "There is no externally validated ADC cutoff for reclassifying LR-3 nodules. A single-center retrospective study (122 lesions in 88 patients; 68 benign, 54 malignant) reported mean ADC of 1.01 ± 0.15 in malignant and 1.41 ± 0.31 in benign lesions (p < 0.0001), with AUC 0.909, 92.6% sensitivity and 74.1% specificity. Diffusion is an ANCILLARY LI-RADS feature — ADC alone never upgrades to LR-5, and absolute values vary with b-values, field strength and vendor. Use it as supporting evidence, never as a numeric management cutoff.", "fonte": "Chen et al., Front Oncol 2023;13:1186290 (PMID 37675222) — estudo unicêntrico retrospectivo, sem validação externa", "faixas": [] } ], "classificacoes": [ { "id": "rm_abdome.c0", "grupo": "rm_abdome", "nome": "LI-RADS v2018 (contrast-enhanced MRI) — diagnostic table (LR-3 to LR-5, LR-M and LR-TIV)", "nota": null, "fonte": "ACR CT/MRI LI-RADS v2018 (ACR) · Chernyak et al., Radiology 2018;289(3):816-830 (PMID 30251931) · Marks RM, Masch WR, Chernyak V. LI-RADS: Past, Present, and Future. AJR Am J Roentgenol 2021;216(2):295-304 (PMID 33052720)", "colunas": [ "Size", "Nonrim APHE", "Additional major features", "Category" ], "linhas": [ { "status": null, "celulas": [ "< 10 mm", "Presente", "Nenhuma", "LR-3" ] }, { "status": null, "celulas": [ "< 10 mm", "Presente", "≥ 1 (washout, cápsula ou crescimento limiar)", "LR-4" ] }, { "status": null, "celulas": [ "10–19 mm", "Presente", "Nenhuma", "LR-3" ] }, { "status": null, "celulas": [ "10–19 mm", "Presente", "Apenas cápsula com realce", "LR-4" ] }, { "status": null, "celulas": [ "10–19 mm", "Presente", "Washout não periférico", "LR-5" ] }, { "status": null, "celulas": [ "10–19 mm", "Presente", "Crescimento limiar (≥ 50% em ≤ 6 meses)", "LR-5" ] }, { "status": null, "celulas": [ "≥ 20 mm", "Presente", "Nenhuma", "LR-4" ] }, { "status": null, "celulas": [ "≥ 20 mm", "Presente", "≥ 1", "LR-5" ] }, { "status": null, "celulas": [ "Qualquer", "Ausente", "—", "Nunca LR-5 (LR-3 ou LR-4)" ] }, { "status": null, "celulas": [ "Qualquer", "Em anel (rim APHE)", "Washout periférico e/ou realce central tardio (alvo)", "LR-M — provável malignidade não-CHC" ] }, { "status": null, "celulas": [ "Qualquer", "—", "Tumor no interior de veia", "LR-TIV" ] } ] }, { "id": "rm_abdome.c1", "grupo": "rm_abdome", "nome": "MRI-PDFF — hepatic steatosis grading", "nota": null, "fonte": "Tang et al., Radiology 2013;267(2):422-431 (PMID 23382291) · Tang et al., Radiology 2015;274(2):416-425 (PMID 25247408) · Stine et al., Clin Gastroenterol Hepatol 2021;19(11):2274-2283 (PMID 32882428)", "colunas": [ "Histologic grade", "PDFF threshold", "Sensitivity / specificity" ], "linhas": [ { "status": null, "celulas": [ "Grau 0 (sem esteatose)", "< 6,4%", "—" ] }, { "status": null, "celulas": [ "Grau ≥ 1", "≥ 6,4%", "86% / 83%" ] }, { "status": null, "celulas": [ "Grau ≥ 2", "≥ 17,4%", "64% / 96%" ] }, { "status": null, "celulas": [ "Grau 3", "≥ 22,1%", "71% / 92%" ] }, { "status": null, "celulas": [ "Resposta ao tratamento (MASH)", "Queda relativa ≥ 30%", "Resposta histológica 51% × 14% (OR 6,98)" ] } ] }, { "id": "rm_abdome.c2", "grupo": "rm_abdome", "nome": "MR elastography (MRE) — fibrosis staging", "nota": null, "fonte": "Moura Cunha et al., Radiology 2024;310(3):e231220 (PMID 38470236) — LI-RADS Quantitative Imaging Working Group e SAR Liver Fibrosis Disease Focus Panel", "colunas": [ "Liver stiffness (60 Hz)", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "< 3,0 kPa", "Fibrose improvável (F0)" ] }, { "status": null, "celulas": [ "≥ 3,0 kPa", "Fibrose F1 ou maior" ] }, { "status": null, "celulas": [ "≥ 3,5 kPa", "Fibrose significativa (F2 ou maior)" ] }, { "status": null, "celulas": [ "≥ 4,0 kPa", "Fibrose avançada (F3 ou maior)" ] }, { "status": null, "celulas": [ "≥ 5,0 kPa", "Cirrose (F4)" ] } ] }, { "id": "rm_abdome.c3", "grupo": "rm_abdome", "nome": "IPMN — Kyoto guidelines 2024 (high-risk stigmata vs worrisome features)", "nota": null, "fonte": "Ohtsuka T, Fernandez-del Castillo C, Furukawa T et al., International evidence-based Kyoto guidelines, Pancreatology 2024;24(2):255-270 (PMID 38182527) — itens de linfonodomegalia, CA 19-9, pancreatite aguda e mudança abrupta de calibre mantidos de Fukuoka 2017", "colunas": [ "Group", "Finding", "Management" ], "linhas": [ { "status": null, "celulas": [ "High-risk stigmata", "Icterícia obstrutiva com lesão cística na cabeça do pâncreas", "Cirurgia em paciente apto" ] }, { "status": null, "celulas": [ "High-risk stigmata", "Nódulo mural com realce ≥ 5 mm ou componente sólido", "Cirurgia em paciente apto" ] }, { "status": null, "celulas": [ "High-risk stigmata", "Ducto pancreático principal ≥ 10 mm", "Cirurgia em paciente apto" ] }, { "status": null, "celulas": [ "High-risk stigmata", "Citologia suspeita ou positiva para malignidade (EUS-PAAF)", "Cirurgia em paciente apto" ] }, { "status": null, "celulas": [ "Worrisome feature", "Cisto ≥ 30 mm", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Nódulo mural com realce < 5 mm", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Parede do cisto espessada ou com realce", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Ducto pancreático principal 5–9,9 mm", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Mudança abrupta de calibre do ducto com atrofia parenquimatosa distal", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Linfonodomegalia regional", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "CA 19-9 sérico elevado", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Crescimento do cisto ≥ 2,5 mm/ano", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Pancreatite aguda atribuível ao cisto", "EUS e vigilância intensificada" ] }, { "status": null, "celulas": [ "Worrisome feature", "Diabetes de início recente ou piora do controle glicêmico", "EUS e vigilância intensificada" ] } ] }, { "id": "rm_abdome.c4", "grupo": "rm_abdome", "nome": "Bosniak v2019 applied to MRI — renal cysts", "nota": null, "fonte": "Silverman SG et al., Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment, Radiology 2019;292(2):475-488 (PMID 31210616) — SAR Disease-Focused Panel on Renal Cell Carcinoma; atualização pendente de validação externa", "colunas": [ "Class", "MRI criteria", "Malignancy risk / management" ], "linhas": [ { "status": null, "celulas": [ "I", "Cisto simples, parede lisa e bem definida ≤ 2 mm, sem septos", "Benigno — sem seguimento" ] }, { "status": null, "celulas": [ "II", "Até 3 septos finos (≤ 2 mm); ou massa homogeneamente hiperintensa em T2 semelhante ao LCR; ou massa homogeneamente hiperintensa em T1 sem contraste e SEM saturação de gordura ≈ 2,5 × o parênquima renal", "Benigno — sem seguimento" ] }, { "status": null, "celulas": [ "IIF", "≥ 4 septos finos (≤ 2 mm) com realce; ou espessamento liso mínimo de 3 mm da parede/septo com realce; ou massa heterogeneamente hiperintensa em T1 sem contraste COM saturação de gordura", "Provavelmente benigno — seguimento por imagem" ] }, { "status": null, "celulas": [ "III", "Parede ou septo espesso (≥ 4 mm) ou irregular, com realce, sem nódulo", "≈ 50% malignos — avaliação urológica" ] }, { "status": null, "celulas": [ "IV", "Nódulo com realce: protrusão convexa de margem aguda (qualquer tamanho) ou de margem obtusa ≥ 4 mm", "≈ 90% malignos — tratamento" ] } ] } ] }, { "metodo": "RM", "chave": "rm_pelve", "slug": "rm-pelve", "nome": "MRI — Male and female pelvis", "temPaginaPublica": false, "medidas": [ { "id": "rm_pelve.0", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Prostate volume — ellipsoid formula", "valor": "0,52 × AP × TR × CC", "unidade": "cm³", "nota": "PI-RADS v2.1 standardizes AP and CC on the mid-sagittal T2 and the transverse diameter on axial T2. This is the volume that feeds PSA density. Because volume grows with BPH, PSAd performs better than PSA alone in large glands.", "fonte": "PI-RADS v2.1 (ACR/ESUR/AdMeTech 2019) — Turkbey et al., Eur Urol 2019 · The Radiology Assistant (Prostate Cancer PI-RADS v2.1)", "faixas": [] }, { "id": "rm_pelve.1", "grupo": "rm_pelve", "ruleId": null, "rotulo": "PSA density (PSAD)", "valor": "< 0,15", "unidade": "ng/mL/cm³", "nota": "PSAD = serum total PSA ÷ MRI-measured prostate volume. NCCN uses < 0.15 as a very-low-risk marker; PI-RADS v2.1 teaching material (The Radiology Assistant) presents ≥ 0.20 as reinforcing suspicion for clinically significant cancer — it is not a normative ACR/ESUR recommendation. Optimal cutoffs vary by zone across studies (0.25 in PZ, 0.33 in TZ in one cohort), so use it to modulate PI-RADS 3 rather than as a hard threshold.", "fonte": "NCCN Prostate Cancer (corte 0,15) · The Radiology Assistant — PI-RADS v2.1 (valor 0,20); cortes por zona em PMC9024291 (2022)", "faixas": [ { "status": "green", "rotulo": "very low risk (NCCN)", "valor": "< 0,15 ng/mL/cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "intermediate zone", "valor": "0,15–0,19 ng/mL/cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "reinforces suspicion", "valor": "≥ 0,20 ng/mL/cm³", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_pelve.2", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Prostate lesion — size cutoff separating PI-RADS 4 from 5", "valor": "1,5", "unidade": "cm", "nota": "A finding that would score 4 (PZ: markedly hypointense on ADC AND markedly hyperintense on high-b DWI; TZ: lenticular or non-circumscribed, homogeneous, moderately hypointense) becomes 5 when it measures ≥ 1.5 cm in greatest dimension. Definite extraprostatic extension or invasive behavior makes it 5 regardless of size.", "fonte": "PI-RADS v2.1 (ACR/ESUR/AdMeTech 2019) — Turkbey et al., Eur Urol 2019", "faixas": [] }, { "id": "rm_pelve.3", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Curvilinear capsular contact length — EPE grade threshold", "valor": "1,5", "unidade": "cm", "nota": "In the Mehralivand system, curvilinear capsular contact ≥ 1.5 cm OR capsular bulge/irregularity defines grade 1; both together define grade 2; frank capsular breach with measurable tumor in the periprostatic space defines grade 3.", "fonte": "Mehralivand et al., Radiology 2019;290(3):709–719 (PMID 30667329)", "faixas": [] }, { "id": "rm_pelve.4", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Pathologically confirmed EPE rate, by EPE grade", "valor": "24 (grau 1) · 38 (grau 2) · 66 (grau 3)", "unidade": "%", "nota": "Rates from the derivation cohort (18/74, 39/102 and 37/56). Use them to calibrate risk language in the report — 'intermediate risk of extraprostatic extension' rather than yes/no — not as an individual patient probability.", "fonte": "Mehralivand et al., Radiology 2019;290(3):709–719 (PMID 30667329)", "faixas": [] }, { "id": "rm_pelve.5", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Junctional zone (JZ) — maximum thickness", "valor": "< 8", "unidade": "mm", "nota": "Measure maximal JZ thickness on T2, sweeping sagittal, axial and coronal planes — measuring on sagittal alone underestimates maximal JZ. Below 8 mm effectively excludes adenomyosis; 8–12 mm is an indeterminate band requiring ancillary criteria; ≥ 12 mm is the most frequently used MRI criterion. The JZ is physiologically thicker in the secretory phase and thin or ill-defined after menopause, under GnRH analogues and on progestins — do not diagnose on JZ alone in those settings. Transient myometrial contraction mimics thickening: repeat the sequence when in doubt.", "fonte": "Agostinho et al., Insights Imaging 2017;8(6):549–556 (PMID 28980163 / PMC5707223) · corte de 12 mm revisitado em Eur Radiol 2019 (doi 10.1007/s00330-019-06308-3)", "faixas": [ { "status": "green", "rotulo": "excludes adenomyosis", "valor": "< 8 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "indeterminate — needs ancillary criterion", "valor": "8–12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "adenomyosis criterion", "valor": "≥ 12 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_pelve.6", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Maximal JZ / myometrial thickness ratio", "valor": "≤ 40", "unidade": "%", "nota": "Ancillary criterion used when JZ falls in the indeterminate 8–12 mm band: a ratio above 40% favors adenomyosis.", "fonte": "Agostinho et al., Insights Imaging 2017;8(6):549–556 (PMC5707223)", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "≤ 40%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "favors adenomyosis", "valor": "> 40%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_pelve.7", "grupo": "rm_pelve", "ruleId": null, "rotulo": "JZ maximum minus JZ minimum difference", "valor": "≤ 5", "unidade": "mm", "nota": "JZ asymmetry between the anterior and posterior uterine walls. A difference above 5 mm is the second ancillary criterion in the 8–12 mm band.", "fonte": "Agostinho et al., Insights Imaging 2017;8(6):549–556 (PMC5707223)", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "≤ 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "favors adenomyosis", "valor": "> 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_pelve.8", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Ovarian follicle / simple cyst — O-RADS MRI 1 limit", "valor": "≤ 3", "unidade": "cm", "nota": "In PREmenopausal women a follicle (simple cyst ≤ 3 cm), corpus luteum and hemorrhagic cyst fall under O-RADS MRI 1 — normal ovary. They are not 'lesions' and should not trigger follow-up. Above 3 cm, characterize with the score. After menopause there is no physiological follicle or corpus luteum: a simple cyst is a lesion and is scored O-RADS MRI 2, not normal ovary.", "fonte": "ACR O-RADS MRI v1 (2020) · Sadowski/Thomassin-Naggara et al., Radiology 2022 (doi 10.1148/radiol.204371)", "faixas": [ { "status": "green", "rotulo": "normal premenopausal ovary (O-RADS MRI 1)", "valor": "≤ 3 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "lesion to characterize by score", "valor": "> 3 cm (ou qualquer cisto na pós-menopausa)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_pelve.9", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Solid-tissue enhancement at 30–40 s (no-DCE protocol)", "valor": "≤ miométrio externo = O-RADS 4 · > miométrio externo = O-RADS 5", "unidade": null, "nota": "When dynamic perfusion with a time–intensity curve is unavailable, O-RADS MRI allows comparing solid-tissue enhancement with the outer myometrium at 30–40 s. In the lexicon, solid tissue is an enhancing component with one of these morphologies: papillary projection, mural nodule, irregular septation or wall, or a larger solid portion — retracted clot and smooth septa do not count.", "fonte": "ACR O-RADS MRI v1 (2020) · revisão de desempenho e notas técnicas em PMC9254700 (2022)", "faixas": [] }, { "id": "rm_pelve.10", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Pelvic lymph node — suspicious short axis", "valor": "> 10", "unidade": "mm", "nota": "Thresholds vary by station: obturator nodes are suspicious above 8 mm, while inguinal nodes may be normal up to 15 mm. Size alone is weak — combine with morphology (rounded shape, fatty hilum loss, irregular contour, central necrosis) and diffusion restriction. In FIGO 2018 cervical staging, a positive node defines stage IIIC.", "fonte": "Revisão do papel da RM no estadiamento do câncer de colo uterino — PMC10605640 (2023)", "faixas": [ { "status": "green", "rotulo": "normal", "valor": "≤ 8 mm de eixo curto", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "borderline / station-dependent", "valor": "8–10 mm (obturador já suspeito)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "suspicious", "valor": "> 10 mm de eixo curto", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_pelve.11", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Uterine cervix — depth of stromal invasion (FIGO IA)", "valor": "< 3 (IA1) · ≥ 3 e < 5 (IA2)", "unidade": "mm", "nota": "Stage IA is essentially pathological: MRI rarely resolves invasion below 5 mm. In the FIGO 2018 revision, horizontal extent was dropped and only depth remains. Note: below 5 mm of depth the stage is IA regardless of tumor diameter — only above 5 mm does size define IB1/IB2/IB3.", "fonte": "FIGO 2018 (colo uterino) · PMC10605640 (2023)", "faixas": [] }, { "id": "rm_pelve.12", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Uterine cervix — tumor size cutoffs (FIGO 2018, invasion ≥ 5 mm)", "valor": "< 2 (IB1) · ≥ 2 e < 4 (IB2) · ≥ 4 (IB3)", "unidade": "cm", "nota": "The size cutoffs apply only to tumors with stromal invasion ≥ 5 mm in depth (below that the stage is IA). Measure the greatest dimension on T2 in three planes (craniocaudal, anteroposterior, transverse). MRI achieves about 93% accuracy for tumor size versus about 60% for clinical examination, and the substage directly changes strategy (surgery versus chemoradiation).", "fonte": "FIGO 2018 (colo uterino) · acurácia da medida em PMC10605640 (2023)", "faixas": [] }, { "id": "rm_pelve.13", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Intact hypointense cervical stromal ring — NPV for parametrial invasion", "valor": "94–100", "unidade": "%", "nota": "Normal cervical stroma appears as a hypointense T2 ring. When intact, it virtually excludes parametrial invasion (stage IIB). Ring disruption with nodular tissue extending into the parametrium indicates invasion; isolated perilesional stranding is less specific and should not by itself establish IIB.", "fonte": "PMC10605640 (2023) — RM no estadiamento do câncer de colo uterino", "faixas": [] }, { "id": "rm_pelve.14", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Endometrium — depth of myometrial invasion", "valor": "< 50 (superficial) · ≥ 50 (profunda)", "unidade": "%", "nota": "This is the axis MRI resolves well and the one that most changes management. Assess on axial-oblique T2 perpendicular to the long axis of the uterine corpus, combined with DWI and multiphase post-contrast imaging. Overestimation pitfalls: adenomyosis, leiomyomas, bulky tumor distending the cavity, and the cornua, where myometrium is physiologically thin.", "fonte": "ESUR — Nougaret et al., Updated ESUR Guidelines for Endometrial Cancer, Eur Radiol 2026;36(1):1–16 (PMID 40586816); versão anterior em Eur Radiol 2019;29(2):792–805", "faixas": [] }, { "id": "rm_pelve.15", "grupo": "rm_pelve", "ruleId": null, "rotulo": "#Enzian — endometrioma / ovarian compartment (O)", "valor": "< 3 (O1) · 3–7 (O2) · > 7 (O3)", "unidade": "cm", "nota": "Size grading of the ovarian compartment; state the side. Infiltrating ovarian surface foci also belong to compartment O when they measure ≥ 5 mm.", "fonte": "Keckstein et al., The #Enzian classification, Acta Obstet Gynecol Scand 2021;100(7):1165–1175 (PMID 33483970)", "faixas": [] }, { "id": "rm_pelve.16", "grupo": "rm_pelve", "ruleId": null, "rotulo": "#Enzian — superficial peritoneal endometriosis (P)", "valor": "< 3 (P1) · 3–7 (P2) · > 7 (P3)", "unidade": "cm", "nota": "Compartment for superficial peritoneal disease, sized by the diameter of a circle encompassing the visible lesions. Note that MRI has low sensitivity for superficial implants: describe what is visible and flag that a negative MRI does not exclude peritoneal disease.", "fonte": "Keckstein et al., Acta Obstet Gynecol Scand 2021;100(7):1165–1175", "faixas": [] }, { "id": "rm_pelve.17", "grupo": "rm_pelve", "ruleId": null, "rotulo": "#Enzian — deep nodules in compartments A, B and C", "valor": "< 1 (grau 1) · 1–3 (grau 2) · > 3 (grau 3)", "unidade": "cm", "nota": "Same size scale for the deep central compartment (A), the lateral compartment (B, state the side) and the rectosigmoid (C). This grading tracks expected surgical difficulty, so the greatest nodule diameter must be reported for every involved compartment.", "fonte": "Keckstein et al., Acta Obstet Gynecol Scand 2021;100(7):1165–1175", "faixas": [] }, { "id": "rm_pelve.18", "grupo": "rm_pelve", "ruleId": null, "rotulo": "#Enzian FI — bowel disease above the rectosigmoid junction", "valor": "> 16", "unidade": "cm da margem anal", "nota": "Compartment C covers the rectum and low sigmoid; bowel disease cranial to the rectosigmoid junction, i.e. above 16 cm from the anal verge, is coded FI. Always report the distance from the nodule to the anal verge — this is what the surgeon uses to choose shaving, disc resection or segmental resection.", "fonte": "Keckstein et al., Acta Obstet Gynecol Scand 2021;100(7):1165–1175", "faixas": [] }, { "id": "rm_pelve.19", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Endometriosis MRI — recommended fasting", "valor": "3–6", "unidade": "h", "nota": "ESUR recommendation to reduce peristalsis and artifact in the posterior compartment. Reported durations across centers range from 3 to 6 hours.", "fonte": "ESUR — Bazot et al., Eur Radiol 2017;27(7):2765–2775 (PMID 27921160)", "faixas": [] }, { "id": "rm_pelve.20", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Endometriosis MRI — bladder filling", "valor": "~1 h sem urinar", "unidade": null, "nota": "A moderately full bladder: instruct the patient not to void for about 1 hour before the exam. An empty bladder hides bladder-wall nodules; an over-distended one distorts the anterior compartment and worsens tolerance. ESUR also recommends an antiperistaltic agent, preferring intravenous glucagon.", "fonte": "ESUR — Bazot et al., Eur Radiol 2017;27(7):2765–2775", "faixas": [] }, { "id": "rm_pelve.21", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Endometriosis MRI — craniocaudal coverage", "valor": "hilos renais → sínfise púbica", "unidade": null, "nota": "Axial 2D T2 from the renal hila to the pubic bone. Extending to the kidneys is not overkill: that is how hydronephrosis from ureteral endometriosis (#Enzian FU compartment) is detected, which changes urgency, and it also covers the right iliac fossa. A pelvic phased-array coil is recommended at both 1.5 T and 3 T.", "fonte": "ESUR — Bazot et al., Eur Radiol 2017;27(7):2765–2775", "faixas": [] }, { "id": "rm_pelve.22", "grupo": "rm_pelve", "ruleId": null, "rotulo": "Leiomyoma — outer free margin (FIGO types 1, 2 and 3)", "valor": "documentar em mm", "unidade": null, "nota": "For myomas that contact the endometrium and may be candidates for the hysteroscopic route (types 1, 2 and 3), record the outer free margin — the distance between the myoma and the serosa. A thin margin raises perforation risk and pushes the decision toward the abdominal route; it is commonly omitted from reports. In type 4 (purely intramural, contacting neither endometrium nor serosa) the hysteroscopic route is not in question — there, document the greatest diameter and the relationship to endometrium and serosa.", "fonte": "FIGO — Munro et al., Int J Gynecol Obstet 2011;113(1):3–13", "faixas": [] } ], "classificacoes": [ { "id": "rm_pelve.c0", "grupo": "rm_pelve", "nome": "PI-RADS v2.1 (2019) — per-zone scoring and dominant-sequence rule", "nota": null, "fonte": "PI-RADS v2.1 (ACR/ESUR/AdMeTech 2019) — Turkbey et al., Eur Urol 2019 · tabelas ZP/ZT conferidas em The Radiology Assistant (Prostate Cancer PI-RADS v2.1)", "colunas": [ "Zone / score", "Dominant sequence", "MRI criterion", "Final PI-RADS" ], "linhas": [ { "status": null, "celulas": [ "ZP — 1", "DWI / ADC", "Sem anormalidade no ADC nem na DWI de alto valor b", "PI-RADS 1" ] }, { "status": null, "celulas": [ "ZP — 2", "DWI / ADC", "Hipossinal linear ou cuneiforme no ADC e/ou hipersinal linear ou cuneiforme na DWI de alto b", "PI-RADS 2" ] }, { "status": null, "celulas": [ "ZP — 3", "DWI / ADC", "Hipossinal focal no ADC e/ou hipersinal focal na DWI de alto b; pode ser acentuado em uma das duas, mas não nas duas", "PI-RADS 3 se DCE negativo · PI-RADS 4 se DCE positivo" ] }, { "status": null, "celulas": [ "ZP — 4", "DWI / ADC", "Hipossinal focal acentuado no ADC E hipersinal focal acentuado na DWI de alto b, medindo < 1,5 cm", "PI-RADS 4" ] }, { "status": null, "celulas": [ "ZP — 5", "DWI / ADC", "Mesmos achados do escore 4, porém ≥ 1,5 cm no maior eixo, ou extensão extraprostática / comportamento invasivo definidos", "PI-RADS 5" ] }, { "status": null, "celulas": [ "ZT — 1", "T2", "Zona de transição normal, ou nódulo redondo completamente encapsulado (nódulo típico de HPB)", "PI-RADS 1" ] }, { "status": null, "celulas": [ "ZT — 2", "T2", "Nódulo predominantemente encapsulado, ou nódulo homogêneo circunscrito sem cápsula (nódulo atípico), ou área homogênea discretamente hipointensa entre nódulos", "PI-RADS 2 se DWI ≤ 3 · PI-RADS 3 se DWI ≥ 4" ] }, { "status": null, "celulas": [ "ZT — 3", "T2", "Sinal heterogêneo com margens obscurecidas; não preenche os critérios dos demais escores", "PI-RADS 3 se DWI ≤ 4 · PI-RADS 4 se DWI = 5" ] }, { "status": null, "celulas": [ "ZT — 4", "T2", "Lenticular ou não circunscrito, homogêneo, moderadamente hipointenso (aspecto de carvão apagado), medindo < 1,5 cm", "PI-RADS 4" ] }, { "status": null, "celulas": [ "ZT — 5", "T2", "Mesmos achados do escore 4, porém ≥ 1,5 cm, ou extensão extraprostática / comportamento invasivo definidos", "PI-RADS 5" ] }, { "status": null, "celulas": [ "DCE", "—", "Positivo: realce focal precoce coincidente com achado suspeito em T2 e/ou DWI. Negativo: sem realce precoce, ou realce difuso não coincidente, ou realce focal correspondente a nódulo de HPB", "Só promove ZP 3 → 4. Não participa da pontuação da ZT" ] }, { "status": null, "celulas": [ "Regra da zona dominante", "ZP: DWI/ADC · ZT: T2", "Na zona periférica a DWI/ADC define a nota e T2 e DCE são coadjuvantes; na zona de transição o T2 define e a DWI só resolve os escores 2 e 3", "Dizer no laudo qual sequência definiu a nota" ] }, { "status": null, "celulas": [ "Categorias finais", "—", "1 = muito baixa, 2 = baixa, 3 = intermediária/equívoca, 4 = alta, 5 = muito alta probabilidade de neoplasia clinicamente significativa", "Escore 3 é a categoria de decisão — modular com densidade de PSA e contexto clínico" ] }, { "status": null, "celulas": [ "Mudanças da v2.1 que passam batido", "—", "Nódulo típico de HPB caiu de T2 2 para T2 1; nódulo atípico (parcialmente encapsulado ou homogêneo circunscrito sem cápsula) caiu de T2 3 para T2 2", "Reduz PI-RADS 3 desnecessário na ZT" ] } ] }, { "id": "rm_pelve.c1", "grupo": "rm_pelve", "nome": "EPE grade (Mehralivand) — local staging of prostate cancer", "nota": null, "fonte": "Mehralivand et al., A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI, Radiology 2019;290(3):709–719 (PMID 30667329) · comparação com escala Likert em Radiol Imaging Cancer 2019 (doi 10.1148/rycan.2019190071)", "colunas": [ "Grade / item", "MRI finding", "EPE confirmed at surgical pathology" ], "linhas": [ { "status": null, "celulas": [ "1", "Contato capsular curvilíneo ≥ 1,5 cm OU abaulamento / irregularidade capsular (apenas um dos dois)", "24% (18/74)" ] }, { "status": null, "celulas": [ "2", "Contato capsular curvilíneo ≥ 1,5 cm E abaulamento / irregularidade capsular (os dois juntos)", "38% (39/102)" ] }, { "status": null, "celulas": [ "3", "Brecha capsular franca, com tumor mensurável estendendo-se ao espaço periprostático", "66% (37/56)" ] }, { "status": null, "celulas": [ "Complementos do estadiamento local", "Contato de base larga com a cápsula; obliteração do ângulo retoprostático; invasão de vesícula seminal (hipossinal em T2 com realce anormal e restrição à difusão, ou apagamento do ângulo entre base prostática e vesícula); feixe neurovascular posterolateral às 5 e 7 horas; extensão ao esfíncter uretral externo no ápice", "Descrever sempre — muda a decisão de preservação de feixes e o risco de incontinência pós-operatória" ] }, { "status": null, "celulas": [ "Como ler as taxas", "Percentagens da coorte de derivação, não probabilidades individuais do paciente", "Usar para calibrar linguagem de risco no laudo em vez de um sim/não" ] } ] }, { "id": "rm_pelve.c2", "grupo": "rm_pelve", "nome": "O-RADS MRI v1 (2020) — indeterminate adnexal mass", "nota": null, "fonte": "ACR O-RADS MRI v1 (2020) — Sadowski/Thomassin-Naggara et al., Radiology 2022 (doi 10.1148/radiol.204371) · VPPs e desempenho em Thomassin-Naggara et al., JAMA Netw Open 2020 · notas técnicas em PMC9254700 (2022)", "colunas": [ "Category / item", "Finding", "Malignancy PPV" ], "linhas": [ { "status": null, "celulas": [ "O-RADS MRI 0", "Exame incompleto ou tecnicamente inadequado para caracterização", "—" ] }, { "status": null, "celulas": [ "O-RADS MRI 1", "Ovário normal na pré-menopausa: folículo (cisto simples ≤ 3 cm), corpo lúteo ou cisto hemorrágico; ou lesão de origem não ovariana. Na pós-menopausa não se aplica o conceito de folículo fisiológico", "—" ] }, { "status": null, "celulas": [ "O-RADS MRI 2", "Quase certamente benigno: cisto unilocular com conteúdo simples ou endometriótico, parede fina realçante e sem tecido sólido; lesão com gordura SEM componente sólido realçante; tecido sólido homogêneo escuro em T2 e escuro na DWI", "< 0,5%" ] }, { "status": null, "celulas": [ "O-RADS MRI 3", "Baixo risco: cisto unilocular com conteúdo proteináceo, hemorrágico ou mucinoso, parede lisa e sem tecido sólido; cisto multilocular sem gordura, com septos lisos e sem tecido sólido; ou tecido sólido com curva tempo-intensidade de baixo risco (tipo 1)", "≈ 5%" ] }, { "status": null, "celulas": [ "O-RADS MRI 4", "Risco intermediário: tecido sólido (excluído o escuro em T2 e na DWI) com curva de risco intermediário (tipo 2); sem DCE disponível, realce ≤ miométrio externo aos 30–40 s; TAMBÉM entra aqui a lesão com conteúdo lipídico que apresenta tecido sólido realçante (excluído o nódulo de Rokitansky)", "≈ 50%" ] }, { "status": null, "celulas": [ "O-RADS MRI 5", "Alto risco: tecido sólido (excluído o escuro em T2 e na DWI) com curva de alto risco (tipo 3); sem DCE disponível, realce > miométrio externo aos 30–40 s; ou nodularidade peritoneal, mesentérica ou omental", "≈ 90%" ] }, { "status": null, "celulas": [ "Tecido sólido (léxico)", "Componente que realça e assume uma destas quatro morfologias: projeção papilar, nódulo mural, septo ou parede irregular, ou porção sólida maior", "Coágulo retraído, septo liso e debris NÃO contam — é o erro que mais infla a categoria" ] }, { "status": null, "celulas": [ "Assimetria proposital do sistema", "Tecido sólido homogeneamente escuro em T2 e na DWI cai em O-RADS 2 (fibroma, fibrotecoma, tumor de Brenner)", "Qualquer outro tecido sólido nunca desce abaixo de 3" ] }, { "status": null, "celulas": [ "Escopo de uso", "Desenhado para massa anexial deixada indeterminada pelo ultrassom", "Não é para rastreamento nem para lesão já caracterizada. Desempenho do escore 4–5: S 93% e E 91% em Thomassin-Naggara et al., JAMA Netw Open 2020; outra série (PMC9254700) relatou S 91% e E 95%" ] } ] }, { "id": "rm_pelve.c3", "grupo": "rm_pelve", "nome": "Junctional zone on MRI — adenomyosis criteria", "nota": null, "fonte": "Agostinho et al., MRI for adenomyosis: a pictorial review, Insights Imaging 2017;8(6):549–556 (PMID 28980163 / PMC5707223) · corte de 12 mm revisitado prospectivamente em Eur Radiol 2019 (doi 10.1007/s00330-019-06308-3)", "colunas": [ "Criterion", "Value", "Reading" ], "linhas": [ { "status": null, "celulas": [ "Espessura máxima da ZJ", "< 8 mm", "Exclui adenomiose na prática" ] }, { "status": null, "celulas": [ "Espessura máxima da ZJ", "8–12 mm", "Faixa indeterminada — só fecha com critério acessório" ] }, { "status": null, "celulas": [ "Espessura máxima da ZJ", "≥ 12 mm", "Critério de RM mais frequentemente usado para adenomiose" ] }, { "status": null, "celulas": [ "Razão ZJ máxima / espessura miometrial", "> 40%", "Critério acessório válido na faixa de 8–12 mm" ] }, { "status": null, "celulas": [ "Diferença ZJ máxima − ZJ mínima (parede anterior versus posterior)", "> 5 mm", "Critério acessório válido na faixa de 8–12 mm" ] }, { "status": null, "celulas": [ "Focos puntiformes de alto sinal em T2 e/ou T1", "Presentes", "Ilhotas de tecido endometrial ectópico e micro-hemorragias — sinal acessório de alta especificidade" ] }, { "status": null, "celulas": [ "Estrias lineares de alto sinal T2 irradiando da camada basal do endométrio", "Presentes", "Sinal acessório descrito na mesma fonte; some com limites mal definidos da ZJ" ] }, { "status": null, "celulas": [ "Técnica de medida", "T2 nos planos sagital, axial e coronal, registrando a maior espessura", "Medir só no sagital subestima a ZJ máxima. Repetir a sequência quando houver suspeita de contração miometrial transitória, que simula espessamento focal" ] }, { "status": null, "celulas": [ "Quando a espessura isolada não vale", "Pós-menopausa, análogo de GnRH, progestágeno; fase secretora", "A ZJ fica fina ou mal definida nas três primeiras situações e é fisiologicamente mais espessa na fase secretora — os critérios acessórios pesam mais" ] }, { "status": null, "celulas": [ "Consequência prática", "Armadilhas ligadas à ZJ", "Adenomiose superestima a invasão miometrial no câncer de endométrio; adenomioma versus leiomioma se separa por margens mal definidas com focos de alto sinal versus pseudocápsula e vasos periféricos" ] } ] }, { "id": "rm_pelve.c4", "grupo": "rm_pelve", "nome": "#Enzian (2021) — compartment-based endometriosis mapping", "nota": null, "fonte": "Keckstein et al., The #Enzian classification: a comprehensive non-invasive and surgical description system for endometriosis, Acta Obstet Gynecol Scand 2021;100(7):1165–1175 (PMID 33483970) · aplicação em RM e laudo estruturado em Insights Imaging 2023 (doi 10.1186/s13244-023-01466-x)", "colunas": [ "Compartment / item", "What it codes", "Grading and note" ], "linhas": [ { "status": null, "celulas": [ "P", "Endometriose peritoneal superficial", "P1 < 3 cm · P2 3–7 cm · P3 > 7 cm (diâmetro do círculo que engloba as lesões)" ] }, { "status": null, "celulas": [ "O", "Ovário: endometrioma e focos infiltrativos de superfície ovariana ≥ 5 mm", "O1 < 3 cm · O2 3–7 cm · O3 > 7 cm (indicar o lado)" ] }, { "status": null, "celulas": [ "T", "Condição tubo-ovariana / aderências", "T1 anexo aderido à parede pélvica · T2 anexo aderido à parede e ao útero · T3 aderências adicionais ao intestino (avaliar cada lado)" ] }, { "status": null, "celulas": [ "A", "Compartimento central profundo: vagina, espaço retovaginal, espaço retrocervical, torus uterino", "A1 < 1 cm · A2 1–3 cm · A3 > 3 cm" ] }, { "status": null, "celulas": [ "B", "Compartimento lateral: ligamentos uterossacros, ligamentos cardinais/paramétrio, parede pélvica lateral", "B1 < 1 cm · B2 1–3 cm · B3 > 3 cm (indicar o lado)" ] }, { "status": null, "celulas": [ "C", "Reto e sigmoide baixo (até a junção retossigmoide)", "C1 < 1 cm · C2 1–3 cm · C3 > 3 cm" ] }, { "status": null, "celulas": [ "FA", "Adenomiose uterina", "Presença" ] }, { "status": null, "celulas": [ "FB", "Bexiga", "Presença" ] }, { "status": null, "celulas": [ "FU", "Ureter, acometimento extrínseco e/ou intrínseco com sinais de obstrução", "Presença (indicar o lado)" ] }, { "status": null, "celulas": [ "FI", "Intestino cranial à junção retossigmoide (> 16 cm da margem anal)", "Presença" ] }, { "status": null, "celulas": [ "FO", "Outras localizações: parede abdominal, diafragma, nervos, cicatriz", "Presença" ] }, { "status": null, "celulas": [ "Como usar", "Codificar só depois de a descrição por compartimentos estar feita — o #Enzian fecha o laudo, não substitui a descrição", "Único sistema desenhado para funcionar igual na imagem e na cirurgia; ao contrário do rASRM cobre superficial, profunda e extragenital numa fórmula só" ] }, { "status": null, "celulas": [ "Não deixar de fora", "Distância do nódulo à margem anal quando houver acometimento intestinal, comprometimento da camada muscular própria e extensão circunferencial", "Hidronefrose no compartimento FU é o achado que muda a urgência da conduta" ] }, { "status": null, "celulas": [ "Cautela", "A graduação de tamanho de A, B e C acompanha a dificuldade cirúrgica esperada, não a intensidade dos sintomas", "RM negativa não exclui doença peritoneal superficial (compartimento P): registrar isso explicitamente na conclusão" ] } ] }, { "id": "rm_pelve.c5", "grupo": "rm_pelve", "nome": "FIGO staging by MRI — uterine cervix (2018) and endometrium", "nota": null, "fonte": "FIGO 2018 (estadiamento do carcinoma de colo uterino) · ESUR — Nougaret et al., Updated ESUR Guidelines for Endometrial Cancer: integrating MRI with the 2023 FIGO Staging Revolution, Eur Radiol 2026;36(1):1–16 (PMID 40586816) · atualização do papel da RM no colo uterino em PMC10605640 (2023)", "colunas": [ "Site", "Stage / descriptor", "MRI criterion" ], "linhas": [ { "status": null, "celulas": [ "Colo", "IA1", "Invasão estromal < 3 mm de profundidade — diagnóstico patológico, abaixo da resolução da RM" ] }, { "status": null, "celulas": [ "Colo", "IA2", "Invasão estromal ≥ 3 mm e < 5 mm de profundidade" ] }, { "status": null, "celulas": [ "Colo", "IB1", "Invasão estromal ≥ 5 mm de profundidade E tumor < 2 cm no maior eixo" ] }, { "status": null, "celulas": [ "Colo", "IB2", "Invasão estromal ≥ 5 mm E tumor ≥ 2 cm e < 4 cm no maior eixo" ] }, { "status": null, "celulas": [ "Colo", "IB3", "Invasão estromal ≥ 5 mm E tumor ≥ 4 cm no maior eixo" ] }, { "status": null, "celulas": [ "Colo", "Regra que evita supraestadiar", "Abaixo de 5 mm de profundidade o estádio é IA independentemente do diâmetro; os cortes de 2 e 4 cm só se aplicam a partir de 5 mm de invasão" ] }, { "status": null, "celulas": [ "Colo", "IIA1", "Invasão dos dois terços superiores da vagina, sem invasão parametrial, tumor < 4 cm" ] }, { "status": null, "celulas": [ "Colo", "IIA2", "Invasão dos dois terços superiores da vagina, sem invasão parametrial, tumor ≥ 4 cm" ] }, { "status": null, "celulas": [ "Colo", "IIB", "Invasão parametrial sem atingir a parede pélvica — interrupção do anel estromal hipointenso com tecido nodular avançando para o paramétrio" ] }, { "status": null, "celulas": [ "Colo", "IIIA", "Acometimento do terço inferior da vagina, sem extensão à parede pélvica" ] }, { "status": null, "celulas": [ "Colo", "IIIB", "Extensão à parede pélvica e/ou hidronefrose ou rim não funcionante" ] }, { "status": null, "celulas": [ "Colo", "IIIC1", "Metástase em linfonodo pélvico" ] }, { "status": null, "celulas": [ "Colo", "IIIC2", "Metástase em linfonodo para-aórtico" ] }, { "status": null, "celulas": [ "Colo", "IVA", "Invasão da mucosa de bexiga ou reto" ] }, { "status": null, "celulas": [ "Colo", "IVB", "Metástase a distância" ] }, { "status": null, "celulas": [ "Colo", "Nota de técnica", "A FIGO 2018 passou a admitir imagem e patologia no estadiamento; a RM é o método de escolha para tamanho, invasão parametrial e extensão vaginal (acurácia de medida ~93% contra ~60% do exame clínico). Anel estromal hipointenso íntegro em T2 tem VPN de 94–100% para invasão parametrial. Medir nos três planos, porque IB1/IB2/IB3 muda a estratégia entre cirurgia e quimiorradiação" ] }, { "status": null, "celulas": [ "Endométrio", "Invasão miometrial superficial", "Tumor invadindo < 50% da espessura miometrial" ] }, { "status": null, "celulas": [ "Endométrio", "Invasão miometrial profunda", "Tumor invadindo ≥ 50% da espessura miometrial" ] }, { "status": null, "celulas": [ "Endométrio", "Invasão do estroma cervical", "Tumor rompendo o estroma cervical, não apenas extensão endocervical superficial" ] }, { "status": null, "celulas": [ "Endométrio", "Serosa e/ou anexos", "Perda do hipossinal seroso com tumor atingindo a superfície uterina, ou acometimento anexial" ] }, { "status": null, "celulas": [ "Endométrio", "Vagina e/ou paramétrio", "Extensão vaginal ou parametrial" ] }, { "status": null, "celulas": [ "Endométrio", "Linfonodos", "Eixo curto > 8 mm nos pélvicos e > 10 mm nos para-aórticos, somado a morfologia alterada (forma arredondada, perda do hilo gorduroso, contorno irregular, necrose) e restrição à difusão. Tamanho isolado é critério fraco — não usar corte único de 10 mm para a pelve, sob risco de subestadiar" ] }, { "status": null, "celulas": [ "Endométrio", "Nota de técnica", "Avaliar a invasão miometrial em T2 axial-oblíqua perpendicular ao eixo longo do corpo uterino, somada a DWI e pós-contraste multifásico. Superestimam a invasão: adenomiose, leiomiomas, tumor volumoso distendendo a cavidade e os cornos, onde o miométrio é fisiologicamente fino" ] }, { "status": null, "celulas": [ "Endométrio", "Nota sobre FIGO 2023 e ESUR 2026", "A FIGO 2023 incorporou tipo histológico, invasão linfovascular e classificação molecular, que não são dados de imagem. A diretriz vigente da ESUR é a atualização de 2026 (Nougaret et al., Eur Radiol 2026;36(1):1–16), que integra a RM à FIGO 2023 e substitui a versão de 2019 — o laudo entrega os descritores e não fecha o estádio sozinho" ] } ] }, { "id": "rm_pelve.c6", "grupo": "rm_pelve", "nome": "Uterine leiomyoma — FIGO classification (PALM-COEIN, Munro 2011)", "nota": null, "fonte": "FIGO — Munro et al., FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding, Int J Gynecol Obstet 2011;113(1):3–13", "colunas": [ "Type", "Location", "Reporting note" ], "linhas": [ { "status": null, "celulas": [ "0", "Submucoso pediculado, inteiramente intracavitário", "Ressecção histeroscópica geralmente factível" ] }, { "status": null, "celulas": [ "1", "Submucoso com < 50% do volume intramural", "Ressecção histeroscópica habitualmente possível — documentar a margem livre externa em mm" ] }, { "status": null, "celulas": [ "2", "Submucoso com ≥ 50% do volume intramural", "Documentar a margem livre externa em mm" ] }, { "status": null, "celulas": [ "3", "100% intramural, mas em contato com o endométrio", "Documentar a margem livre externa em mm" ] }, { "status": null, "celulas": [ "4", "Intramural, inteiramente circundado por miométrio, sem contato com endométrio nem serosa", "Sem contato endometrial: via histeroscópica não se aplica — documentar maior diâmetro e relação com endométrio e serosa" ] }, { "status": null, "celulas": [ "5", "Subseroso com ≥ 50% do volume intramural", "Em contato com a serosa" ] }, { "status": null, "celulas": [ "6", "Subseroso com < 50% do volume intramural", "Em contato com a serosa" ] }, { "status": null, "celulas": [ "7", "Subseroso pediculado", "Diferenciar de massa anexial — procurar o pedículo e os vasos-ponte" ] }, { "status": null, "celulas": [ "8", "Outro (especificar: cervical, do ligamento largo, parasita)", "Fora do corpo uterino" ] }, { "status": null, "celulas": [ "Híbrido", "Toca endométrio e serosa: dois números separados por hífen, por exemplo 2–5", "O primeiro número é a relação com o endométrio; o segundo, com a serosa" ] }, { "status": null, "celulas": [ "O que mais informar", "Número de nódulos, maiores diâmetros dos dominantes, localização (anterior, posterior, fúndica, lateral, cervical) e comportamento em T2 (degeneração hialina, cística, mixoide ou vermelha)", "A margem livre externa nos tipos 1, 2 e 3 pesa na escolha entre via histeroscópica e abdominal e no risco de perfuração" ] }, { "status": null, "celulas": [ "Sinal de alerta", "Hipersinal em T2 e na DWI, margens irregulares, necrose e crescimento rápido", "Não permitem diagnóstico de leiomiossarcoma por imagem, mas merecem ressalva explícita na conclusão em vez de o nódulo ser chamado de mioma" ] } ] }, { "id": "rm_pelve.c7", "grupo": "rm_pelve", "nome": "Perianal fistula — Parks (surgical) and St James University Hospital (MRI)", "nota": null, "fonte": "Parks, Gordon & Hardcastle, A classification of fistula-in-ano, Br J Surg 1976 · Morris, Spencer & Ambrose, MR imaging classification of perianal fistulas (St James University Hospital), RadioGraphics 2000", "colunas": [ "System / item", "Type, grade or item", "Description" ], "linhas": [ { "status": null, "celulas": [ "Parks", "I — Interesfincteriana", "Trajeto que se ramifica apenas no plano interesfincteriano; pode ter extensão alta" ] }, { "status": null, "celulas": [ "Parks", "II — Transesfincteriana", "Do plano interesfincteriano, o trajeto atravessa o complexo esfincteriano externo em altura variável, alcançando a fossa isquioanal" ] }, { "status": null, "celulas": [ "Parks", "III — Supraesfincteriana", "O trajeto sobe no plano interesfincteriano por cima do puborretal e desce pela fossa isquioanal até a pele" ] }, { "status": null, "celulas": [ "Parks", "IV — Extraesfincteriana", "O trajeto vai da pele perineal, atravessa a gordura isquioanal e o elevador do ânus, e alcança o reto sem relação com a linha pectínea" ] }, { "status": null, "celulas": [ "St James", "Grau 0", "Aspecto normal, sem fístula demonstrável" ] }, { "status": null, "celulas": [ "St James", "Grau 1", "Fístula interesfincteriana linear simples" ] }, { "status": null, "celulas": [ "St James", "Grau 2", "Fístula interesfincteriana com abscesso ou trajeto secundário" ] }, { "status": null, "celulas": [ "St James", "Grau 3", "Fístula transesfincteriana" ] }, { "status": null, "celulas": [ "St James", "Grau 4", "Fístula transesfincteriana com abscesso ou trajeto secundário na fossa isquioanal" ] }, { "status": null, "celulas": [ "St James", "Grau 5", "Doença supraelevadora / translevatória (supraesfincteriana e extraesfincteriana)" ] }, { "status": null, "celulas": [ "Correspondência", "Grau 1 ≈ Parks I · grau 3 ≈ Parks II · grau 5 cobre supra e extraesfincteriana", "Parks organiza pela relação do trajeto com o complexo esfincteriano; St James traduz Parks para a RM e acrescenta o que muda conduta: abscesso e trajeto secundário" ] }, { "status": null, "celulas": [ "O que o coloproctologista precisa", "Roteiro do laudo", "Posição do orifício interno em horas do relógio (posição de litotomia) e sua distância à margem anal; trajeto primário e sua relação com esfíncter interno, esfíncter externo e puborretal; trajetos secundários e coleções; posição do orifício externo; sinalizar doença de Crohn, que muda a estratégia" ] }, { "status": null, "celulas": [ "Atividade do trajeto", "T2/STIR e pós-contraste", "Hipersinal em T2/STIR com realce indica trajeto ativo; hipossinal fibroso indica trajeto inativo" ] } ] }, { "id": "rm_pelve.c8", "grupo": "rm_pelve", "nome": "PSA density — reading by range", "nota": null, "fonte": "Nordström T et al., Prostate Cancer Prostatic Dis 2018;21:57-63 · Washington SL et al., J Urol 2022 · PI-RADS v2.1 (volume por elipsoide)", "colunas": [ "Density (ng/mL/mL)", "Reading", "Practical use" ], "linhas": [ { "status": null, "celulas": [ "< 0,10", "Baixa", "Em PI-RADS 3, apoia vigilância em vez de biópsia imediata." ] }, { "status": null, "celulas": [ "0,10 – 0,14", "Intermediária", "Zona cinzenta: decidir com idade, toque retal, história familiar e preferência do paciente." ] }, { "status": null, "celulas": [ "≥ 0,15", "Elevada", "Aumenta a probabilidade de câncer clinicamente significativo; em PI-RADS 3 costuma inclinar para biópsia." ] } ] } ] }, { "metodo": "RM", "chave": "rm_mama_cardio", "slug": "rm-mama-cardio", "nome": "MRI — Breast and Cardiac", "temPaginaPublica": false, "medidas": [ { "id": "rm_mama_cardio.0", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "LV end-diastolic volume index (LVEDVi) — SSFP cine", "valor": "Homens 79 ± 15 (50–108) · Mulheres 73 ± 12 (50–96)", "unidade": "mL/m²", "nota": "Mean ± SD with limits of normal in parentheses. Table with papillary muscles included in LV mass (hence excluded from cavity volume). Indexed to body surface area.", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 — Reference ranges (\"normal values\") for CMR in adults and children: 2020 update (Tabela 2; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval", "valor": "50–108 (homens) · 50–96 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above upper limit of normal — LV dilatation", "valor": "> 108 (homens) · > 96 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.1", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "LV end-systolic volume index (LVESVi)", "valor": "Homens 29 ± 9 (11–47) · Mulheres 25 ± 7 (10–40)", "unidade": "mL/m²", "nota": "More sensitive than EDV for remodelling in valvular disease and cardiomyopathy. Same contouring convention as the EDV table.", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 (Tabela 2; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval", "valor": "11–47 (homens) · 10–40 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above upper limit of normal", "valor": "> 47 (homens) · > 40 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.2", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Left ventricular ejection fraction (LVEF) by CMR", "valor": "Homens 64 ± 8 (49–79) · Mulheres 66 ± 7 (52–79)", "unidade": "%", "nota": "CMR is the reference standard for EF. The lower limit by CMR is higher than that used in echocardiography — do not transplant the echo cutoffs (52% men / 54% women) into a CMR report without qualification.", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 (Tabela 2; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval", "valor": "49–79% (homens) · 52–79% (mulheres)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Below lower limit of normal", "valor": "< 49% (homens) · < 52% (mulheres)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.3", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "LV mass index", "valor": "Homens 62 ± 11 (39–85) · Mulheres 49 ± 10 (30–68)", "unidade": "g/m²", "nota": "Measured at end-diastole, with papillary muscles INCLUDED in mass in this table. Excluding papillary muscles lowers mass by roughly 5–10% — state the convention in the report, especially on follow-up.", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 (Tabela 2; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval", "valor": "39–85 (homens) · 30–68 (mulheres) g/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above upper limit — increased LV mass", "valor": "> 85 (homens) · > 68 (mulheres) g/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.4", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "RV end-diastolic volume index (RVEDVi)", "valor": "Homens 88 ± 17 (53–123) · Mulheres 76 ± 14 (48–104)", "unidade": "mL/m²", "nota": "The normal RV exceeds the LV in indexed volume. Central parameter in arrhythmogenic cardiomyopathy, shunt and pulmonary valve disease.", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 (Tabela 10 — músculos papilares incluídos no volume do VD; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval", "valor": "53–123 (homens) · 48–104 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above upper limit — RV dilatation", "valor": "> 123 (homens) · > 104 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.5", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "RV end-systolic volume index (RVESVi)", "valor": "Homens 38 ± 11 (17–59) · Mulheres 30 ± 9 (13–48)", "unidade": "mL/m²", "nota": "Same contouring convention as RV EDV (papillary muscles included in the volume).", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 (Tabela 10; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval", "valor": "17–59 (homens) · 13–48 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above upper limit of normal", "valor": "> 59 (homens) · > 48 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.6", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Right ventricular ejection fraction (RVEF) by CMR", "valor": "Homens 57 ± 8 (42–72) · Mulheres 60 ± 7 (46–74)", "unidade": "%", "nota": "Normal RVEF is physiologically lower than LVEF. CMR is the method of choice for the RV, whose geometry precludes reliable volumetric estimation by echocardiography.", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 (Tabela 10; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval", "valor": "42–72% (homens) · 46–74% (mulheres)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Below lower limit of normal", "valor": "< 42% (homens) · < 46% (mulheres)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.7", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Maximum left atrial volume index", "valor": "Homens 38 ± 11 (17–59) · Mulheres 39 ± 11 (17–61)", "unidade": "mL/m²", "nota": "Biplane area-length method, with pulmonary veins and atrial appendage EXCLUDED from the volume. The same table also reports Simpson's method values WITH the appendage included (men 40 ± 8 [25–56]; women 39 ± 7 [25–53]) — state which method was used, especially on follow-up. CMR values run systematically higher than echocardiographic cutoffs: do not apply the echo 34 mL/m² threshold to CMR.", "fonte": "Kawel-Boehm N et al., J Cardiovasc Magn Reson 2020;22:87 (Tabela 14; doi 10.1186/s12968-020-00683-3)", "faixas": [ { "status": "green", "rotulo": "Within reference interval (biplane area-length)", "valor": "17–59 (homens) · 17–61 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above upper limit — left atrial enlargement", "valor": "> 59 (homens) · > 61 (mulheres) mL/m²", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.8", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Native myocardial T1 — 3 T, MOLLI (biopsy-validated cohort)", "valor": "Biópsia negativa 1195 ± 43 · Miocardite 1252 ± 42 · corte 1228", "unidade": "ms", "nota": "Cutoff 1228 ms with 86.0% sensitivity and 93.3% specificity for biopsy-proven myocarditis (43 positive, 30 negative); MOLLI 5(3)3 pre-contrast, Philips Ingenia 3 T. NOTE: the 1195 ms group consists of BIOPSY-NEGATIVE patients (idiopathic arrhythmia, dilated cardiomyopathy and others), not healthy volunteers — do not use it as a normal 3 T T1 value. NOT transferable to 1.5 T or to another sequence: the SCMR/EACVI consensus states that without a local reference range for native T1, quantitative results should not be reported clinically. Elevated native T1 is non-specific (oedema, inflammation, fibrosis, amyloid).", "fonte": "Li S et al., Front Cardiovasc Med 2021;8:739892 (doi 10.3389/fcvm.2021.739892; PMID 34712710) · advertência de dependência técnica e exigência de faixa local em Messroghli DR et al., J Cardiovasc Magn Reson 2017;19:75 (consenso SCMR/EACVI, doi 10.1186/s12968-017-0389-8)", "faixas": [ { "status": "green", "rotulo": "Below cohort cutoff", "valor": "≤ 1228 ms (3 T, MOLLI)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above cutoff — Lake Louise T1 criterion met", "valor": "> 1228 ms (3 T, MOLLI)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.9", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Myocardial T2 mapping — 3 T, GraSE (biopsy-validated cohort)", "valor": "Biópsia negativa 54,5 ± 3,7 · Miocardite 63,2 ± 6,1 · corte 58,5", "unidade": "ms", "nota": "Cutoff 58.5 ms with 83.7% sensitivity and 93.3% specificity, six-echo GraSE sequence at 3 T. T2 mapping outperformed T2-weighted imaging in the same cohort (83.7% vs 69.8% sensitivity). Elevated T2 = myocardial oedema, a marker of activity/acuity — the criterion that separates active inflammation from scar. The 54.5 ms group consists of biopsy-negative patients, not healthy volunteers.", "fonte": "Li S et al., Front Cardiovasc Med 2021;8:739892 (doi 10.3389/fcvm.2021.739892; PMID 34712710)", "faixas": [ { "status": "green", "rotulo": "Below cohort cutoff", "valor": "≤ 58,5 ms (3 T, GraSE)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above cutoff — T2 (oedema) criterion met", "valor": "> 58,5 ms (3 T, GraSE)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.10", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Myocardial extracellular volume (ECV) — 3 T", "valor": "Biópsia negativa 29,3 ± 4,1 · Miocardite 32,7 ± 3,3 · corte 31,0", "unidade": "%", "nota": "Cutoff 31.0% with 65.1% sensitivity and 83.3% specificity — the least sensitive of the three mapping parameters. Requires haematocrit plus pre- and post-contrast acquisition. Plausibility benchmarks, taken from the AMYLOIDOSIS section of the SCMR/EACVI consensus: diffuse fibrosis rarely raises ECV above 40%, and ECV above ~55% appears with transmural late gadolinium enhancement — magnitude benchmarks, not diagnostic cutoffs for myocarditis.", "fonte": "Li S et al., Front Cardiovasc Med 2021;8:739892 (doi 10.3389/fcvm.2021.739892) · balizas de 40% e 55% na seção de amiloidose de Messroghli DR et al., J Cardiovasc Magn Reson 2017;19:75 (doi 10.1186/s12968-017-0389-8)", "faixas": [ { "status": "green", "rotulo": "Below cohort cutoff", "valor": "≤ 31,0%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above cutoff — T1/ECV criterion met", "valor": "> 31,0%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.11", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Myocardial T2* — iron overload (1.5 T)", "valor": "> 20 (baixo risco) · 10–20 (intermediário) · < 10 (alto risco)", "unidade": "ms", "nota": "Stratification derived from Anderson 2001, in which no patient without overload showed T2* below 20 ms — supporting 20 ms as the clinical threshold. The SCMR/EACVI consensus does not publish these cutoffs; it recommends that T2* be acquired at 1.5 T with a multi-echo gradient-echo of 8 equally spaced echoes from 2 to 18 ms, an interventricular septal ROI, and a dark-blood approach when available. Myocardial T2* does not track serum ferritin or hepatic T2* — cardiac overload must be measured in the heart.", "fonte": "Anderson LJ et al., Eur Heart J 2001;22:2171-2179 — Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload (PMID 11913479) · desfechos em Kirk P et al., Circulation 2009;120:1961-1968 (PMID 19801505) · parâmetros de aquisição em Messroghli DR et al., J Cardiovasc Magn Reson 2017;19:75 (doi 10.1186/s12968-017-0389-8)", "faixas": [ { "status": "green", "rotulo": "Low risk — no significant overload", "valor": "> 20 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Intermediate risk — myocardial overload", "valor": "10–20 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "High risk — intensive chelation", "valor": "< 10 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.12", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Myocardial T2* and heart failure risk (thalassaemia major)", "valor": "< 10 ms: RR 160 (IC 95% 39–653) · < 6 ms: IC em 47% em 1 ano, RR 270 (IC 95% 64–1129)", "unidade": "ms", "nota": "Cohort of 652 patients and 1442 scans. Cardiac T2* was below 10 ms in 98% of scans from patients who developed heart failure; 83% of those who developed arrhythmia had T2* < 20 ms (arrhythmia RR 4.6; 95% CI 2.66–7.95). The ROC area under the curve for predicting heart failure was 0.948 for cardiac T2*, versus 0.589 for hepatic T2* and 0.629 for serum ferritin. T2* < 6 ms warrants intensive chelation even with normal ventricular function — the finding that changes management the same day.", "fonte": "Kirk P et al., Circulation 2009;120:1961-1968 — Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major (PMID 19801505; doi 10.1161/CIRCULATIONAHA.109.874487)", "faixas": [ { "status": "green", "rotulo": "Low risk — no significant overload", "valor": "> 20 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Intermediate arrhythmia risk", "valor": "10–20 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "High heart failure risk", "valor": "< 10 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Very high risk — immediate intensive chelation", "valor": "< 6 ms", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.13", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Transmural extent of late gadolinium enhancement and myocardial viability", "valor": "< 50% da espessura parietal = segmento viável", "unidade": null, "nota": "With the 50% threshold, 381 of 609 dysfunctional segments with < 50% enhancement (63%) recovered contraction at 6 months after surgical revascularisation (segmental analysis on a 48-segment model). Also with the 50% threshold, and now on the 16-segment AHA model, ≥ 10 viable or normal segments predicted ≥ 3% LVEF gain with 95% sensitivity and 75% specificity (AUC 0.90). Small study (33 patients); the authors themselves regard the findings as preliminary. Original principle established by Kim et al., N Engl J Med 2000.", "fonte": "Pegg TJ et al., J Cardiovasc Magn Reson 2010;12:56 (doi 10.1186/1532-429X-12-56; PMID 20929540) · princípio original em Kim RJ et al., N Engl J Med 2000;343:1445-1453", "faixas": [ { "status": "green", "rotulo": "Viable — high probability of functional recovery", "valor": "< 50% da espessura parietal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Non-viable — low probability of recovery", "valor": "≥ 50% da espessura parietal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.14", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Maximal LV wall thickness — hypertrophic cardiomyopathy diagnosis", "valor": "≥ 15 mm (caso índice) · ≥ 13 mm (história familiar ou genótipo positivo)", "unidade": "mm", "nota": "End-diastolic thickness in any segment, not explained by loading conditions alone. CMR is used when echocardiography is inconclusive and for sudden cardiac death risk stratification when an ICD is not clearly indicated after clinical assessment — CMR detects apical and basal anterolateral hypertrophy that echo underestimates, as well as apical aneurysm and the extent of fibrosis on late gadolinium enhancement.", "fonte": "Ommen SR et al., 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy — Circulation 2024;149:e1239-e1311 (doi 10.1161/CIR.0000000000001250; PMID 38718139) e J Am Coll Cardiol 2024;83:2324-2405 (doi 10.1016/j.jacc.2024.02.014; PMID 38727647)", "faixas": [ { "status": "green", "rotulo": "Below diagnostic threshold", "valor": "< 13 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Diagnostic only with family history or positive genotype", "valor": "13–14 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Diagnostic threshold in the index case", "valor": "≥ 15 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.15", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Performance of 2018 vs 2009 Lake Louise Criteria (biopsy reference)", "valor": "2018: sensibilidade 95,3%, especificidade 86,7%, acurácia 91,8% · 2009: 79,1%, 73,3%, 76,7%", "unidade": null, "nota": "Cohort with endomyocardial biopsy confirmation (43 positive, 30 negative), 3 T. The gain of the 2018 version comes from the introduction of parametric mapping, replacing signal-intensity-ratio criteria. Single-centre study with a small sample; specificity is penalised by the sampling false negatives of biopsy itself.", "fonte": "Li S et al., Front Cardiovasc Med 2021;8:739892 — Multiparametric CMR in Acute Myocarditis: Comparison of 2009 and 2018 Lake Louise Criteria With Endomyocardial Biopsy Confirmation (doi 10.3389/fcvm.2021.739892; PMID 34712710)", "faixas": [] }, { "id": "rm_mama_cardio.16", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Standalone performance of parametric mapping in acute myocarditis (meta-analysis)", "valor": "T1 nativo: S 83% / E 86% (AUC 0,91) · T2: S 81% / E 86% (AUC 0,89) · ECV: S 71% / E 81% (AUC 0,83)", "unidade": null, "nota": "Meta-analysis of 11 studies and 677 patients, predominantly at 1.5 T with MOLLI. Native T1 had the highest standalone diagnostic accuracy, but no single parameter replaces the mandatory T2 + T1 combination of the 2018 Lake Louise Criteria. Pooled 1.5 T cutoffs: native T1 1021 ms, T2 52 ms, ECV 28% — with high heterogeneity (I² 69–75%) and a need for local validation.", "fonte": "Ganesan L et al., Diagnostic performance of cardiovascular magnetic resonance parametric mapping as per modified Lake Louise Criteria in acute myocarditis: an updated systematic review and meta-analysis — J Cardiovasc Imaging 2025 (doi 10.1186/s44348-025-00048-3; PMID 40462222; PMC12131415)", "faixas": [] }, { "id": "rm_mama_cardio.17", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "BI-RADS 3 on breast MRI — ceiling likelihood of malignancy", "valor": "> 0% e ≤ 2%", "unidade": null, "nota": "Category reserved for findings with at most 2% likelihood of malignancy, managed by short-interval follow-up (typically 6 months) rather than biopsy. On MRI, category 3 presupposes technically adequate imaging and background enhancement that does not obscure the finding — marked BPE undermines comfortable use of the category.", "fonte": "ACR BI-RADS Atlas 5ª ed (2013) · limiares consolidados em StatPearls, Breast Imaging Reporting and Data System (NCBI Bookshelf NBK459169)", "faixas": [ { "status": "green", "rotulo": "Categories 1 and 2 — benign", "valor": "essencialmente 0%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Category 3 — probably benign", "valor": "> 0% e ≤ 2%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Category 4 or above — biopsy", "valor": "> 2%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.18", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "BI-RADS 5 — floor likelihood of malignancy", "valor": "≥ 95%", "unidade": null, "nota": "Expected positive predictive value of at least 95%. A benign histological result in a category 5 finding is discordant and mandates re-discussion — management does not end with the pathology report.", "fonte": "ACR BI-RADS Atlas 5ª ed (2013) · StatPearls, Breast Imaging Reporting and Data System (NCBI Bookshelf NBK459169)", "faixas": [] }, { "id": "rm_mama_cardio.19", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Lifetime risk threshold for annual screening breast MRI", "valor": "≥ 20%", "unidade": null, "nota": "Lifetime risk calculated with a model incorporating family history. Annual MRI is also indicated for: genetics-based risk (BRCA and other mutation carriers), chest irradiation at a young age, breast cancer diagnosed before age 50, and personal history of breast cancer with dense breasts. Women with a personal history outside those conditions, or atypia at biopsy, should strongly consider MRI. MRI is the supplemental method of choice; for those who qualify but cannot undergo MRI, the ACR accepts contrast-enhanced mammography or ultrasound. Between 15% and 20% lifetime risk the 2023 ACR does not establish a routine indication — the decision is individualised.", "fonte": "Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023;20(9):902-914 (doi 10.1016/j.jacr.2023.04.002; PMID 37150275)", "faixas": [ { "status": "green", "rotulo": "Average risk — annual mammography from age 40", "valor": "< 15%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Intermediate zone — no routine indication; individualised decision", "valor": "15% a < 20%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "High risk — annual MRI indicated", "valor": "≥ 20%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rm_mama_cardio.20", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Starting age for screening MRI and for formal risk assessment", "valor": "RM aos 25–30 anos · avaliação de risco até os 25 anos", "unidade": null, "nota": "Every woman should undergo formal risk assessment by age 25 to identify those needing earlier screening. In high-risk women, MRI starts between ages 25 and 30 and mammography between ages 25 and 40, depending on the risk type; mutation carriers may delay mammography until age 40 if annual screening MRI is performed as recommended. The recommendation emphasises early assessment in Black women and in women of Ashkenazi Jewish heritage.", "fonte": "Monticciolo DL et al. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023;20(9):902-914 (doi 10.1016/j.jacr.2023.04.002; PMID 37150275)", "faixas": [] }, { "id": "rm_mama_cardio.21", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Diagnostic performance of the kinetic curve on breast MRI", "valor": "Sensibilidade 91% · especificidade 83% · acurácia 86%", "unidade": null, "nota": "Original study of 266 lesions (101 malignant, 165 benign) that defined type I, II and III curves. Distribution in carcinomas: type I 8.9%, type II 33.6%, type III 57.4%; in benign lesions: type I 83.0%, type II 11.5%, type III 5.5%. Kinetics is adjunctive: it adds specificity to morphology but must not downgrade a morphologically suspicious finding — well-differentiated carcinomas and lobular carcinoma can display a type I curve.", "fonte": "Kuhl CK, Mielcareck P, Klaschik S et al. Dynamic Breast MR Imaging: Are Signal Intensity Time Course Data Useful for Differential Diagnosis of Enhancing Lesions? Radiology 1999;211:101-110 (PMID 10189459; doi 10.1148/radiology.211.1.r99ap38101)", "faixas": [] }, { "id": "rm_mama_cardio.22", "grupo": "rm_mama_cardio", "ruleId": null, "rotulo": "Neoadjuvant response by MRI — RECIST 1.1", "valor": "Resposta parcial: redução ≥ 30% · Doença progressiva: aumento ≥ 20% e ≥ 5 mm em valor absoluto", "unidade": null, "nota": "Sum of the longest diameters of target lesions. Partial response is referenced to baseline; progression is referenced to the SMALLEST sum on study (nadir) and requires, beyond the 20%, an absolute increase of at least 5 mm — a rule created precisely to avoid false progression in small lesions. Complete response is disappearance of all target lesions, and for nodes requires the short axis to fall below 10 mm. A lymph node with short axis ≥ 15 mm is measurable and counts as a target lesion. Practical limitation in the breast: MRI may underestimate fragmented residual disease and overestimate in concentrically responding tumours — the final reference is pathological complete response.", "fonte": "Eisenhauer EA et al., New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1) — Eur J Cancer 2009;45:228-247", "faixas": [ { "status": "green", "rotulo": "Partial or complete response", "valor": "redução ≥ 30% do somatório", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Stable disease", "valor": "entre redução < 30% e aumento < 20%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Progressive disease", "valor": "aumento ≥ 20% em relação ao nadir e ≥ 5 mm absolutos", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] } ], "classificacoes": [ { "id": "rm_mama_cardio.c0", "grupo": "rm_mama_cardio", "nome": "BI-RADS MRI — assessment categories (ACR 5th ed, 2013)", "nota": null, "fonte": "ACR BI-RADS Atlas 5ª ed (2013) — a 5ª edição harmonizou o léxico e as categorias entre mamografia, ultrassom e RM · limiares conferidos em StatPearls (NCBI Bookshelf NBK459169)", "colunas": [ "Category", "Meaning", "Likelihood of malignancy", "Management" ], "linhas": [ { "status": null, "celulas": [ "0", "Avaliação incompleta — necessita avaliação adicional por imagem", "Não se aplica", "Comparar com exames prévios ou completar com método adicional" ] }, { "status": null, "celulas": [ "1", "Negativa — sem realce anômalo", "Essencialmente 0%", "Rastreamento de rotina conforme o nível de risco" ] }, { "status": null, "celulas": [ "2", "Achado benigno (cisto, linfonodo intramamário, necrose gordurosa, implante)", "Essencialmente 0%", "Rastreamento de rotina conforme o nível de risco" ] }, { "status": null, "celulas": [ "3", "Provavelmente benigno", "> 0% e ≤ 2%", "Controle em intervalo curto, tipicamente 6 meses" ] }, { "status": null, "celulas": [ "4A", "Suspeita baixa", "> 2% a ≤ 10%", "Biópsia (guiada por RM se não houver correlato)" ] }, { "status": null, "celulas": [ "4B", "Suspeita intermediária", "> 10% a ≤ 50%", "Biópsia; avaliar concordância radiopatológica" ] }, { "status": null, "celulas": [ "4C", "Suspeita alta", "> 50% a < 95%", "Biópsia; resultado benigno exige rediscussão" ] }, { "status": null, "celulas": [ "5", "Altamente sugestivo de malignidade", "≥ 95%", "Biópsia e tratamento apropriado; resultado benigno é discordante" ] }, { "status": null, "celulas": [ "6", "Malignidade já comprovada por biópsia", "Não se aplica", "Estadiamento local, planejamento cirúrgico ou monitorização neoadjuvante" ] } ] }, { "id": "rm_mama_cardio.c1", "grupo": "rm_mama_cardio", "nome": "Kinetic curves on breast MRI — initial and delayed phases", "nota": null, "fonte": "ACR BI-RADS Atlas 5ª ed (2013), léxico de RM · classificação original e desempenho em Kuhl CK et al., Radiology 1999;211:101-110 (sensibilidade 91%, especificidade 83%, acurácia 86% em 266 lesões; PMID 10189459)", "colunas": [ "Type / phase", "Time definition", "Signal behaviour", "Interpretation" ], "linhas": [ { "status": null, "celulas": [ "Fase inicial", "Primeiros 2 minutos após a injeção, ou até a primeira inflexão da curva", "Descrita como lenta, média ou rápida", "Velocidade de captação; compõe a descrição junto com a fase tardia" ] }, { "status": null, "celulas": [ "Tipo I — persistente", "Fase tardia, após cerca de 2 minutos", "O sinal continua subindo ao longo de toda a aquisição", "Mais frequente em lesões benignas (83,0% das benignas na série original), mas ocorre em 8,9% dos carcinomas; não exclui carcinoma bem diferenciado nem carcinoma lobular" ] }, { "status": null, "celulas": [ "Tipo II — platô", "Fase tardia, após cerca de 2 minutos", "O sinal estabiliza após o pico inicial", "Indeterminado — a categoria é definida pelos descritores morfológicos" ] }, { "status": null, "celulas": [ "Tipo III — washout", "Fase tardia, após cerca de 2 minutos", "O sinal cai após o pico inicial", "Mais frequente em lesões malignas (57,4% dos carcinomas); eleva a suspeita mas não substitui a morfologia" ] } ] }, { "id": "rm_mama_cardio.c2", "grupo": "rm_mama_cardio", "nome": "Enhancement descriptors — BI-RADS MRI lexicon", "nota": null, "fonte": "ACR BI-RADS Atlas 5ª ed (2013), léxico de RM de mama · enumeração conferida em RadioGraphics 2016, A Pictorial Review of Changes in the BI-RADS Fifth Edition (doi 10.1148/rg.2016150178)", "colunas": [ "Finding type", "Lexicon descriptors" ], "linhas": [ { "status": null, "celulas": [ "Foco", "Realce puntiforme, pequeno demais para que forma e margem sejam caracterizadas" ] }, { "status": null, "celulas": [ "Massa — forma", "Oval, redonda, irregular" ] }, { "status": null, "celulas": [ "Massa — margem", "Circunscrita, irregular, espiculada" ] }, { "status": null, "celulas": [ "Massa — realce interno", "Homogêneo, heterogêneo, anelar (rim enhancement), septos internos escuros" ] }, { "status": null, "celulas": [ "Realce não-massa — distribuição", "Focal, linear, segmentar, regional, múltiplas regiões, difuso" ] }, { "status": null, "celulas": [ "Realce não-massa — padrão interno", "Homogêneo, heterogêneo, agrupado (clumped), em anéis agrupados (clustered ring)" ] }, { "status": null, "celulas": [ "Simetria", "Simétrico ou assimétrico, aplicável a realce não-massa em achados bilaterais" ] }, { "status": null, "celulas": [ "Achados associados", "Retração cutânea ou papilar, espessamento cutâneo, invasão de músculo peitoral ou parede torácica, linfonodopatia axilar, edema" ] } ] }, { "id": "rm_mama_cardio.c3", "grupo": "rm_mama_cardio", "nome": "Fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) on breast MRI", "nota": null, "fonte": "ACR BI-RADS Atlas 5ª ed (2013) — o TFG é categorizado com as letras a a d, à semelhança da densidade mamográfica, e avaliado em T1 sem contraste; o BPE é estimativa visual do volume e da intensidade do realce do parênquima normal nas imagens pós-contraste (MIP axial) e é graduado como mínimo, leve, moderado ou acentuado, sem usar as mesmas letras · categorias conferidas em RadioGraphics 2016 (doi 10.1148/rg.2016150178)", "colunas": [ "Category", "Fibroglandular tissue — non-contrast T1", "Background parenchymal enhancement (BPE) — first post-contrast phase" ], "linhas": [ { "status": null, "celulas": [ "a", "Quase inteiramente adiposo", "Mínimo" ] }, { "status": null, "celulas": [ "b", "Tecido fibroglandular esparso", "Leve" ] }, { "status": null, "celulas": [ "c", "Tecido fibroglandular heterogêneo", "Moderado" ] }, { "status": null, "celulas": [ "d", "Tecido fibroglandular extremo", "Acentuado" ] } ] }, { "id": "rm_mama_cardio.c4", "grupo": "rm_mama_cardio", "nome": "2018 Lake Louise Criteria — myocarditis", "nota": null, "fonte": "Ferreira VM et al., Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations — J Am Coll Cardiol 2018;72:3158-3176 · validação com biópsia endomiocárdica em Li S et al., Front Cardiovasc Med 2021;8:739892 (sensibilidade 95,3%, especificidade 86,7%, acurácia 91,8%; doi 10.3389/fcvm.2021.739892)", "colunas": [ "Criterion", "What satisfies it", "Role in the diagnosis" ], "linhas": [ { "status": null, "celulas": [ "Critério T2 — edema miocárdico", "Aumento regional ou global do T2 no mapa de T2; ou hipersinal regional em T2/STIR; ou razão de intensidade global de T2 elevada", "Obrigatório — pelo menos um item positivo" ] }, { "status": null, "celulas": [ "Critério T1 — lesão miocárdica", "Aumento do T1 nativo; ou aumento do ECV; ou realce tardio com padrão não-isquêmico", "Obrigatório — pelo menos um item positivo" ] }, { "status": null, "celulas": [ "Diagnóstico de miocardite", "Um critério T2 positivo E um critério T1 positivo", "Os dois são necessários; um só critério positivo apenas apoia a hipótese" ] }, { "status": null, "celulas": [ "Critérios de apoio", "Derrame pericárdico ou realce/edema pericárdico; alteração segmentar da contratilidade sistólica do VE", "Reforçam o diagnóstico mas não substituem os critérios principais" ] }, { "status": null, "celulas": [ "Observação de agudeza", "O critério T2 (edema) é o que indica atividade inflamatória; realce tardio isolado, sem T2 elevado, favorece cicatriz prévia e não miocardite ativa", "Separa miocardite ativa de sequela" ] } ] }, { "id": "rm_mama_cardio.c5", "grupo": "rm_mama_cardio", "nome": "Myocardial T2* — iron overload stratification", "nota": null, "fonte": "Limiar de 20 ms e estratificação original em Anderson LJ et al., Eur Heart J 2001;22:2171-2179 (PMID 11913479) · desfechos clínicos em Kirk P et al., Circulation 2009;120:1961-1968 (PMID 19801505; 652 pacientes, 1442 exames) · parâmetros de aquisição (1,5 T, gradiente-eco multi-eco com 8 ecos de 2 a 18 ms, ROI septal) em Messroghli DR et al., J Cardiovasc Magn Reson 2017;19:75 (doi 10.1186/s12968-017-0389-8), que não publica estes cortes de risco", "colunas": [ "Myocardial T2* (1.5 T)", "Stratum", "Clinical implication" ], "linhas": [ { "status": null, "celulas": [ "> 20 ms", "Baixo risco — sem sobrecarga miocárdica significativa", "Nenhum paciente sem sobrecarga apresentou T2* abaixo de 20 ms na série de Anderson 2001, o que sustenta esse valor como limiar clínico" ] }, { "status": null, "celulas": [ "10 a 20 ms", "Risco intermediário — sobrecarga miocárdica presente", "83% dos pacientes que desenvolveram arritmia tinham T2* menor que 20 ms (risco relativo de arritmia 4,6; IC 95% 2,66 a 7,95)" ] }, { "status": null, "celulas": [ "< 10 ms", "Alto risco", "Risco relativo de insuficiência cardíaca de 160 (IC 95% 39 a 653) em comparação com T2* acima de 10 ms; 98% dos exames de quem desenvolveu insuficiência cardíaca estavam abaixo de 10 ms" ] }, { "status": null, "celulas": [ "< 6 ms", "Risco muito alto", "Insuficiência cardíaca sintomática em 47% dos pacientes em 1 ano (risco relativo 270; IC 95% 64 a 1129); indica quelação intensiva mesmo com função ventricular normal" ] } ] }, { "id": "rm_mama_cardio.c6", "grupo": "rm_mama_cardio", "nome": "Late gadolinium enhancement — ischaemic vs non-ischaemic pattern", "nota": null, "fonte": "Lewis AJM et al., Cardiovascular magnetic resonance imaging for inflammatory heart diseases — Cardiovasc Diagn Ther (PMID 32695640) · regra de viabilidade em Pegg TJ et al., J Cardiovasc Magn Reson 2010;12:56 (doi 10.1186/1532-429X-12-56) e princípio original em Kim RJ et al., N Engl J Med 2000;343:1445-1453", "colunas": [ "Pattern", "Distribution across the wall", "Typical context" ], "linhas": [ { "status": null, "celulas": [ "Isquêmico", "Acomete obrigatoriamente o subendocárdio, com extensão variável até transmural, respeitando território de artéria coronária", "Infarto do miocárdio e doença arterial coronariana" ] }, { "status": null, "celulas": [ "Não-isquêmico — mesocárdico (mid-wall)", "Faixa média da parede, poupando o subendocárdio", "Cardiomiopatia dilatada, miocardite, sarcoidose; satisfaz o critério T1 de Lake Louise" ] }, { "status": null, "celulas": [ "Não-isquêmico — subepicárdico", "Camada subepicárdica, tipicamente em focos manchados e não contíguos nas paredes lateral ou septal", "Miocardite — é o padrão mais característico, e satisfaz o critério T1 de Lake Louise tanto quanto o mesocárdico" ] }, { "status": null, "celulas": [ "Não-isquêmico — transmural sem território coronariano", "Acometimento transmural sem correspondência com território de artéria coronária", "Pode ocorrer em miocardite grave, sarcoidose e doença de Chagas; exige exclusão de infarto antes de ser chamado de não-isquêmico" ] }, { "status": null, "celulas": [ "Regra de viabilidade", "Extensão transmural do realce menor que 50% da espessura parietal", "Segmento considerado viável: 63% dos segmentos disfuncionais com realce menor que 50% recuperaram contração em 6 meses após revascularização" ] } ] }, { "id": "rm_mama_cardio.c7", "grupo": "rm_mama_cardio", "nome": "Native T1 — what raises and what lowers it", "nota": null, "fonte": "Messroghli DR et al., Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: consenso SCMR endossado pela EACVI — J Cardiovasc Magn Reson 2017;19:75 (doi 10.1186/s12968-017-0389-8)", "colunas": [ "Direction", "Conditions", "Practical use" ], "linhas": [ { "status": null, "celulas": [ "Elevam o T1 nativo", "Amiloidose, inflamação aguda, isquemia aguda, necrose, fibrose difusa, edema", "T1 nativo elevado é sensível mas inespecífico — precisa do T2 e do realce tardio para separar edema agudo de fibrose crônica" ] }, { "status": null, "celulas": [ "Reduzem o T1 nativo", "Doença de Anderson-Fabry, sobrecarga de ferro, gordura, hemorragia", "T1 nativo reduzido é um achado de alto valor: em hipertrofia ventricular inexplicada, sugere Fabry e muda a investigação" ] }, { "status": null, "celulas": [ "Advertência técnica", "Os valores dependem de sequência (MOLLI, ShMOLLI, SASHA), campo magnético (1,5 T x 3 T), idade e sexo; a variação por sexo e idade é da ordem de 0,5 desvio-padrão da média normal", "O consenso recomenda comparar com faixas publicadas mas usar prioritariamente a faixa de referência LOCAL, com limites definidos pela média ± 2 desvios-padrão; sem faixa local para T1 nativo e T2, o resultado quantitativo NÃO deve ser reportado clinicamente" ] }, { "status": null, "celulas": [ "ECV — referência de magnitude", "Na amiloidose, fibrose difusa raramente ultrapassa 40%; valores acima de cerca de 55% aparecem em áreas de realce tardio transmural", "Ajuda a checar plausibilidade do valor medido antes de laudar; não é corte diagnóstico" ] } ] } ] }, { "metodo": "RX", "chave": "rx_torax", "slug": "rx-torax", "nome": "Chest Radiography — Measurements, Technical Quality and Signs", "temPaginaPublica": false, "medidas": [ { "id": "rx_torax.0", "grupo": "rx_torax", "ruleId": null, "rotulo": "Cardiothoracic ratio (CTR) — upright PA", "valor": "≤ 0,50", "unidade": "razão", "nota": "Sum of the greatest cardiac diameters to the right and left of midline divided by the greatest internal thoracic diameter, on the same inspiration. On an upright PA film a CTR ≥ 0.50 already defines cardiomegaly — there is no 'borderline' band in this projection. Valid only on upright PA with adequate inspiration.", "fonte": "Chon SB, Oh WS, Cho JH, Kim SS, Lee SJ. Calculation of the cardiothoracic ratio from portable anteroposterior chest radiography. J Korean Med Sci 2011;26(11):1446-53 (define cardiomegalia como ICT ≥ 0,50)", "faixas": [ { "status": "green", "rotulo": "Normal (upright PA)", "valor": "< 0,50", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Cardiomegaly (upright PA)", "valor": "≥ 0,50", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.1", "grupo": "rx_torax", "ruleId": null, "rotulo": "Cardiothoracic ratio (CTR) — portable/supine AP radiograph", "valor": "≤ 0,55", "unidade": "razão", "nota": "ROC-derived cut-off on portable supine digital radiographs of ICU patients with pulmonary artery catheters. Even combined with a vascular pedicle width ≥ 70 mm, radiologists' accuracy in separating PAOP > 18 mmHg from PAOP < 18 mmHg was only 70% — the cut-off describes a trend, it does not settle volume status. Alternative: correct the AP cardiac diameter by the 0.925 factor and apply the 0.50 cut-off (Chon 2011).", "fonte": "Ely EW, Smith AC, Chiles C, et al. Radiologic determination of intravascular volume status using portable, digital chest radiography. Crit Care Med 2001;29(8):1502-8", "faixas": [ { "status": "green", "rotulo": "Below the portable ROC cut-off", "valor": "≤ 0,55", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Above the portable ROC cut-off — correlate clinically", "valor": "> 0,55", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.2", "grupo": "rx_torax", "ruleId": null, "rotulo": "Cardiac diameter magnification on AP projection", "valor": "≈ 7,5% a 140 cm de distância foco-filme", "unidade": "%", "nota": "The AP pitfall: CD(PA)/CD(AP) ratio = [0.00099 × distance in cm] + 0.79. At 140 cm the calculation yields 0.9286, rounded by the authors themselves to 0.925 — about 7.5% overestimation of the cardiac diameter on AP. The shorter the source-to-image distance, the greater the overestimation — never call cardiomegaly on a portable AP film alone.", "fonte": "Chon SB et al. Calculation of the cardiothoracic ratio from portable anteroposterior chest radiography. J Korean Med Sci 2011;26(11):1446-53", "faixas": [] }, { "id": "rx_torax.3", "grupo": "rx_torax", "ruleId": null, "rotulo": "Trachea — coronal diameter", "valor": "Homens 13 – 25 mm · Mulheres 10 – 21 mm", "unidade": "mm", "nota": "Measured on the tracheal air column on the PA film. Limits defined as mean ± 3 SD (99.7% of the normal population) in 808 adults aged 10-79. No statistically significant correlation with weight or height in the original series. Saber-sheath trachea is NOT defined by the coronal diameter alone: it requires a coronal/sagittal ratio ≤ 2/3 in the intrathoracic segment, typically in COPD.", "fonte": "Breatnach E, Abbott GC, Fraser RG. Dimensions of the normal human trachea. AJR 1984;142(5):903-6 (n=808)", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "H 13–25 mm · M 10–21 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Pathologic widening — tracheobronchomegaly (Mounier-Kuhn) to investigate", "valor": "H > 25 mm · M > 21 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Pathologic narrowing to investigate (compute the coronal/sagittal ratio)", "valor": "H < 13 mm · M < 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.4", "grupo": "rx_torax", "ruleId": null, "rotulo": "Trachea — sagittal diameter", "valor": "Homens 13 – 27 mm · Mulheres 10 – 23 mm", "unidade": "mm", "nota": "Measured on the lateral view. Lower limits of normal are identical in both planes: 13 mm (men) and 10 mm (women).", "fonte": "Breatnach E, Abbott GC, Fraser RG. AJR 1984;142(5):903-6", "faixas": [] }, { "id": "rx_torax.5", "grupo": "rx_torax", "ruleId": null, "rotulo": "Right paratracheal stripe", "valor": "1 – 4 mm", "unidade": "mm", "nota": "Water-density stripe between the tracheal air column and the right lung. In the series of 1,259 normal subjects the width ranged from 1 to 4 mm; 5 mm or more is reliable evidence of tracheal, mediastinal (adenopathy, haemorrhage) or pleural disease.", "fonte": "Savoca CJ, Austin JH, Goldberg HI. The right paratracheal stripe. Radiology 1977;122(2):295-301", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "1 – 4 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Reliable evidence of disease", "valor": "≥ 5 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.6", "grupo": "rx_torax", "ruleId": null, "rotulo": "Azygos arch (upright)", "valor": "< 10 mm", "unidade": "mm", "nota": "Measured at the right tracheobronchial angle. Physiologically larger when supine, in pregnancy and with the Müller manoeuvre (inspiration against a closed glottis); the Valsalva manoeuvre, by contrast, reduces its calibre. Loses value as a volume marker on supine films.", "fonte": "Klein JS, Rosado-de-Christenson ML. A Systematic Approach to Chest Radiographic Analysis. In: IDKD Springer Series — Diseases of the Chest, Breast, Heart and Vessels 2019-2022 (acesso aberto, NBK553874)", "faixas": [ { "status": "green", "rotulo": "Normal upright", "valor": "< 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Enlarged — hypervolaemia, SVC obstruction, azygos continuation", "valor": "≥ 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.7", "grupo": "rx_torax", "ruleId": null, "rotulo": "Relative hilar position", "valor": "Hilo direito mais baixo que o esquerdo em 97% dos casos; mesmo nível em 3%", "unidade": null, "nota": "The reverse pattern (left hilum lower than the right) is not described in this series — when seen, look for volume loss (left lower lobe atelectasis) or a mass tethering the hilum.", "fonte": "Klein JS, Rosado-de-Christenson ML. IDKD Springer Series 2019 (acesso aberto, NBK553874)", "faixas": [] }, { "id": "rx_torax.8", "grupo": "rx_torax", "ruleId": null, "rotulo": "Adequate inspiration (PA)", "valor": "Cúpula diafragmática direita no 6º arco costal anterior ou 10º arco posterior, na linha hemiclavicular", "unidade": null, "nota": "Single reproducible landmark: count at the midclavicular line. Hypoinflation increases the CTR, widens the mediastinum, blurs the bases and mimics congestion.", "fonte": "Klein JS, Rosado-de-Christenson ML. IDKD Springer Series 2019 (acesso aberto, NBK553874)", "faixas": [] }, { "id": "rx_torax.9", "grupo": "rx_torax", "ruleId": null, "rotulo": "Rotation (PA)", "valor": "Processos espinhosos projetados na linha média entre as extremidades mediais das clavículas", "unidade": null, "nota": "Rotation produces asymmetric lung transradiancy, spurious mediastinal widening, spurious tracheal deviation and distorts vascular pedicle measurement.", "fonte": "Klein JS, Rosado-de-Christenson ML. IDKD Springer Series 2019 (acesso aberto, NBK553874)", "faixas": [] }, { "id": "rx_torax.10", "grupo": "rx_torax", "ruleId": null, "rotulo": "Adequate penetration / exposure", "valor": "Corpos vertebrais e espaços discais fracamente visíveis através do mediastino, pulmões cinzentos e vasos pulmonares facilmente identificáveis", "unidade": null, "nota": "Underpenetration hides retrocardiac and retrodiaphragmatic disease; overpenetration erases the visceral pleural line of a pneumothorax and peripheral vascular detail.", "fonte": "Klein JS, Rosado-de-Christenson ML. IDKD Springer Series 2019 (acesso aberto, NBK553874)", "faixas": [] }, { "id": "rx_torax.11", "grupo": "rx_torax", "ruleId": null, "rotulo": "Pleural effusion — minimum volume detectable on the lateral view", "valor": "≈ 50 mL", "unidade": "mL", "nota": "Meniscus blunting the posterior costophrenic sulcus. The lateral view detects volumes roughly four times smaller than the PA (50 mL vs. 200 mL in the same series) — mandatory when a small effusion is suspected.", "fonte": "Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol 1996;3(2):103-9", "faixas": [] }, { "id": "rx_torax.12", "grupo": "rx_torax", "ruleId": null, "rotulo": "Pleural effusion — minimum volume detectable on PA", "valor": "≈ 200 mL", "unidade": "mL", "nota": "Meniscus blunting the lateral costophrenic sulcus. Prediction rule validated against CT, with weighted accuracy of 86% (test) and 85% (validation) and interobserver agreement of 97% and 88%.", "fonte": "Blackmore CC et al. Acad Radiol 1996;3(2):103-9", "faixas": [ { "status": "green", "rotulo": "Clear sulci on PA and lateral", "valor": "< 50 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Detectable on the lateral only", "valor": "≈ 50 – 200 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Detectable on PA", "valor": "≥ 200 mL", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.13", "grupo": "rx_torax", "ruleId": null, "rotulo": "Pleural effusion — volume obscuring the hemidiaphragm", "valor": "≈ 500 mL", "unidade": "mL", "nota": "Practical landmark for volume estimation in the report: blunted lateral sulcus ≈ 200 mL; obscured hemidiaphragm ≈ 500 mL or more.", "fonte": "Blackmore CC et al. Acad Radiol 1996;3(2):103-9", "faixas": [] }, { "id": "rx_torax.14", "grupo": "rx_torax", "ruleId": null, "rotulo": "Vascular pedicle width — upright PA", "valor": "≤ 53 mm", "unidade": "mm", "nota": "Measured from a perpendicular dropped at the take-off of the left subclavian artery to the point where the superior vena cava crosses the right main bronchus. CAUTION: published decision cut-offs (≥ 70 mm) were derived on supine ICU AP films and do NOT apply to this scale. On upright PA, a pedicle above 53 mm is a descriptive finding — compare only films of identical technique.", "fonte": "Milne EN, Pistolesi M, Miniati M, Giuntini C. The radiologic distinction of cardiogenic and noncardiogenic edema. AJR 1985;144:879-94", "faixas": [ { "status": "green", "rotulo": "Normal on upright PA", "valor": "≤ 53 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Widened on upright PA — descriptive; no validated decision cut-off in this projection", "valor": "> 53 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.15", "grupo": "rx_torax", "ruleId": null, "rotulo": "Vascular pedicle width — portable/supine AP (ICU)", "valor": "≥ 70 mm", "unidade": "mm", "nota": "ROC-derived cut-off for cardiogenic pulmonary oedema in critically ill patients with pulmonary artery catheters: sensitivity 55%, specificity 88%, PPV 81%, NPV 69%, accuracy 73% (n=80); AUC 0.72. Combined with a CTR of 0.55 on portable digital radiography, radiologists' accuracy for volume status was 70%. Valid on supine AP only — do not transpose to upright PA.", "fonte": "Farshidpanah S et al. Anaesth Intensive Care 2014;42(3):349-56 · Ely EW et al. Crit Care Med 2001;29(8):1502-8", "faixas": [ { "status": "green", "rotulo": "Below the cut-off", "valor": "< 70 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Probable volume overload / cardiogenic oedema", "valor": "≥ 70 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.16", "grupo": "rx_torax", "ruleId": null, "rotulo": "Upper mediastinal width on supine AP (trauma)", "valor": "> 8 cm", "unidade": "cm", "nota": "Classic widened-mediastinum criterion in blunt trauma. It is a trigger for CT angiography, not a diagnosis: in a series of 749 patients, 502 (67%) had a mediastinum > 8 cm and only 2 had confirmed aortic injury — sensitivity 100%, specificity 33% for traumatic findings and positive predictive value alone for aortic injury < 1%. Always confirm with associated findings (loss of the aortic contour, rightward tracheal/NG tube deviation, apical cap).", "fonte": "Vasileiou G, Qian S, Al-Ghamdi H, et al. Blunt Trauma: What Is Behind the Widened Mediastinum on Chest X-Ray? J Surg Res 2019;243:23-26", "faixas": [ { "status": "green", "rotulo": "Not widened", "valor": "≤ 8 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Widened mediastinum — proceed to CT angiography", "valor": "> 8 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.17", "grupo": "rx_torax", "ruleId": null, "rotulo": "Left mediastinal width (trauma) — alternative criterion", "valor": "≥ 6 cm", "unidade": "cm", "nota": "Distance from the midline to the left mediastinal border at the level of the aortic knob. In a series of 51 patients (21 with aortic injury), with cut-offs set by ROC analysis TO force 100% sensitivity, specificity was 40.0% and PPV 53.8% — better than total mediastinal width ≥ 8 cm (specificity 13.3%, PPV 44.7%). A mediastinal width ratio ≥ 0.60 had 43.3% specificity and, combined with left width, 66.7%. Small series: use for triage, not diagnosis.", "fonte": "Wong YC, Ng CJ, Wang LJ, Hsu KH, Chen CJ. Left mediastinal width and mediastinal width ratio are better radiographic criteria than general mediastinal width for predicting blunt traumatic aortic injury. J Trauma 2004", "faixas": [] }, { "id": "rx_torax.18", "grupo": "rx_torax", "ruleId": null, "rotulo": "Endotracheal tube — tip above the carina (neutral head)", "valor": "5 ± 2 cm", "unidade": "cm", "nota": "Always state chin/mandible position: in neutral the lower border of the mandible projects over C5-C6. Too short risks selective right main bronchus intubation; too long risks extubation and vocal cord injury.", "fonte": "Goodman LR, Conrardy PA, Laing F, Singer MM. Radiographic evaluation of endotracheal tube position. AJR 1976;127(3):433-4", "faixas": [ { "status": "red", "rotulo": "Too low — risk of selective intubation", "valor": "< 3 cm da carina", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "green", "rotulo": "Adequate in neutral position", "valor": "3 – 7 cm da carina", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Too high — risk of extubation", "valor": "> 7 cm da carina", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.19", "grupo": "rx_torax", "ruleId": null, "rotulo": "Endotracheal tube — target when the carina is not visible", "valor": "Ponta em T3 – T4", "unidade": null, "nota": "In the original series the carina projected over T5, T6 or T7 in 92 of 100 portable radiographs — hence a tip at T3-T4 is safe even when the carina is not seen.", "fonte": "Goodman LR et al. AJR 1976;127(3):433-4", "faixas": [] }, { "id": "rx_torax.20", "grupo": "rx_torax", "ruleId": null, "rotulo": "Endotracheal tube — displacement with neck flexion and extension", "valor": "≈ 2 cm em cada sentido", "unidade": "cm", "nota": "Flexion advances the tip ≈ 2 cm toward the carina; extension withdraws it ≈ 2 cm. Adjusted targets: 3 ± 2 cm (flexed), 5 ± 2 cm (neutral), 7 ± 2 cm (extended).", "fonte": "Conrardy PA, Goodman LR, Laing F, Singer MM. Alteration of endotracheal tube position: flexion and extension of the neck. Crit Care Med 1976;4(1):8-12", "faixas": [] }, { "id": "rx_torax.21", "grupo": "rx_torax", "ruleId": null, "rotulo": "Central venous catheter — cavoatrial junction", "valor": "≈ 2 corpos vertebrais abaixo da carina", "unidade": null, "nota": "The carina is the most reliable landmark; use the thoracic spine as an internal ruler (one unit = distance between the inferior endplates of adjacent vertebrae). A tip above this point lies in the SVC (acceptable); below it, the tip enters the right atrium (risk of arrhythmia and perforation). Caveat: the original series comprised 100 CT studies in patients aged 12-28 years (mean 16), and the lack of association with age refers to that age range.", "fonte": "Baskin KM, Jimenez RM, Cahill AM, Jawad AF, Towbin RB. Cavoatrial junction and central venous anatomy: implications for central venous access tip position. J Vasc Interv Radiol 2008;19(3):359-65", "faixas": [] }, { "id": "rx_torax.22", "grupo": "rx_torax", "ruleId": null, "rotulo": "Pneumothorax — interpleural distance at the level of the hilum (BTS)", "valor": "≥ 2 cm = grande", "unidade": "cm", "nota": "BTS size criterion: sensitivity 0.667 and specificity 0.805 when compared with the ACCP criterion. Note: the 2023 BTS guideline removed size from the treatment decision in minimally symptomatic primary spontaneous pneumothorax (management guided by symptoms and risk); the measurement remains useful to describe the case and judge procedural safety.", "fonte": "MacDuff A, Arnold A, Harvey J. BTS Pleural Disease Guideline 2010. Thorax 2010;65(Suppl 2):ii18-31 · Roberts ME et al. BTS Guideline for pleural disease. Thorax 2023;78(11):1143-56 · comparação em Eur Respir J 2015;45(6):1731", "faixas": [ { "status": "green", "rotulo": "Small (BTS)", "valor": "< 2 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Large (BTS)", "valor": "≥ 2 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.23", "grupo": "rx_torax", "ruleId": null, "rotulo": "Pneumothorax — apex-to-cupola distance (ACCP/CHEST)", "valor": "≥ 3 cm = grande", "unidade": "cm", "nota": "ACCP Delphi consensus criterion. Compared with BTS it is far more sensitive (0.948) and far less specific (0.351): under the CHEST definition, 65% of patients whose pneumothorax could have been managed conservatively or by aspiration would be admitted unnecessarily for an intercostal drain.", "fonte": "Baumann MH, Strange C, Heffner JE et al. ACCP Delphi consensus statement. Chest 2001;119:590-602 · comparação em Eur Respir J 2015;45(6):1731", "faixas": [ { "status": "green", "rotulo": "Small (ACCP)", "valor": "< 3 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Large (ACCP)", "valor": "≥ 3 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_torax.24", "grupo": "rx_torax", "ruleId": null, "rotulo": "Pneumothorax — percentage quantification (Collins formula)", "valor": "% = 4,2 + 4,7 × (A + B + C)", "unidade": "%", "nota": "A = apical interpleural distance; B = at the midpoint of the upper half of the collapsed lung; C = at the midpoint of the lower half, in centimetres, on an erect PA film. Correlation r = 0.98 (p < 0.0001) with helical CT-measured volume — but in a small series (20 pneumothoraces in 19 patients).", "fonte": "Collins CD, Lopez A, Mathie A, Wood V, Jackson JE, Roddie ME. Quantification of pneumothorax size on chest radiographs using interpleural distances. AJR 1995;165:1127-30", "faixas": [] } ], "classificacoes": [ { "id": "rx_torax.c0", "grupo": "rx_torax", "nome": "Cardiothoracic ratio — reading by range and technique", "nota": null, "fonte": "Danzer CS, Am J Med Sci 1919;157:513-54 · Dimopoulos K et al., Int J Cardiol 2013;167(5):1935-41 · Chest radiograph interpretation (ACR appropriateness / técnica PA x AP)", "colunas": [ "Range", "Reading", "Technique caveat" ], "linhas": [ { "status": null, "celulas": [ "≤ 0,50 (PA ortostático)", "Área cardíaca dentro do esperado", "Vale só em PA ortostático com inspiração adequada; conte 9-10 arcos costais posteriores." ] }, { "status": null, "celulas": [ "0,51 – 0,55 (PA ortostático)", "Limítrofe / aumento discreto", "Confirme rotação (clavículas simétricas em relação às apófises espinhosas) antes de concluir — rotação estreita o tórax e infla o índice." ] }, { "status": null, "celulas": [ "> 0,55 (PA ortostático)", "Aumento importante da área cardíaca", "Descrever a configuração (câmaras, pedículo) e correlacionar; o índice não define qual câmara está aumentada." ] }, { "status": null, "celulas": [ "Qualquer valor em AP, leito ou decúbito", "Índice não aplicável para afirmar cardiomegalia", "A projeção AP magnifica o coração (distância foco-objeto menor). Descreva a silhueta e, se a dúvida for relevante, repita em PA ortostático." ] }, { "status": null, "celulas": [ "Inspiração incompleta (< 9 arcos posteriores)", "Índice superestimado", "Diafragma alto horizontaliza o coração e alarga a silhueta; a mesma pessoa pode variar mais de 0,05 entre inspiração boa e ruim." ] } ] }, { "id": "rx_torax.c1", "grupo": "rx_torax", "nome": "Technical quality criteria for the chest radiograph", "nota": null, "fonte": "Klein JS, Rosado-de-Christenson ML. A Systematic Approach to Chest Radiographic Analysis. IDKD Springer Series — Diseases of the Chest, Breast, Heart and Vessels 2019-2022 (acesso aberto, NBK553874) · Chon SB et al. J Korean Med Sci 2011;26(11):1446-53 (magnificação em AP) · Ely EW et al. Crit Care Med 2001;29(8):1502-8 (cortes de ICT e pedículo em portátil)", "colunas": [ "Criterion", "Target", "How to check", "What it distorts if it fails" ], "linhas": [ { "status": null, "celulas": [ "Inspiração", "Cúpula diafragmática direita no 6º arco costal anterior ou 10º posterior", "Contar os arcos na linha hemiclavicular", "Hipoinsuflação eleva o ICT, alarga o mediastino, aglomera a trama e simula congestão e opacidade de bases" ] }, { "status": null, "celulas": [ "Rotação", "Processos espinhosos na linha média entre as extremidades mediais das clavículas", "Comparar as distâncias clavícula-espinhosa dos dois lados", "Assimetria de transparência pulmonar, falso alargamento mediastinal, falso desvio traqueal, pedículo vascular falseado" ] }, { "status": null, "celulas": [ "Penetração", "Corpos vertebrais e espaços discais fracamente visíveis através do mediastino; vasos pulmonares facilmente identificáveis", "Olhar a região retrocardíaca e retrodiafragmática", "Subpenetrado esconde lesão retrocardíaca; superpenetrado apaga a linha pleural do pneumotórax e o detalhe vascular periférico" ] }, { "status": null, "celulas": [ "Ausência de movimento", "Corticais superiores dos arcos costais, margens vasculares e contornos diafragmáticos nítidos", "Procurar borramento de bordas", "Borramento cinético simula opacidade em vidro fosco e infiltrado" ] }, { "status": null, "celulas": [ "Projeção e distância", "PA em ortostase com distância foco-filme padronizada", "Conferir o marcador de incidência e a posição do paciente", "AP/portátil magnifica o coração em ≈7,5% a 140 cm, além do mediastino e do pedículo vascular — cortes de PA não se aplicam (ICT no portátil: corte 0,55; pedículo: 70 mm)" ] }, { "status": null, "celulas": [ "Cobertura", "Ápices, seios costofrênicos e ambas as paredes torácicas incluídos", "Verificar as bordas do campo", "Seio cortado impede excluir derrame pequeno; ápice cortado impede excluir pneumotórax apical" ] } ] }, { "id": "rx_torax.c2", "grupo": "rx_torax", "nome": "Pneumothorax size estimation — published methods", "nota": null, "fonte": "MacDuff A, Arnold A, Harvey J. Thorax 2010;65(Suppl 2):ii18-31 · Baumann MH et al. Chest 2001;119:590-602 · Roberts ME et al. Thorax 2023;78(11):1143-56 · Collins CD et al. AJR 1995;165:1127-30 · Rhea JT, DeLuca SA, Greene RE. Radiology 1982 · Hoi K, Turchin B, Kelly AM. How accurate is the Light index for estimating pneumothorax size? Emerg Radiol 2007 · Eur Respir J 2015;45(6):1731", "colunas": [ "Method", "What is measured", "Cut-off / formula", "Practical note" ], "linhas": [ { "status": null, "celulas": [ "BTS (Thorax 2010)", "Distância interpleural no nível do hilo", "≥ 2 cm = grande; < 2 cm = pequeno", "Mais específico (0,805) e menos sensível (0,667) que o ACCP; leva a menos drenagens. Na atualização BTS 2023 o tamanho deixou de definir a conduta no pneumotórax espontâneo primário pouco sintomático" ] }, { "status": null, "celulas": [ "ACCP/CHEST (Chest 2001)", "Distância do ápice pulmonar à cúpula torácica", "≥ 3 cm = grande; < 3 cm = pequeno", "Sensibilidade 0,948 e especificidade 0,351; 65% dos pacientes tratáveis de forma conservadora ou por aspiração seriam internados desnecessariamente para dreno" ] }, { "status": null, "celulas": [ "Collins (AJR 1995)", "A = ápice; B = ponto médio da metade superior; C = ponto médio da metade inferior (cm)", "% = 4,2 + 4,7 × (A + B + C)", "Regressão validada contra TC, r = 0,98, porém em apenas 20 pneumotórax — método prático para dar um percentual no laudo, com essa ressalva" ] }, { "status": null, "celulas": [ "Rhea (Radiology 1982)", "Distância interpleural média (AID) das três medidas", "Nomograma AID → percentual", "Método gráfico anterior ao de Collins; exige o nomograma original e é pouco prático no fluxo digital" ] }, { "status": null, "celulas": [ "Índice de Light", "DL = diâmetro médio do pulmão colapsado; DH = diâmetro médio do hemitórax", "% = 100 × [1 − (DL³/DH³)]", "Assume geometria esférica e colapso uniforme; perde acurácia no colapso assimétrico ou com aderências" ] }, { "status": null, "celulas": [ "Radiografia em expiração", "Distância interpleural em inspiração vs. expiração", "Sem corte próprio", "Não aumenta a detecção o bastante para justificar uso rotineiro; laude sobre o filme inspiratório" ] } ] }, { "id": "rx_torax.c3", "grupo": "rx_torax", "nome": "Position of thoracic devices", "nota": null, "fonte": "Goodman LR, Conrardy PA, Laing F, Singer MM. AJR 1976;127(3):433-4 · Conrardy PA, Goodman LR, Laing F, Singer MM. Crit Care Med 1976;4(1):8-12 · Baskin KM et al. J Vasc Interv Radiol 2008;19(3):359-65 · Amorosa JK et al. J Am Coll Radiol 2013;10(3)", "colunas": [ "Device / situation", "Radiographic target", "Typical error and consequence", "Source" ], "linhas": [ { "status": null, "celulas": [ "Tubo orotraqueal — cabeça neutra", "Ponta 5 ± 2 cm acima da carina (mandíbula projetada sobre C5-C6)", "Ponta < 3 cm: intubação seletiva do brônquio principal direito com atelectasia do pulmão esquerdo. Ponta > 7 cm: extubação e lesão glótica", "Goodman LR et al. AJR 1976;127(3):433-4" ] }, { "status": null, "celulas": [ "Tubo orotraqueal — carina não visível", "Ponta projetada em T3-T4", "A carina está em T5-T7 em 92% dos portáteis; assumir nível errado gera falso alarme", "Goodman LR et al. AJR 1976;127(3):433-4" ] }, { "status": null, "celulas": [ "Tubo orotraqueal — pescoço fletido ou estendido", "3 ± 2 cm (flexão) · 5 ± 2 cm (neutro) · 7 ± 2 cm (extensão)", "Laudar sem considerar a posição do queixo gera recuo/avanço desnecessário do tubo", "Conrardy PA et al. Crit Care Med 1976;4(1):8-12" ] }, { "status": null, "celulas": [ "Cateter venoso central", "Ponta na VCS inferior / junção cavoatrial ≈ 2 corpos vertebrais abaixo da carina", "Ponta em átrio direito (arritmia, perfuração, tamponamento) ou refluída para jugular/subclávia contralateral", "Baskin KM et al. J Vasc Interv Radiol 2008;19(3):359-65 (casuística de 12-28 anos)" ] }, { "status": null, "celulas": [ "Radiografia de controle na UTI", "Indicada após inserção ou troca de dispositivo e diante de mudança clínica", "Radiografia diária de rotina não melhora desfecho na maioria dos pacientes estáveis", "Amorosa JK et al. ACR Appropriateness Criteria — Routine Chest Radiographs in ICU Patients. J Am Coll Radiol 2013;10(3)" ] } ] }, { "id": "rx_torax.c4", "grupo": "rx_torax", "nome": "Pulmonary congestion and oedema pattern (Milne-Pistolesi)", "nota": null, "fonte": "Milne EN, Pistolesi M, Miniati M, Giuntini C. The radiologic distinction of cardiogenic and noncardiogenic edema. AJR 1985;144:879-94 (três achados principais: distribuição do fluxo pulmonar, distribuição do edema e largura do pedículo vascular; acurácia global 86-89%) · Ely EW et al. Crit Care Med 2001;29(8):1502-8 · Farshidpanah S et al. Anaesth Intensive Care 2014;42(3):349-56 · padrão peri-hilar em asa de morcego do edema cardiogênico conforme StatPearls, Cardiogenic Pulmonary Edema (NBK544260) · terminologia conforme Bankier AA et al. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2024;310(2):e232558", "colunas": [ "Finding", "Hydrostatic (cardiogenic) oedema", "Permeability oedema (ARDS)" ], "linhas": [ { "status": null, "celulas": [ "Pedículo vascular", "Alargado (> 53 mm em PA ereto; ≥ 70 mm em AP supino de UTI)", "Normal ou estreito" ] }, { "status": null, "celulas": [ "Área cardíaca", "Aumentada", "Normal" ] }, { "status": null, "celulas": [ "Redistribuição de fluxo (cefalização)", "Presente — proeminência dos vasos dos lobos superiores; só avaliável em ortostase", "Ausente" ] }, { "status": null, "celulas": [ "Distribuição das opacidades", "Central e peri-hilar, relativamente simétrica — padrão em asa de morcego (borboleta) nos casos graves", "Periférica e irregular (patchy), não gravitacional, poupando relativamente a região peri-hilar" ] }, { "status": null, "celulas": [ "Broncograma aéreo", "Menos frequente", "Frequente" ] }, { "status": null, "celulas": [ "Espessamento septal (linhas B de Kerley) e cuffing peribrônquico", "Presente", "Ausente ou tardio" ] }, { "status": null, "celulas": [ "Derrame pleural", "Comum", "Incomum" ] }, { "status": null, "celulas": [ "Volume pulmonar", "Reduzido", "Normal ou reduzido — isoladamente pouco discriminante" ] } ] }, { "id": "rx_torax.c5", "grupo": "rx_torax", "nome": "Pleural effusion detection by projection", "nota": null, "fonte": "Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol 1996;3(2):103-9 (acurácia ponderada 86% e 85%) · Klein JS, Rosado-de-Christenson ML. IDKD Springer Series 2019 (acesso aberto, NBK553874)", "colunas": [ "Projection", "Threshold", "Radiographic finding" ], "linhas": [ { "status": null, "celulas": [ "Perfil em ortostase", "≈ 50 mL", "Menisco velando o seio costofrênico posterior — a incidência mais sensível" ] }, { "status": null, "celulas": [ "PA em ortostase", "≈ 200 mL", "Menisco velando o seio costofrênico lateral" ] }, { "status": null, "celulas": [ "PA em ortostase", "≈ 500 mL ou mais", "Opacidade apagando o contorno da hemicúpula diafragmática" ] }, { "status": null, "celulas": [ "Decúbito lateral com raio horizontal", "Sem volume mínimo estabelecido em fonte primária verificada", "Confirma se o derrame é livre (estratifica na parede dependente) e permite medir a espessura da lâmina antes da toracocentese" ] }, { "status": null, "celulas": [ "AP em supino", "Menos sensível que as incidências em ortostase", "O líquido se estratifica posteriormente: velamento difuso do hemitórax com trama vascular preservada, sem menisco" ] } ] }, { "id": "rx_torax.c6", "grupo": "rx_torax", "nome": "Classic localization and characterization signs", "nota": null, "fonte": "Felson B, Felson H. Localization of intrathoracic lesions by means of the postero-anterior roentgenogram: the silhouette sign. Radiology 1950;55(3):363-74 · Bankier AA et al. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2024;310(2):e232558 (edição vigente, substitui 1984/1996/2008) · Klein JS, Rosado-de-Christenson ML. IDKD Springer Series 2019 (sinal cervicotorácico e convergência hilar) · Gordon R. The deep sulcus sign. Radiology 1980;136(1):25-7", "colunas": [ "Sign", "Definition", "Reporting application" ], "linhas": [ { "status": null, "celulas": [ "Sinal da silhueta", "Perda do contorno de uma interface ar/tecido mole por uma opacidade adjacente de densidade semelhante e em contato anatômico com ela", "Localiza a lesão: apagamento da borda cardíaca direita indica lobo médio; da borda cardíaca esquerda, língula; do contorno diafragmático com bordas cardíacas preservadas, lobos inferiores" ] }, { "status": null, "celulas": [ "Broncograma aéreo", "Brônquio preenchido por ar tornado visível por dentro de uma opacidade de partes moles adjacente", "Confirma doença do espaço aéreo (consolidação) e afasta massa extrapulmonar, derrame ou espessamento pleural" ] }, { "status": null, "celulas": [ "Sinal cervicotorácico", "Contorno mediastinal anormal que se apaga ao ultrapassar a clavícula indica lesão anterior; contorno que permanece visível acima da clavícula indica lesão posterior", "Localiza massas do mediastino superior sem exame adicional e orienta o próximo método" ] }, { "status": null, "celulas": [ "Convergência hilar", "Vasos aumentados que convergem para o hilo alargado", "Separa aumento hilar de causa vascular (artéria pulmonar dilatada) de adenopatia ou massa" ] }, { "status": null, "celulas": [ "Sinal do sulco profundo", "Seio costofrênico lateral aprofundado e hipertransparente na radiografia em supino", "Reconhece pneumotórax no paciente deitado, em que o ar se acumula ântero-inferiormente e a linha pleural apical não aparece" ] } ] } ] }, { "metodo": "RX", "chave": "rx_msk", "slug": "rx-msk", "nome": "Radiography — Musculoskeletal: angles, indices and measurements", "temPaginaPublica": false, "medidas": [ { "id": "rx_msk.0", "grupo": "rx_msk", "ruleId": null, "rotulo": "Cobb angle (scoliosis)", "valor": "≥ 10° com rotação vertebral define escoliose", "unidade": "°", "nota": "Measured on the standing full-spine radiograph, from the superior endplate of the upper end vertebra to the inferior endplate of the lower end vertebra. Structural scoliosis requires a coronal curve ≥ 10° together with vertebral rotation; without rotation (and below 10°) it is postural asymmetry and the term scoliosis should not be used. Intra- and interobserver variability is relevant (typically ±5°): compare with the same technique and the same end vertebrae before calling progression.", "fonte": "SOSORT 2016 — Negrini S, et al. Scoliosis Spinal Disord 2018;13:3 (definição SRS/SOSORT: ≥ 10° com rotação vertebral)", "faixas": [ { "status": "green", "rotulo": "Not scoliosis (postural asymmetry)", "valor": "< 10°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Mild to moderate scoliosis — observation or conservative treatment by maturity", "valor": "10–30°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Risk of progression into adulthood; above 50° progression is near-certain", "valor": "> 30°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.1", "grupo": "rx_msk", "ruleId": null, "rotulo": "Thoracic kyphosis (T4–T12)", "valor": "37,4 ± 10,9", "unidade": "°", "nota": "Normative value from asymptomatic multi-ethnic adult volunteers (MEANS study, n = 468, mean age 40.4 ± 14.8 years). Kyphosis increases with age; in the same study lumbar lordosis did NOT change with age — read the reference against the patient's age band.", "fonte": "MEANS — Sardar ZM, et al. Spine (Phila Pa 1976) 2022 (PMID 35797462)", "faixas": [] }, { "id": "rx_msk.2", "grupo": "rx_msk", "ruleId": null, "rotulo": "Lumbar lordosis (L1–S1)", "valor": "57,4 ± 11,3", "unidade": "°", "nota": "Same asymptomatic adult normative cohort (MEANS); lordosis did not change with age in that group. Always interpret alongside the patient's own pelvic incidence (mean 52.0 ± 10.7°): the pelvic incidence–lordosis mismatch, not lordosis alone, drives adult sagittal deformity classification.", "fonte": "MEANS — Sardar ZM, et al. Spine (Phila Pa 1976) 2022 (PMID 35797462)", "faixas": [] }, { "id": "rx_msk.3", "grupo": "rx_msk", "ruleId": null, "rotulo": "Vertebral slip (Meyerding index)", "valor": "Grau I = até 25% de escorregamento", "unidade": "%", "nota": "Percentage of anteroposterior displacement of the upper vertebra divided by the AP diameter of the lower vertebral endplate, on a standing lateral. Any grade (including I) is a pathological finding — there is no 'grade 0'. Supine laterals underestimate the slip: if instability is suspected the study must be upright (with flexion-extension when indicated).", "fonte": "Meyerding HW 1932 · Koslosky E, Gendelberg D. Clin Orthop Relat Res 2020;478:1125-30", "faixas": [ { "status": "green", "rotulo": "No slip", "valor": "0%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Grades I–II", "valor": "> 0% e ≤ 50%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Grades III–V (grade V = spondyloptosis)", "valor": "> 50%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.4", "grupo": "rx_msk", "ruleId": null, "rotulo": "Vertebral height loss (Genant criterion)", "valor": "≥ 20% de altura (com 10–20% de redução de área) caracteriza fratura", "unidade": "%", "nota": "Visual semiquantitative assessment of T4–L4 on the lateral, comparing anterior, middle and posterior body heights with each other and with adjacent bodies. The original method grades by height loss AND estimated area reduction (grade 1: 20–25% height, 10–20% area; grade 2: 25–40% and 20–40%; grade 3: > 40% and > 40%). Below 20% reduction do not call it a fracture — describe as a deformity to be clarified, especially with Schmorl nodes, degenerative remodelling or shape variants.", "fonte": "Genant HK, Wu CY, van Kuijk C, Nevitt MC. J Bone Miner Res 1993;8:1137-48 · International Osteoporosis Foundation — Assessing vertebral fractures", "faixas": [ { "status": "green", "rotulo": "Grade 0 — no fracture", "valor": "< 20%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Grade 1 — mild fracture", "valor": "20–25%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Grade 2 (moderate, 25–40%) and grade 3 (severe, > 40%)", "valor": "> 25%", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.5", "grupo": "rx_msk", "ruleId": null, "rotulo": "Lateral center-edge angle (Wiberg)", "valor": "> 25", "unidade": "°", "nota": "On the AP pelvis, between a vertical through the femoral head center (perpendicular to the interteardrop line) and a line from the center to the most lateral bony edge of the acetabular roof. Pelvic rotation and tilt change the value; confirm symmetric obturator foramina before measuring. In skeletally immature patients different references apply.", "fonte": "Wiberg G 1939 · ESSR 2019 EPOS P-0091 (Radiography of the Hip: a systematic approach) · Radsource — Developmental Dysplasia of the Hip", "faixas": [ { "status": "green", "rotulo": "Normal acetabular coverage", "valor": "> 25°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline dysplasia", "valor": "20–25°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Acetabular dysplasia", "valor": "< 20°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.6", "grupo": "rx_msk", "ruleId": null, "rotulo": "Tönnis angle (sourcil inclination / weight-bearing acetabular roof)", "valor": "0–10", "unidade": "°", "nota": "Inclination of the sourcil (sclerotic weight-bearing acetabular roof), between a horizontal parallel to the interteardrop line and a line joining the medial and lateral sourcil edges. Do NOT confuse with the paediatric acetabular index (measured from Hilgenreiner's line), which has age-specific values. Series differ on the dysplasia cutoff (> 10° in most; some only above 14°) — state the reference used. A negative value suggests overcoverage.", "fonte": "Tönnis D. Clin Orthop Relat Res 1976;119:39-47 · ESSR 2019 EPOS P-0091 · Radsource — Developmental Dysplasia of the Hip", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "0–10°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Grey zone across series", "valor": "10–14°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Acetabular dysplasia", "valor": "> 14°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.7", "grupo": "rx_msk", "ruleId": null, "rotulo": "Sharp angle", "valor": "33–38", "unidade": "°", "nota": "Acetabular inclination measured between the interteardrop line and a line from the teardrop to the lateral acetabular edge, on the AP pelvis. Less dependent on the sourcil than the Tönnis angle but more dependent on pelvic positioning — useful as a supporting parameter when the sourcil is poorly defined. Dysplasia cutoff: > 42° in current references (some series only above 45°); 39–42° is borderline and requires correlation with the Wiberg CE and Tönnis angles.", "fonte": "Sharp IK. J Bone Joint Surg Br 1961;43-B:268-72 · ESSR 2019 EPOS P-0091 — Radiography of the Hip: a systematic approach", "faixas": [ { "status": "green", "rotulo": "Normal in adults", "valor": "33–38°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Borderline", "valor": "39–42°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Suggests acetabular dysplasia", "valor": "> 42°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.8", "grupo": "rx_msk", "ruleId": null, "rotulo": "Alpha angle (cam morphology / femoroacetabular impingement)", "valor": "> 55–60 (limiares originados em RM)", "unidade": "°", "nota": "Measures loss of head-neck sphericity. MODALITY CAVEAT: the 55° and 60° cutoffs and their performance come from radial 1.5 T MRI (Sutter 2012) — sensitivity 81–90% and specificity 47–65% at 55°; 72–80% and 73–76% at 60°. On radiographs the angle depends on the projection used (Dunn 45°, frog-leg, cross-table) and values are not interchangeable with MRI: state the view used. In that same study 38–62% of ASYMPTOMATIC volunteers exceeded 55° — cam morphology alone is not a diagnosis. FAI syndrome requires the triad of symptoms + clinical signs + imaging findings.", "fonte": "Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CWA. Radiology 2012;264:514-21 (PMID 22653190 — medido em RM radial) · Warwick Agreement — Griffin DR, et al. Br J Sports Med 2016;50:1169-76", "faixas": [ { "status": "green", "rotulo": "No cam morphology by the classic cutoff", "valor": "≤ 55°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Overlap zone with asymptomatic subjects", "valor": "55–60°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Cam morphology — correlate clinically", "valor": "> 60°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.9", "grupo": "rx_msk", "ruleId": null, "rotulo": "Femoral neck-shaft angle", "valor": "120–135", "unidade": "°", "nota": "Between the femoral neck axis and the shaft axis, on an AP with ~15° internal rotation to compensate anteversion. External rotation makes the angle appear falsely reduced. Series differ on the upper limit (ESSR calls coxa valga above 130°) — report the measured value and the reference used.", "fonte": "Radsource — Developmental Dysplasia of the Hip · ESSR 2019 EPOS P-0091", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "120–130°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Zone of disagreement across series (ESSR already calls valga)", "valor": "130–135°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Coxa vara (below 120°) or coxa valga (above 135°)", "valor": "< 120° ou > 135°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.10", "grupo": "rx_msk", "ruleId": null, "rotulo": "Shenton line", "valor": "Arco contínuo", "unidade": null, "nota": "Imaginary arc joining the inferomedial border of the femoral neck to the superior border of the obturator foramen on the AP pelvis. A qualitative sign, not a measurement: a broken arc indicates proximal or lateral migration of the femoral head (dysplasia, dislocation, impacted neck fracture, Perthes disease). Marked external rotation can simulate a break — confirm positioning first.", "fonte": "ESSR 2019 EPOS P-0091 · Radsource — Developmental Dysplasia of the Hip", "faixas": [ { "status": "green", "rotulo": "Continuous arc — preserved head-acetabulum relationship", "valor": "contínuo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Step-off/discontinuity — subluxation or femoral head migration", "valor": "descontínuo", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.11", "grupo": "rx_msk", "ruleId": null, "rotulo": "Lower limb mechanical axis (mechanical femorotibial / hip-knee-ankle angle)", "valor": "≈ 1–1,5° de varo entre os eixos mecânicos femoral e tibial", "unidade": "°", "nota": "Only measurable on a weight-bearing full-length lower limb radiograph with patellae facing forward. The reference comes from a small selected sample (25 healthy male volunteers, mean age 30: 1.5° right, 1.1° left) — treat as orientation, not population norm. The femoral anatomical axis does not pass through the knee center, so the anatomical and mechanical femorotibial angles are not interchangeable and the report must state which was used. Limb rotation is the main source of error.", "fonte": "Moreland JR, Bassett LW, Hanker GJ. J Bone Joint Surg Am 1987;69:745-9 (PMID 3597474)", "faixas": [] }, { "id": "rx_msk.12", "grupo": "rx_msk", "ruleId": null, "rotulo": "Insall-Salvati index (patellar height)", "valor": "0,8–1,2", "unidade": "razão (comprimento do tendão patelar / comprimento da patela)", "nota": "Lateral knee at ~30° flexion. Independent of flexion degree but dependent on patellar tendon integrity and length — in operated knees, shortened tendon or bipartite patella, prefer Caton-Deschamps. On MRI the patella alta threshold is higher (from 1.5). Population caveat: in 434 healthy CT-modelled knees the ≤ 0.74 baja cutoff OVERdiagnoses (5th centile was 0.59).", "fonte": "Insall J, Salvati E. Radiology 1971;101:101-4 · ressalva populacional em Vella-Baldacchino M, et al. Sci Rep 2025;15:89 (medido em modelos derivados de TC)", "faixas": [ { "status": "green", "rotulo": "Normal patellar height", "valor": "0,80–1,19", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Lower borderline", "valor": "0,75–0,79", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Patella alta (≥ 1.20) or patella baja (≤ 0.74)", "valor": "≥ 1,20 ou ≤ 0,74", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.13", "grupo": "rx_msk", "ruleId": null, "rotulo": "Caton-Deschamps index (patellar height)", "valor": "0,6–1,2", "unidade": "razão (superfície articular inferior da patela ao ângulo anterossuperior da tíbia / comprimento da superfície articular patelar)", "nota": "Uses bony landmarks rather than the tendon — the index of choice in operated knees (tubercle osteotomy, arthroplasty) and patellar tendon injury. Note: Insall-Salvati and Caton-Deschamps classify the same normal knee discordantly (kappa 0.01 between indices), so state which was used. Population caveat: in the same CT-model study the ≤ 0.6 baja cutoff UNDERdiagnoses (5th centile 0.75) and the 95th centile was 1.3.", "fonte": "Caton J, Deschamps G, et al. Rev Chir Orthop 1982 · ressalva populacional em Vella-Baldacchino M, et al. Sci Rep 2025;15:89 (modelos derivados de TC)", "faixas": [ { "status": "green", "rotulo": "Normal patellar height", "valor": "> 0,6 e < 1,2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Patella alta", "valor": "≥ 1,2", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Patella baja", "valor": "≤ 0,6", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.14", "grupo": "rx_msk", "ruleId": null, "rotulo": "Trochlear sulcus angle", "valor": "138 ± 6", "unidade": "°", "nota": "Measured on the axial patellar view (Merchant, knee at ~45°, or at 30° in Dejour's technique). The larger the angle, the shallower the trochlea. The 145° cutoff has high specificity but limited sensitivity (≈ 65%) for trochlear dysplasia — subtle dysplasia can occur with a normal sulcus, and MRI (trochlear depth ≤ 3 mm) is more sensitive. Dysplasia mainly involves the proximal trochlea, poorly seen on flexed axial views.", "fonte": "Merchant AC, et al. J Bone Joint Surg Am 1974 · desempenho reportado em ECR 2014 EPOS C-2236 (Patellar Instability: What a Radiologist Should Know) · Radsource — Trochlear Dysplasia", "faixas": [ { "status": "green", "rotulo": "Normal trochlear depth", "valor": "≤ 144°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Trochlear dysplasia (shallow/flat trochlea)", "valor": "≥ 145°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.15", "grupo": "rx_msk", "ruleId": null, "rotulo": "Böhler angle (calcaneus)", "valor": "20–40 (adulto)", "unidade": "°", "nota": "On the lateral hindfoot, between a line from the posterior tuberosity to the highest point of the posterior facet and a line from there to the highest point of the anterior process. A reduced angle indicates posterior facet depression. AGE CAVEAT: in children the angle is physiologically LOWER (mean 35.2° in 763 patients aged 0–14 versus 39.2° in the adult comparison group) — do not apply adult cutoffs to children. Individual variation is wide: compare with the contralateral side whenever possible. A reduced Böhler angle mandates CT for classification (Sanders).", "fonte": "Davis D, Seaman TJ, Newton EJ. Calcaneus Fractures. StatPearls, 2023 (faixa adulta 20–40°) · valores pediátricos e do grupo adulto de comparação em Boyle MJ, Walker CG, Crawford HA. J Orthop Surg Res 2011;6:2 (PMID 21214961)", "faixas": [ { "status": "green", "rotulo": "Normal (adult)", "valor": "20–40°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Reduced — suspect depression; complete with CT", "valor": "0–20°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Inverted — worse functional prognosis", "valor": "< 0°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.16", "grupo": "rx_msk", "ruleId": null, "rotulo": "Crucial angle of Gissane (calcaneus)", "valor": "Referência divergente entre séries (≈ 114° medido; 130–145° em textos)", "unidade": "°", "nota": "Formed by the anterior downward and posterior upward slopes of the superior calcaneal surface on the lateral view. It has the widest reference discrepancy in the literature: series that actually measured normal populations report means around 111° in children and 114° in adults, while reference texts quote 120–145°. Use it as a relative sign — an increase suggests posterior facet depression — always against the contralateral side, never as an isolated number in the report.", "fonte": "Boyle MJ, Walker CG, Crawford HA. J Orthop Surg Res 2011;6:2 (PMID 21214961 — média 111,3° em 0–14 anos e 113,8° no grupo adulto de comparação) · Davis D, Seaman TJ, Newton EJ. Calcaneus Fractures. StatPearls, 2023 (faixa de texto 120–145°)", "faixas": [] }, { "id": "rx_msk.17", "grupo": "rx_msk", "ruleId": null, "rotulo": "Hallux valgus angle (HVA)", "valor": "≤ 15", "unidade": "°", "nota": "Between the longitudinal axes of the proximal phalanx and the first metatarsal, mandatorily on a weight-bearing radiograph (standing dorsoplantar). Non-weight-bearing studies systematically underestimate the deformity.", "fonte": "ESR/ECR 2025 EPOS C-22317 (Between lines and silhouettes: radiographic evaluation of the angles of the foot) · Perler A, Dixon M, Alvi F. Hallux Valgus. StatPearls", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "≤ 15°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Mild hallux valgus", "valor": "> 15° e ≤ 30°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Moderate (30–40°) to severe (> 40°) hallux valgus", "valor": "> 30°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.18", "grupo": "rx_msk", "ruleId": null, "rotulo": "First-second intermetatarsal angle", "valor": "< 9–10", "unidade": "°", "nota": "Between the longitudinal axes of the first and second metatarsals, also weight-bearing. Above the limit it defines metatarsus primus varus, the component that largely drives surgical technique (distal versus proximal osteotomy/arthrodesis). References differ slightly on the normal cutoff (< 9° in surgical texts, < 10° in the ESR material).", "fonte": "ESR/ECR 2025 EPOS C-22317 · Perler A, Dixon M, Alvi F. Hallux Valgus. StatPearls", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "< 9°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Mild metatarsus primus varus", "valor": "9–13°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Moderate (13–20°) to severe (> 20°)", "valor": "> 13°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.19", "grupo": "rx_msk", "ruleId": null, "rotulo": "Meary angle (talo-first metatarsal)", "valor": "0 ± 4 (eixos praticamente colineares)", "unidade": "°", "nota": "Weight-bearing lateral foot, between the talar longitudinal axis and the first metatarsal axis; in the normal foot the axes are essentially collinear (deviation up to ~4°). Assesses the medial longitudinal arch and identifies the apex of deformity. Describe by APEX DIRECTION, not by sign: plantar apex (collapsed arch) = pes planus; dorsal apex = pes cavus. Sign conventions (positive/negative) differ across series and should not be used alone — if quoting a signed value, state the convention. Read alongside the calcaneal pitch (≈ 17–32°; below 17–18° supports pes planus, above 30° pes cavus).", "fonte": "ESR/ECR 2025 EPOS C-22317 — Between lines and silhouettes: radiographic evaluation of the angles of the foot", "faixas": [ { "status": "green", "rotulo": "Normal medial longitudinal arch (collinear axes)", "valor": "desvio ≤ 4°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Pes planus (plantar apex)", "valor": "> 4° com ápice plantar", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Pes cavus (dorsal apex)", "valor": "> 4° com ápice dorsal", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.20", "grupo": "rx_msk", "ruleId": null, "rotulo": "Acromiohumeral interval", "valor": "7–14 mm (normal clássico; média ≈ 10)", "unidade": "mm", "nota": "Shortest distance between the inferior acromial cortex and the superior humeral head cortex on a true AP shoulder with the arm in neutral rotation. The bands below are NOT anatomical normality ranges: they are the tear-prevalence strata of the source study (≤ 7 mm / 8–10 mm / > 10 mm). In shoulders with ≤ 7 mm there were full-thickness supraspinatus tears in 90% (19/21), infraspinatus in 67% (14/21) and subscapularis in 43% (9/21). Tear size and infraspinatus fatty degeneration most influence the interval. Supine versus upright positioning and rotation change the value.", "fonte": "Saupe N, Pfirrmann CWA, Schmid MR, Jost B, Werner CML, Zanetti M. AJR Am J Roentgenol 2006 (PMID 16861541)", "faixas": [ { "status": "green", "rotulo": "Preserved subacromial space (lowest tear-prevalence stratum)", "valor": "> 10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Intermediate stratum — within the classic normal range but with increased tear prevalence", "valor": "8–10 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Marked narrowing — high prevalence of full-thickness cuff tear", "valor": "≤ 7 mm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.21", "grupo": "rx_msk", "ruleId": null, "rotulo": "Acromial index", "valor": "0,64 ± 0,06 (controles assintomáticos)", "unidade": "razão (distância glenoide-acrômio / distância glenoide-face lateral da cabeça umeral)", "nota": "Quantifies lateral acromial extension over the humeral head on a true AP shoulder with the arm in neutral rotation. Patients with full-thickness cuff tears had an index of 0.73 ± 0.06 versus 0.64 ± 0.06 in asymptomatic controls (n = 70) and 0.60 ± 0.08 in osteoarthritis with intact cuff (p < 0.0001). A predisposing morphological factor, not a stand-alone diagnostic criterion — and sensitive to positioning.", "fonte": "Nyffeler RW, Werner CML, Sukthankar A, Schmid MR, Gerber C. J Bone Joint Surg Am 2006;88:800-5 (PMID 16595470)", "faixas": [ { "status": "green", "rotulo": "Asymptomatic control range", "valor": "≈ 0,64", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Range observed in full-thickness cuff tears", "valor": "≈ 0,73", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.22", "grupo": "rx_msk", "ruleId": null, "rotulo": "Scapholunate angle", "valor": "30–60", "unidade": "°", "nota": "True neutral lateral wrist, between the scaphoid and lunate axes. Above 60° is already abnormal; above 70–80° strongly suggests scapholunate dissociation. DISI requires the combination: flexed scaphoid, extended lunate, capitolunate angle > 30° and widened scapholunate interval on the PA view. VISI = flexed lunate with a scapholunate angle < 30°. A flexed or extended wrist falsifies the angle — check radio-lunate-capitate alignment before measuring and compare with the contralateral side.", "fonte": "The Radiology Assistant (Radiological Society of the Netherlands) — Carpal instability · critérios de instabilidade carpal conforme Linscheid RL, Dobyns JH, et al. J Bone Joint Surg Am 1972;54:1612-32", "faixas": [ { "status": "green", "rotulo": "Normal", "valor": "30–60°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Abnormal/equivocal — correlate with stress views and the scapholunate interval", "valor": "60–80°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Scapholunate dissociation / DISI (> 80°, with capitolunate > 30°) or VISI (< 30°)", "valor": "> 80° ou < 30°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_msk.23", "grupo": "rx_msk", "ruleId": null, "rotulo": "Ulnar variance", "valor": "+0,74 ± 1,46", "unidade": "mm", "nota": "Height difference between the distal ulnar articular surface and the ulnar border of the radius on a standardised PA with shoulder abducted 90°, elbow flexed 90° and forearm in neutral rotation. About 26% of normal individuals have negative variance. The measurement is dynamic: it increases with gripping in pronation (+1.52 ± 1.56 mm) and decreases in relaxed supination (+0.19 ± 1.43 mm), mean change 1.34 ± 0.53 mm — so the technique must be stated in the report.", "fonte": "Jung JM, Baek GH, Kim JH, Lee YH, Chung MS. J Bone Joint Surg Br 2001;83-B:1029-33 (PMID 11603517)", "faixas": [] }, { "id": "rx_msk.24", "grupo": "rx_msk", "ruleId": null, "rotulo": "Distal radius: radial inclination, volar tilt and radial height", "valor": "Inclinação radial ≈ 23° (13–30°) · inclinação volar ≈ 11° (variação ampla entre séries) · altura radial 11–13 mm", "unidade": "° e mm", "nota": "Trio of parameters used to judge distal radius fracture reduction: radial inclination and radial height on the PA, volar (palmar) tilt on a true lateral; reference ulnar variance is neutral and radial shortening should be quantified by it. Commonly accepted reduction criteria: loss of radial inclination < 5°, radial shortening (ulnar variance) < 2–3 mm and residual dorsal angulation up to 0–10° depending on functional demand. Forearm rotation and beam angulation mostly affect volar tilt — the lateral must be a true lateral. Report the measured value and the deviation from the contralateral side when available.", "fonte": "Gartland JJ, Werley CW 1951 — valores tabulados no OTA Core Curriculum (Distal Radius Fractures); Schuind et al. relatam inclinação radial 24° (19–29°)", "faixas": [] } ], "classificacoes": [ { "id": "rx_msk.c0", "grupo": "rx_msk", "nome": "Cobb angle — idiopathic scoliosis severity", "nota": null, "fonte": "SOSORT 2016 — Negrini S, et al. Scoliosis Spinal Disord 2018;13:3 · BrAIST — Weinstein SL, Dolan LA, Wright JG, Dobbs MB. N Engl J Med 2013;369:1512-21 (desfecho de falha = progressão para ≥ 50°; sucesso 72% com colete versus 48% com observação na análise por intenção de tratar, 75% versus 42% na análise por tratamento recebido)", "colunas": [ "Cobb angle", "Interpretation", "Usual management in the skeletally immature" ], "linhas": [ { "status": null, "celulas": [ "< 10° (ou sem rotação vertebral)", "Assimetria postural / atitude escoliótica — não caracteriza escoliose estrutural", "Não usar o rótulo diagnóstico de escoliose no laudo" ] }, { "status": null, "celulas": [ "10–20°", "Escoliose leve", "Observação clínico-radiológica seriada" ] }, { "status": null, "celulas": [ "20–30°", "Escoliose leve a moderada", "Observação ou colete conforme risco de progressão (Risser, menarca, idade)" ] }, { "status": null, "celulas": [ "30–50°", "Escoliose moderada a acentuada", "Aumenta o risco de progressão e de repercussão na vida adulta; acompanhamento estreito" ] }, { "status": null, "celulas": [ "> 50°", "Escoliose grave", "Progressão na vida adulta é praticamente certa; avaliação cirúrgica" ] } ] }, { "id": "rx_msk.c1", "grupo": "rx_msk", "nome": "Böhler angle — posterior facet depression of the calcaneus", "nota": null, "fonte": "Davis D, Seaman TJ, Newton EJ. Calcaneus Fractures. StatPearls, 2023 · Boyle MJ, Walker CG, Crawford HA. J Orthop Surg Res 2011;6:2 (PMID 21214961 — série pediátrica com grupo adulto de comparação)", "colunas": [ "Böhler angle", "Interpretation", "Reporting implication" ], "linhas": [ { "status": null, "celulas": [ "20–40° (adulto)", "Normal", "Altura do calcâneo e faceta posterior preservadas" ] }, { "status": null, "celulas": [ "Criança (0–14 anos): média ≈ 35°", "Valor fisiologicamente menor que no adulto", "Usar referência pediátrica; não laudar afundamento por comparação com a faixa adulta" ] }, { "status": null, "celulas": [ "< 20°", "Reduzido — sugere afundamento da faceta posterior", "Indicar TC do retropé para classificação de Sanders" ] }, { "status": null, "celulas": [ "< 15° pós-redução", "Restauração insuficiente da altura", "Associa-se a pior resultado funcional que valores > 15°" ] }, { "status": null, "celulas": [ "< 0° (invertido)", "Afundamento grave", "Pior prognóstico funcional independentemente do tratamento" ] } ] }, { "id": "rx_msk.c2", "grupo": "rx_msk", "nome": "Patellar height — Insall-Salvati and related indices", "nota": null, "fonte": "Insall J, Salvati E. Radiology 1971;101:101-4 · Caton J, Deschamps G, et al. Rev Chir Orthop 1982 · Blackburne JS, Peel TE. J Bone Joint Surg Br 1977 · Grelsamer RP, et al. Clin Orthop 1992 · ressalva de população em Vella-Baldacchino M, et al. Sci Rep 2025;15:89 (434 joelhos saudáveis em modelos derivados de TC: P5 do Insall-Salvati = 0,59 e do Caton-Deschamps = 0,75; kappa entre os dois índices = 0,01)", "colunas": [ "Index", "Normal range", "Patella alta", "Patella baja" ], "linhas": [ { "status": null, "celulas": [ "Insall-Salvati (radiografia)", "0,80–1,19", "≥ 1,20", "≤ 0,74 (corte clássico; tende a superdiagnosticar)" ] }, { "status": null, "celulas": [ "Insall-Salvati (RM)", "—", "≥ 1,5", "—" ] }, { "status": null, "celulas": [ "Caton-Deschamps", "> 0,6 e < 1,2", "≥ 1,2", "≤ 0,6 (corte clássico; tende a subdiagnosticar)" ] }, { "status": null, "celulas": [ "Blackburne-Peel", "média 0,8", "> 1,0", "—" ] }, { "status": null, "celulas": [ "Insall-Salvati modificado", "—", "—", "> 2,0" ] } ] }, { "id": "rx_msk.c3", "grupo": "rx_msk", "nome": "Wiberg center-edge angle — acetabular coverage", "nota": null, "fonte": "Wiberg G 1939 · ESSR 2019 EPOS P-0091 (Radiography of the Hip: a systematic approach) · Radsource MRI Web Clinic — Developmental Dysplasia of the Hip", "colunas": [ "Lateral CE angle (Wiberg)", "Interpretation", "Parameters to correlate" ], "linhas": [ { "status": null, "celulas": [ "> 25°", "Cobertura acetabular normal", "—" ] }, { "status": null, "celulas": [ "20–25°", "Displasia limítrofe (borderline)", "Ângulo de Tönnis, índice de extrusão (> 25–27% = displásico), paredes anterior e posterior, CE anterior" ] }, { "status": null, "celulas": [ "< 20°", "Displasia acetabular", "Tönnis > 10°, linha de Shenton, índice de extrusão, ângulo colodiafisário" ] }, { "status": null, "celulas": [ "CE anterior < 20°", "Deficiência de cobertura anterior", "Medido no perfil falso de Lequesne; 20–25° é limítrofe" ] } ] }, { "id": "rx_msk.c4", "grupo": "rx_msk", "nome": "Hallux valgus — radiographic severity (HVA and intermetatarsal angle)", "nota": null, "fonte": "Perler A, Dixon M, Alvi F. Hallux Valgus. StatPearls · valores de normalidade confirmados em ESR/ECR 2025 EPOS C-22317 (HVA ≤ 15°, ângulo intermetatarsal < 10°)", "colunas": [ "Severity", "Hallux valgus angle (HVA)", "First-second intermetatarsal angle" ], "linhas": [ { "status": null, "celulas": [ "Normal", "≤ 15°", "< 9°" ] }, { "status": null, "celulas": [ "Leve", "> 15° e ≤ 30°", "9–13°" ] }, { "status": null, "celulas": [ "Moderado", "> 30° e ≤ 40°", "13–20°" ] }, { "status": null, "celulas": [ "Grave", "> 40°", "> 20°" ] } ] }, { "id": "rx_msk.c5", "grupo": "rx_msk", "nome": "Meyerding — spondylolisthesis grade", "nota": null, "fonte": "Meyerding HW 1932 · Koslosky E, Gendelberg D. Classification in Brief: The Meyerding Classification System of Spondylolisthesis. Clin Orthop Relat Res 2020;478:1125-30", "colunas": [ "Grade", "Slip", "Comment" ], "linhas": [ { "status": null, "celulas": [ "Sem escorregamento", "0%", "Normal — não usar grau" ] }, { "status": null, "celulas": [ "Grau I", "> 0% e ≤ 25%", "Mais frequente; medir no perfil em ortostase" ] }, { "status": null, "celulas": [ "Grau II", "> 25% e ≤ 50%", "—" ] }, { "status": null, "celulas": [ "Grau III", "> 50% e ≤ 75%", "—" ] }, { "status": null, "celulas": [ "Grau IV", "> 75% e ≤ 100%", "—" ] }, { "status": null, "celulas": [ "Grau V", "> 100%", "Espondiloptose" ] } ] }, { "id": "rx_msk.c6", "grupo": "rx_msk", "nome": "Genant — semiquantitative vertebral fracture assessment", "nota": null, "fonte": "Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993;8:1137-48 · International Osteoporosis Foundation — Assessing vertebral fractures", "colunas": [ "Grade", "Vertebral height loss", "Area reduction", "Reading" ], "linhas": [ { "status": null, "celulas": [ "Grau 0", "< 20%", "—", "Normal — sem fratura" ] }, { "status": null, "celulas": [ "Grau 1", "20–25%", "10–20%", "Fratura leve" ] }, { "status": null, "celulas": [ "Grau 2", "25–40%", "20–40%", "Fratura moderada" ] }, { "status": null, "celulas": [ "Grau 3", "> 40%", "> 40%", "Fratura grave" ] } ] } ] }, { "metodo": "RX", "chave": "rx_abdome_ped", "slug": "rx-abdome-ped", "nome": "Radiography — Abdomen and Pediatrics", "temPaginaPublica": false, "medidas": [ { "id": "rx_abdome_ped.0", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Transverse colon — toxic megacolon threshold", "valor": "6", "unidade": "cm", "nota": "Measure the transverse colon at its most distended point, preferably supine (it is the most anterior segment and traps gas in that position). The radiographic cutoff alone is not diagnostic: Jalan criteria require dilatation PLUS at least 3 of 4 systemic signs (temperature > 38.6 °C, HR > 120 bpm, leukocytosis > 10,500/µL with left shift, anemia) and at least 1 sign of toxicity (altered sensorium, hypotension, dehydration/hypovolemia, electrolyte disturbance). Serial radiographs are the follow-up tool in severe colitis.", "fonte": "Jalan KN, Sircus W, Card WI et al., Gastroenterology 1969;57:68-82 (critérios de Jalan, 55 casos; PMID 5305933) · síntese em StatPearls 'Toxic Megacolon' (NBK547679)", "faixas": [ { "status": "green", "rotulo": "Normal colonic caliber", "valor": "< 6 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Colonic dilatation without systemic toxicity — repeat film", "valor": "> 6 cm isolado", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Toxic megacolon (dilatation + ≥3 Jalan criteria)", "valor": "> 6 cm + toxicidade", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_abdome_ped.1", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Cecum — diameter and perforation risk", "valor": "12", "unidade": "cm", "nota": "Series of 400 cases of acute colonic pseudo-obstruction (Ogilvie). The cecum has the largest radius and, by Laplace's law, perforates first — hence its lower action threshold (9 cm normal, 12 cm act) relative to the rest of the colon. What the primary source states: with a cecal diameter of 12 cm or greater, or failure of conservative management, colonoscopic or operative decompression is needed; mortality is approximately 15% with early appropriate management versus 36–44% with perforated or ischemic bowel. The graded perforation risks circulating in secondary literature (≈0% below 12 cm, ≈7% at 12–14 cm, ≈23% above 14 cm) are derived from that series and do not appear in the original abstract — treat them as orders of magnitude, not hard numbers. Beyond the absolute value, rate of onset and duration matter: dilatation persisting beyond 48–72 h despite medical therapy indicates endoscopic decompression or neostigmine.", "fonte": "Vanek VW & Al-Salti M, Dis Colon Rectum 1986;29:203-10 (400 casos; PMID 3753674) · ASGE guideline, Gastrointest Endosc 2020 (descompressão acima de 12 cm)", "faixas": [ { "status": "green", "rotulo": "Below the action threshold (normal cecum: ≤ 9 cm)", "valor": "< 12 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Action threshold — decompression indicated", "valor": "12–14 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Highest perforation risk — urgent", "valor": "> 14 cm", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_abdome_ped.2", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Pneumoperitoneum — smallest detectable gas volume", "valor": "1", "unidade": "mL", "nota": "Experimental and clinical figure: 1 mL is detectable with a horizontal beam, in the left lateral decubitus position (gas rises between liver and lateral wall) or on an erect chest radiograph (subdiaphragmatic crescent). Two technical conditions are mandatory and often skipped: a HORIZONTAL beam (decubitus with a vertical beam is useless) and 5–10 minutes in position before exposure so gas can migrate. Left lateral decubitus is the view of choice for patients who cannot stand. Absence of free air does not exclude perforation.", "fonte": "Miller RE & Nelson SW, Am J Roentgenol Radium Ther Nucl Med 1971;112:574-85 (PMID 5570369)", "faixas": [] }, { "id": "rx_abdome_ped.3", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Free air volume by perforation site (CT)", "valor": "40–333 mL (medianas)", "unidade": null, "nota": "Median FREE AIR volumes across 172 surgically confirmed perforations: stomach 333 mL, descending colon 333 mL, sigmoid 143 mL, small bowel 40 mL and ascending colon 40 mL. This quantifies why small-bowel perforation so often shows no free air on radiographs — the released volume is small. Do not confuse this with the study's other axis, ASCITES volume: median 333 mL in upper GI perforations versus 100 mL in lower ones, with ascites > 333 mL favoring an upper GI site (AUC 0.63 ± 0.04). In such cases the decision is clinical and CT settles it.", "fonte": "Drakopoulos D et al., Abdom Radiol (NY) 2021;46:4536-47 (PMID 34114087)", "faixas": [] }, { "id": "rx_abdome_ped.4", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Pneumoperitoneum on supine film — detection by ≥1 sign", "valor": "59", "unidade": "%", "nota": "Among 44 confirmed pneumoperitoneums versus 87 controls, at least one sign was present in 26 cases (59%), with 11 false positives (13%). Frequency by sign: right-upper-quadrant gas 41%, Rigler sign 32%, falciform ligament 2%, football sign 2%; the inverted-V sign was also assessed. Two morphologic criteria separate true from false positives: true RUQ gas is always TRIANGULAR OR LINEAR, oriented inferolateral→superomedial and, when triangular, with a concave superolateral border; for Rigler, bowel wall thickness ranged 1–8 mm in true positives, whereas ALL false positives had a wall ≤ 1 mm.", "fonte": "Levine MS, Scheiner JD, Rubesin SE, Laufer I & Herlinger H, AJR 1991;156:731-5 (PMID 2003436)", "faixas": [] }, { "id": "rx_abdome_ped.5", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Rigler sign (double-wall sign) — frequency", "valor": "32", "unidade": "%", "nota": "Gas on both sides of the bowel wall, outlining the serosa as well. Described by Leo G. Rigler in 1941. It requires a reasonable volume of free gas — it is not a sign of minimal pneumoperitoneum. The pitfall is two apposed distended loops simulating an outlined wall; Levine's objective criterion resolves it: wall thickness 1–8 mm in true positives, ≤ 1 mm in every false positive. Confirm by repositioning — if the 'wall' is the interface of two loops, it disappears. Do not confuse it with the subdiaphragmatic crescent of erect free air, nor with the crescent sign of intussusception.", "fonte": "Levine MS et al., AJR 1991;156:731-5 (frequência e critério de espessura) · descrição original: Rigler LG et al., 1941", "faixas": [] }, { "id": "rx_abdome_ped.6", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Radiography for mechanical obstruction / ileus — accuracy", "valor": "S 69,7% (supino) → 80,0% (supino + ortostase)", "unidade": null, "nota": "Study of 40 patients with CT as reference: supine alone Se 69.7% / Sp 61.0% / AUROC 0.642; supine plus erect Se 80.0% / Sp 53.4% / AUROC 0.632, with no significant difference between strategies (p > 0.05). Adding the erect view buys sensitivity at the cost of specificity and does not improve overall accuracy (intra- and inter-rater agreement did improve). Since CT achieves Se 90–94% and Sp 93–100%, radiography is a triage test, not a rule-out test.", "fonte": "Geng WZM, Fuller M, Osborne B & Thoirs K, J Med Radiat Sci 2018;65:259-66 (PMID 30039624) · Silva AC, Pimenta M & Guimarães LS, RadioGraphics 2009;29:423-39", "faixas": [] }, { "id": "rx_abdome_ped.7", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Urinary calculus — direct detection on plain film", "valor": "40–60", "unidade": "%", "nota": "Direct stone detection on plain film in roughly 40–60% of cases. Systematically missed: stones < 5 mm, those overlying bone (transverse process, sacrum) and those obscured by bowel gas. Pure uric acid stones are radiolucent. Indirect signs (pelvicalyceal dilatation, loss of the psoas line) help raise suspicion but have no reliably quantified sensitivity gain — do not treat them as a number. Unenhanced CT is the reference standard (sensitivity and specificity on the order of 94–100% and 92–100%), largely independent of size, site and composition; plain film today mainly serves to follow a known radiopaque stone.", "fonte": "Heidenreich A, Desgrandschamps F & Terrier F, Eur Urol 2002;41:351-62 · Brisbane W, Bailey MR & Sorensen MD, Nat Rev Urol 2016;13:654-62", "faixas": [] }, { "id": "rx_abdome_ped.8", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Gallstone — radiopacity on plain film", "valor": "minoria opaca (opacidade ∝ teor de cálcio)", "unidade": null, "nota": "Radiographic opacity of a gallstone correlates directly with calcium and mineral content: pure cholesterol stones are radiolucent, while pigment stones are opaque far more often. Practical consequence for the report: a normal radiograph does NOT exclude cholelithiasis, and ultrasound is the method of choice. When visible, the stone tends to be faceted, laminated and in the right hypochondrium — separate it from a right renal calcification by changing projection (oblique).", "fonte": "Trotman BW, Petrella EJ, Soloway RD et al., Gastroenterology 1975;68:1563-6 (PMID 1093922) · Bortoff GA et al., RadioGraphics 2000;20:751-66", "faixas": [] }, { "id": "rx_abdome_ped.9", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Intussusception — 3-view radiograph as a rule-out test", "valor": "VPN 100% (IC95% 79,1–100)", "unidade": null, "nota": "In 128 children aged 3 months to 3 years (19, or 14.8%, with confirmed intussusception), gas in the ascending colon on ALL THREE views — SUPINE, PRONE and LEFT LATERAL DECUBITUS (the protocol includes no erect view) — yielded 100% sensitivity (95% CI 79.1–100) and 100% NPV, but only 17.4% specificity (95% CI 11.1–26.1). Alternative criteria from the same study: gas in the ascending colon on ≥2 of 3 views, Se 89.5% / Sp 45.0%; gas in the transverse colon on the supine view, Se 84.2% / Sp 63.3%. Correct reading: the test only serves to RULE OUT in low-suspicion children; never to confirm. Classic signs — right upper quadrant soft-tissue mass, target/doughnut sign and the crescent/meniscus sign (the intussusceptum head projected against colonic gas) — are specific but insensitive. Ultrasound is diagnostic and enema (air or hydrostatic) therapeutic.", "fonte": "Roskind CG, Kamdar G, Ruzal-Shapiro CB, Bennett JE & Dayan PS, Pediatr Emerg Care 2012;28:855-8 (PMID 22929143) · Applegate KE, Pediatr Radiol 2009;39(Supl 2):S140-3", "faixas": [] }, { "id": "rx_abdome_ped.10", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Esophageal button battery — window to removal", "valor": "2", "unidade": "horas", "nota": "Full-thickness burn can develop in as little as 2 hours — an esophageal button battery is an endoscopic emergency, not an observation case. Always AP + LATERAL covering neck, esophagus and abdomen. Distinction from a coin: double-ring / halo (ring within a ring) on the frontal view and a STEP-OFF on the lateral, marking the negative pole (the side causing the worst injury). Pitfalls: stacked coins of different diameters mimic the halo; and the step-off may be invisible in a very thin battery or if the lateral is not perpendicular to the battery plane. Lithium cells of ~20 mm in children under 5 account for most severe cases. The National Capital Poison Center guideline is revised periodically and includes pre-hospital temporizing measures (honey or sucralfate, depending on age and time since ingestion) — always check the current version before advising management.", "fonte": "National Capital Poison Center — Button Battery Ingestion Triage and Treatment Guideline (conferir a versão vigente) · NASPGHAN: Kramer RE et al., J Pediatr Gastroenterol Nutr 2015;60:562-74", "faixas": [] }, { "id": "rx_abdome_ped.11", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Double bubble sign — reading the distal gas", "valor": "sem gás distal = atresia duodenal; com gás distal = obstrução incompleta", "unidade": null, "nota": "Two gas bubbles (dilated stomach and duodenal bulb/second portion) with a gasless remaining abdomen indicates duodenal atresia — high, complete obstruction, scheduled surgery. If distal gas IS present, the obstruction is incomplete and the differential shifts: annular pancreas, fenestrated duodenal web, stenosis, or — the one that cannot be missed — malrotation with midgut volvulus, a surgical emergency requiring immediate upper GI series. In a neonate with bilious vomiting, a double bubble WITH distal gas is a critical-communication finding.", "fonte": "Vinocur DN, Lee EY & Eisenberg RL, AJR 2012;198:W1-10 (PMID 22194504)", "faixas": [] }, { "id": "rx_abdome_ped.12", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Bone age — Greulich-Pyle vs Tanner-Whitehouse 3 (variability)", "valor": "desvio RMS ~1,21 ano (GP) x ~1,11 ano (TW3)", "unidade": null, "nota": "GP compares the LEFT hand and wrist radiograph as a whole with the closest atlas standard — fast, but semiquantitative (one standard per year, which caps resolution). TW3 scores bone by bone (radius, ulna and short bones — the RUS system), is more laborious and more reproducible. In a cohort of 851 healthy INDIAN children aged 2–16.5 years (Pune district), root-mean-square deviation from chronological age was 1.21 years for GP (1.26 boys / 1.16 girls) and 1.11 years for TW3 (1.14 boys / 1.00 girls). Two mandatory cautions in the report: (1) the GP atlas derives from a 1930s–40s white middle-class US cohort and tends to fit other populations poorly, Brazil included (and note the RMS figures above themselves come from an Indian, not a Western, cohort); (2) always state WHICH method was used, since GP and TW3 are not interchangeable and follow-up must use the same one.", "fonte": "Shah N et al., Indian J Endocrinol Metab 2021 (PMC8547392; n=851, 2–16,5 anos, Pune) · atlas original: Greulich WW & Pyle SI, Radiographic Atlas of Skeletal Development of the Hand and Wrist, 2ª ed., Stanford Univ Press, 1959 · TW3: Tanner JM et al., 2001", "faixas": [] }, { "id": "rx_abdome_ped.13", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Acetabular index — normal hips up to 6 months", "valor": "25,4° ± 3,5° (E) / 24,4° ± 3,3° (D)", "unidade": "graus", "nota": "Measured between Hilgenreiner's line (horizontal through the triradiate cartilages) and the line joining the lowest iliac point to the lateral rim of the acetabular roof. It falls progressively with age (≈26–27° in the first month → ≈22–25° at 6 months; negative correlation with age, r ≈ −0.29 left and −0.25 right). In the reference cohort — 1132 newborns and infants (2264 hips), a retrospective cross-sectional Turkish study — LEFT-sided values were significantly higher than right-sided ones in every band except 4 to ≤5 months; values tend to be higher in girls, but the sex difference formally demonstrated in that study is for the acetabular depth ratio (ADR-B), not the acetabular index. Always compare against the age-band table, never a single number. The measurement is sensitive to pelvic obliquity and rotation: a rotated pelvis invalidates the index. AI reproducibility in the study: interobserver ICC 0.845–0.989.", "fonte": "Sari AS, Karakus O, Gultekin MZ & Senaran H, Medicine (Baltimore) 2023;102(16):e33631 (PMID 37083764; 1132 lactentes / 2264 quadris, RN–6 meses)", "faixas": [] }, { "id": "rx_abdome_ped.14", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Wiberg center-edge angle (CEA-W)", "valor": "≥ 20° (definição da revisão de 2024) — 20–25° é limítrofe pelo critério clássico", "unidade": null, "nota": "Angle between the vertical through the femoral head center and the line to the lateral acetabular rim on an AP pelvis view. Measurable only once the femoral head ossification center is well formed and spherical — below ~5 years prefer the acetabular index. MIND the age context: the 15–20° (mild) and < 15° (severe) cutoffs are those used by the cited systematic review, which covers ages 2–18, and the review itself warns they are ADULT-DERIVED values applied to children — the preferred reading in children is by standard deviation for age. By the classic adult Wiberg criterion, 20–25° is a BORDERLINE band, not normal: do not report a 22° hip as normal without qualifying. The review shows 'dysplasia' prevalence ranging from 13.4–25.6% (mild) and 2.2–10.9% (severe) purely as a function of the cutoff chosen: always state the criterion used in the report.", "fonte": "Revisão sistemática 'Prevalence and radiological definitions of acetabular dysplasia after the age of 2 years', J Child Orthop 2024 (PMC11132094) · critério clássico: Wiberg G, 1939", "faixas": [ { "status": "green", "rotulo": "No dysplasia by this definition (note: 20–25° is borderline by the classic Wiberg criterion)", "valor": "≥ 20°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Mild dysplasia (or −1 to −2 SD for age)", "valor": "15–20°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Severe dysplasia (or < −2 SD for age)", "valor": "< 15°", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_abdome_ped.15", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "DDH — when radiography replaces ultrasound", "valor": "4–6 meses", "unidade": null, "nota": "Before ~4–6 months the femoral head is cartilaginous and ULTRASOUND is the method (Graf/Harcke); radiography adds little at that age because the lines depend on the ossification center. From ~4–6 months, once the center appears, the AP pelvis view becomes the study of choice. Useful collateral finding: asymmetry or delay of the ossification center on the affected side. On any pediatric pelvis radiograph check the three lines — Hilgenreiner (horizontal through the triradiate cartilages), Perkins (perpendicular to Hilgenreiner through the lateral acetabular rim; the femoral center must lie MEDIAL to it and INFERIOR to Hilgenreiner) and Shenton (a continuous arc from the inferior border of the superior pubic ramus to the inferomedial femoral neck; disruption = superolateral displacement).", "fonte": "AAP — Shaw BA & Segal LS, Section on Orthopaedics, Pediatrics 2016;138(6):e20163107 (PMID 27940740) · definições das linhas em Pediatric Imaging (pediatricimaging.org) e Tönnis D, 1976", "faixas": [] }, { "id": "rx_abdome_ped.16", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Salter-Harris — most frequent type", "valor": "tipo II ≈ 75%", "unidade": null, "nota": "Type II (line through the physis exiting into the metaphysis, with the Thurston-Holland metaphyseal fragment) accounts for about three quarters of physeal fractures. Type I may show a NORMAL radiograph — focal tenderness over the physis in a child with open physes is a clinical diagnosis, and the report should say so explicitly rather than 'no fracture'. Types III and IV are intra-articular and change management (anatomic reduction). Type V is almost always a retrospective diagnosis, once the physeal bar and angular deformity appear.", "fonte": "Salter RB & Harris WR, J Bone Joint Surg Am 1963;45:587-622 (classificação original) · frequências: StatPearls 'Salter-Harris Fracture' (NBK430688)", "faixas": [] }, { "id": "rx_abdome_ped.17", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Rickets — Thacher radiographic severity score (RSS)", "valor": "0–10 pontos (punho 0–4 + joelho 0–6)", "unidade": null, "nota": "Objective score in half-point increments from 0 (normal) to 10 (severe), applied to AP wrist and knee views of the more affected side. It grades metaphyseal fraying, cupping and the PROPORTION of the growth plate involved. Prospectively validated in 67 children with active rickets, with four trained physicians scoring on two occasions: interobserver correlation ≥ 0.84 for all pairs and intraobserver ≥ 0.89 for each observer; only moderate correlation with alkaline phosphatase (r = 0.58) — the score tracks, but does not replace, biochemistry. Underlying radiographic findings are physeal widening, metaphyseal irregularity and fraying, widened costochondral junctions (rachitic rosary) and delayed bone age. The Global Consensus requires RADIOGRAPHIC confirmation for the diagnosis of nutritional rickets — biochemistry alone is not enough.", "fonte": "Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Manaster BJ & Reading JC, J Trop Pediatr 2000;46:132-9 (PMID 10893912; n=67) · Munns CF et al., Global Consensus, J Clin Endocrinol Metab 2016;101:394-415 (PMID 26745253)", "faixas": [] }, { "id": "rx_abdome_ped.18", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Pediatric pneumonic consolidation — WHO/PERCH standardized definition", "valor": "opacidade densa ou 'fofa' ocupando parte ou todo um lobo, ou todo o pulmão, com ou sem broncograma aéreo", "unidade": null, "nota": "Definition from the WHO standardized methodology, EVALUATED (not validated) in the PERCH study, which tested it precisely beyond its intended application. 'Other infiltrate' covers linear and patchy densities in a bilateral lacy pattern with peribronchial thickening and small atelectases. Decisive caveat: across 4172 radiographs, agreement among trained readers for detecting consolidation was only moderate (78% observed agreement, κ = 0.50; among arbitrators 84%, κ = 0.61), and agreement across the FIVE conclusion categories collapsed to 43.5% (κ = 0.25) for primary readers and 48.5% (κ = 0.32) for arbitrators. The most frequent disagreement was precisely between 'other infiltrate' and 'normal' — that is, the infiltrate category is the least reproducible of all, despite a rigorous standardization process. The definition was built for EPIDEMIOLOGY and vaccine trials, not for case-by-case antibiotic decisions — using it as a clinical criterion is a misapplication.", "fonte": "Fancourt N, Deloria Knoll M, Barger-Kamate B et al., Clin Infect Dis 2017;64(supl 3):S253-61 (PMID 28575359) · metodologia OMS: Cherian T et al., Bull World Health Organ 2005;83:353-9", "faixas": [] }, { "id": "rx_abdome_ped.19", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Pediatric CAP — when to obtain (and not obtain) a chest radiograph", "valor": "não rotineiro no ambulatorial; PA + perfil em todo internado (PIDS/IDSA 2011)", "unidade": null, "nota": "Numbered recommendations from the 2011 PIDS/IDSA guideline. Recommendation 31 (strong, high quality): radiographs are NOT needed to confirm CAP in a child well enough for outpatient treatment. Recommendations 32 and 33 (strong, moderate quality): PA and lateral views in hypoxemia, significant respiratory distress, failure of initial therapy, and in EVERY hospitalized patient — to document the presence, size and character of the infiltrate and detect complications (effusion, necrotizing pneumonia, pneumothorax). Recommendation 34: follow-up imaging is not routine in uneventful recovery (recommendations 35–37 address clinical deterioration and complications). Recommendation 38: follow-up at 4–6 WEEKS when there is recurrent pneumonia in the same lobe or suspicion of anatomic anomaly, mass or foreign body. CURRENCY WARNING: IDSA/PIDS published an update to this guideline in 2026 — check the current version before citing management.", "fonte": "PIDS/IDSA — Bradley JS, Byington CL, Shah SS et al., Clin Infect Dis 2011;53(7):e25-76 (PMID 21880587; recomendações 31–38) · atualização IDSA/PIDS 2026 — conferir versão vigente", "faixas": [] }, { "id": "rx_abdome_ped.20", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Bronchiolitis — chest radiograph", "valor": "não solicitar de rotina", "unidade": null, "nota": "When bronchiolitis is diagnosed on history and physical examination, radiographic or laboratory studies should NOT be obtained routinely. Guideline rationale: many infants have radiographic abnormalities, but these correlate poorly with severity, and obtaining radiographs was associated with more antibiotic prescribing WITHOUT any difference in outcome. Reserve the initial radiograph for respiratory effort severe enough to warrant ICU admission or for suspected airway complication (pneumothorax). Expected findings when performed: hyperinflation, diaphragmatic flattening, peribronchial thickening and subsegmental atelectasis — which should NOT be reported as consolidation.", "fonte": "AAP Clinical Practice Guideline — Ralston SL et al., Pediatrics 2014;134(5):e1474-502 (PMID 25349312)", "faixas": [] }, { "id": "rx_abdome_ped.21", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Umbilical arterial catheter (UAC) — tip position", "valor": "T6–T9 (posição alta)", "unidade": null, "nota": "How to tell it is ARTERIAL on the film: the catheter first courses caudally (down the umbilical artery to the internal iliac), loops, and only then ascends the aorta, to the LEFT of the spine, in a straight line. The venous catheter, by contrast, ascends directly. The high position (T6–T9) is preferred over the low one because of fewer thrombotic and vascular events. For the low position the lower limit is the AORTIC BIFURCATION (~L4): a tip at L5 is already in the common iliac artery and is not an acceptable low position — it is a malposition. Reposition whenever the tip lands between T10 and L2, or below L4.", "fonte": "van Schuppen J, Onland W & van Rijn RR, 'Lines and tubes in Neonates', The Radiology Assistant, 2013 · StatPearls 'Umbilical Artery Catheterization' (NBK559111) · Liszewski MC, Daltro P & Lee EY, AJR 2019;212:988-96 (PMID 30779658)", "faixas": [ { "status": "green", "rotulo": "High position — preferred, fewer vascular complications", "valor": "T6–T9", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Low position — acceptable, below the renal arteries and above the aortic bifurcation", "valor": "L3–L4", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Forbidden zone (across the visceral ostia: celiac T12, SMA T12–L1, renal L1) or tip at L5 / common iliac", "valor": "T10–L2 ou ≤ L5", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_abdome_ped.22", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Umbilical venous catheter (UVC) — tip position", "valor": "T8–T9 (junção VCI–átrio direito, na altura do diafragma)", "unidade": null, "nota": "The bands are separated by ANATOMIC LOCATION, not vertebral level alone: a level outside T8–T9 is only 'yellow' if the tip is still within the cava; a low tip usually means a portal branch or hepatic parenchyma, and an excessively high tip means intracardiac — both red. Correct course: umbilical vein → left portal branch → ductus venosus → hepatic vein → inferior vena cava, tip at the junction with the right atrium. On the frontal film the catheter ascends directly, without the arterial catheter's caudal loop. The frontal view alone is misleading: a LATERAL view adds real information on tip position and prevents calling well-positioned a catheter that actually entered a portal branch.", "fonte": "van Schuppen J, Onland W & van Rijn RR, The Radiology Assistant, 2013 · Liszewski MC, Daltro P & Lee EY, AJR 2019;212:988-96 (PMID 30779658)", "faixas": [ { "status": "green", "rotulo": "IVC–right atrium junction", "valor": "T8–T9", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "yellow", "rotulo": "Marginal — tip still within the inferior vena cava but outside T8–T9; reposition", "valor": "fora de T8–T9, ainda na VCI", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null }, { "status": "red", "rotulo": "Deep intracardiac (atrium/ventricle), portal branch or intrahepatic — risk of arrhythmia, tamponade, portal thrombosis and extravasation", "valor": "posição aberrante (confirmar no perfil)", "min": null, "max": null, "incluiMin": true, "incluiMax": true, "quando": null } ] }, { "id": "rx_abdome_ped.23", "grupo": "rx_abdome_ped", "ruleId": null, "rotulo": "Neonatal endotracheal tube — tip position", "valor": "entre a abertura torácica superior e 1 cm acima da carina", "unidade": null, "nota": "Narrow window: the neonatal trachea is short, and only a few millimeters separate right main bronchus intubation from accidental extubation. The tip migrates CAUDALLY with neck flexion and CRANIALLY with extension — so the report should record head position at the time of the film; without it, the measurement loses half its value. On the same film, check the gastric tube (tip in the stomach, below the diaphragm) and the umbilical catheters.", "fonte": "van Schuppen J, Onland W & van Rijn RR, The Radiology Assistant, 2013 · Liszewski MC, Daltro P & Lee EY, AJR 2019;212:988-96 (PMID 30779658)", "faixas": [] } ], "classificacoes": [ { "id": "rx_abdome_ped.c0", "grupo": "rx_abdome_ped", "nome": "3/6/9 rule — bowel caliber on abdominal radiograph", "nota": null, "fonte": "Regra 3/6/9 (regra consagrada de radiologia abdominal), com os cortes ancorados em fontes primárias: cólon > 6 cm — Jalan KN et al., Gastroenterology 1969;57:68-82 (PMID 5305933); ceco ≥ 12 cm — Vanek VW & Al-Salti M, Dis Colon Rectum 1986;29:203-10 (PMID 3753674). O critério neonatal de comparação com a largura interpedicular é regra prática de ensino, sem fonte primária de acurácia — usar como orientação, não como corte.", "colunas": [ "Segment", "Normal limit", "Dilated", "Perforation risk / action" ], "linhas": [ { "status": null, "celulas": [ "Delgado", "≤ 3 cm", "> 3 cm — obstrução ou íleo", "Não há corte radiográfico validado de perfuração para o delgado — a decisão é clínica e a TC é o exame que resolve" ] }, { "status": null, "celulas": [ "Cólon (transverso)", "≤ 6 cm", "> 6 cm", "> 6 cm + toxicidade sistêmica = megacólon tóxico (critérios de Jalan)" ] }, { "status": null, "celulas": [ "Ceco", "≤ 9 cm", "> 9 cm", "≥ 12 cm ou falha do manejo conservador = descompressão (Vanek); risco cresce acima de 14 cm" ] }, { "status": null, "celulas": [ "Neonato / lactente", "alça ≲ largura interpedicular de L1–L2 (regra prática, não corte validado)", "alça mais larga que a interpedicular de L1–L2", "A régua 3/6/9 é convenção derivada do adulto e não se transporta para o lactente" ] } ] }, { "id": "rx_abdome_ped.c1", "grupo": "rx_abdome_ped", "nome": "Mechanical obstruction vs adynamic ileus", "nota": null, "fonte": "Geng WZM, Fuller M, Osborne B & Thoirs K, J Med Radiat Sci 2018;65:259-66 (PMID 30039624; n=40, TC como referência) · Silva AC, Pimenta M & Guimarães LS, RadioGraphics 2009;29:423-39 · Paulson EK & Thompson WM, Radiology 2015;275:332-42", "colunas": [ "Finding", "Mechanical obstruction", "Adynamic (paralytic) ileus" ], "linhas": [ { "status": null, "celulas": [ "Distribuição do gás", "Dilatação proximal a um ponto de transição, com colapso distal", "Dilatação difusa e homogênea, do estômago ao reto" ] }, { "status": null, "celulas": [ "Gás no reto / ampola retal", "Ausente ou escasso na obstrução completa", "Habitualmente presente" ] }, { "status": null, "celulas": [ "Níveis hidroaéreos (ortostase)", "Numerosos, em alturas diferentes dentro da MESMA alça (sinal da escada)", "Poucos e alinhados na mesma altura" ] }, { "status": null, "celulas": [ "Cólon na obstrução de delgado", "Colapsado", "Dilatado junto com o delgado" ] }, { "status": null, "celulas": [ "Contexto clínico típico", "Aderências, hérnia, neoplasia, bridas, volvo", "Pós-operatório, distúrbio eletrolítico, sepse, opioide, pancreatite" ] }, { "status": null, "celulas": [ "Desempenho do RX simples", "Supino S 69,7% / E 61,0%; supino + ortostase S 80,0% / E 53,4% — sem ganho de AUROC", "TC (S 90–94%, E 93–100%) é o exame que resolve quando a suspeita é alta" ] } ] }, { "id": "rx_abdome_ped.c2", "grupo": "rx_abdome_ped", "nome": "Pneumoperitoneum signs on the supine film — frequency and pitfalls", "nota": null, "fonte": "Levine MS, Scheiner JD, Rubesin SE, Laufer I & Herlinger H, AJR 1991;156:731-5 (44 pneumoperitônios x 87 controles, PMID 2003436) · limiar de 1 mL: Miller RE & Nelson SW, AJR 1971;112:574-85 (PMID 5570369)", "colunas": [ "Sign", "What it is", "Frequency (supine film)" ], "linhas": [ { "status": null, "celulas": [ "Gás no quadrante superior direito", "Coleção peri/subhepática; o verdadeiro-positivo é sempre TRIANGULAR OU LINEAR, com orientação inferolateral→superomedial e, se triangular, borda superolateral côncava", "41%" ] }, { "status": null, "celulas": [ "Sinal de Rigler (dupla parede)", "Gás dos dois lados da parede da alça, delineando também a serosa; parede de 1–8 mm nos verdadeiro-positivos, ≤ 1 mm em TODOS os falso-positivos", "32%" ] }, { "status": null, "celulas": [ "Sinal do ligamento falciforme", "Ligamento delineado por ar, linear e vertical à direita da linha média", "2%" ] }, { "status": null, "celulas": [ "Sinal da bola de futebol ('football')", "Grande coleção aérea oval sob a parede abdominal anterior — típico do neonato", "2%" ] }, { "status": null, "celulas": [ "Sinal do V invertido", "Ar delineando as pregas umbilicais mediais", "Avaliado no estudo; frequência não destacada" ] }, { "status": null, "celulas": [ "Qualquer um dos sinais (global)", "Pelo menos 1 sinal presente", "59% dos pneumoperitônios (26/44); 11 falso-positivos (13%) entre os 87 controles" ] }, { "status": null, "celulas": [ "Crescente subdiafragmático ('croissant')", "Ar livre sob a cúpula diafragmática na incidência em ORTOSTASE — não é sinal de supino", "Detecta a partir de ~1 mL, com raio horizontal e 5–10 min na posição" ] } ] }, { "id": "rx_abdome_ped.c3", "grupo": "rx_abdome_ped", "nome": "Salter-Harris — physeal fractures", "nota": null, "fonte": "Salter RB & Harris WR, 'Injuries involving the epiphyseal plate', J Bone Joint Surg Am 1963;45:587-622 (classificação original) · frequências relativas: StatPearls 'Salter-Harris Fracture' (NBK430688)", "colunas": [ "Type", "Fracture line", "Frequency", "Prognosis / pitfall" ], "linhas": [ { "status": null, "celulas": [ "I", "Somente através da fise (separação epifisária pura)", "≈ 5%", "Radiografia pode ser NORMAL — dor sobre a fise é diagnóstico clínico; bom prognóstico" ] }, { "status": null, "celulas": [ "II", "Fise + fragmento metafisário (Thurston-Holland)", "≈ 75%", "Tipo mais comum; extra-articular; bom prognóstico" ] }, { "status": null, "celulas": [ "III", "Fise + epífise, atingindo a articulação", "≈ 8–10%", "Intra-articular — exige redução anatômica; considerar TC" ] }, { "status": null, "celulas": [ "IV", "Metáfise + fise + epífise (traço vertical único)", "≈ 10%", "Intra-articular; maior risco de ponte fisária e desvio angular" ] }, { "status": null, "celulas": [ "V", "Esmagamento / compressão axial da fise", "< 1%", "Quase sempre retrospectivo (barra fisária e deformidade tardias); pior prognóstico" ] } ] }, { "id": "rx_abdome_ped.c4", "grupo": "rx_abdome_ped", "nome": "Acetabular index by age — normal values and Tönnis cutoffs", "nota": null, "fonte": "Sari AS, Karakus O, Gultekin MZ & Senaran H, Medicine (Baltimore) 2023;102(16):e33631 (PMID 37083764; 1132 lactentes / 2264 quadris, RN–6 meses, coorte turca retrospectiva; valores por sexo) · cortes patológicos: Tönnis D, Clin Orthop Relat Res 1976;119:39-47 (conferir a tabela original antes de usar os limites por faixa) · revisão sistemática J Child Orthop 2024 (PMC11132094)", "colunas": [ "Age band", "Mean AI in normal hips — left (M/F)", "Mean AI — right (M/F)", "Tönnis pathological cutoff" ], "linhas": [ { "status": null, "celulas": [ "≤ 1 mês", "26,6° / 27,2°", "25,2° / 26,1°", "> 35,8°" ] }, { "status": null, "celulas": [ "> 1 a 2 meses", "25,1° / 27,4°", "23,9° / 26,1°", "> 35,8°" ] }, { "status": null, "celulas": [ "> 2 a 3 meses", "24,7° / 26,3°", "23,7° / 25,5°", "> 31,4°" ] }, { "status": null, "celulas": [ "> 3 a 4 meses", "24,0° / 25,2°", "23,1° / 24,4°", "> 31,4°" ] }, { "status": null, "celulas": [ "> 4 a 5 meses", "23,5° / 25,4°", "23,0° / 24,9°", "> 27,3°" ] }, { "status": null, "celulas": [ "> 5 a 6 meses", "22,9° / 25,0°", "22,1° / 23,9°", "> 27,3°" ] }, { "status": null, "celulas": [ "Global ≤ 6 meses", "25,4° ± 3,5°", "24,4° ± 3,3°", "Esquerdo significativamente maior que o direito em todas as faixas exceto 4 a ≤5 meses" ] }, { "status": null, "celulas": [ "> 6 meses a 7 anos", "Queda progressiva (≈ 22° ao 1º ano, ≈ 20° aos 2 anos)", "idem", "Usar a tabela normativa de Tönnis (1976) por idade, sexo e lado — a única específica até 7 anos" ] } ] }, { "id": "rx_abdome_ped.c5", "grupo": "rx_abdome_ped", "nome": "Fractures by specificity for child physical abuse", "nota": null, "fonte": "AAP — Flaherty EG, Perez-Rossello JM, Levine MA & Hennrikus WL, 'Evaluating children with fractures for child physical abuse', Pediatrics 2014;133(2):e477-89 (PMID 24470642; tabela de especificidade adaptada de Kleinman) · ACR Appropriateness Criteria® Suspected Physical Abuse—Child, J Am Coll Radiol — conferir a revisão vigente no ACR AC Portal · Kleinman PK, Diagnostic Imaging of Child Abuse, 3ª ed., Cambridge Univ Press, 2015", "colunas": [ "Specificity", "Fractures", "Radiological action" ], "linhas": [ { "status": null, "celulas": [ "ALTA", "Lesão metafisária clássica (LMC — 'corner fracture' / 'bucket-handle'); fraturas de arcos costais posteriores e posteromediais; escápula; processo espinhoso; esterno", "Inquérito esquelético completo e notificação obrigatória; comunicação imediata à equipe" ] }, { "status": null, "celulas": [ "MODERADA", "Fraturas múltiplas, sobretudo bilaterais; fraturas em estágios DIFERENTES de consolidação; separações epifisárias; fraturas vertebrais e de corpo vertebral; fraturas de dedos; fraturas complexas de crânio", "Inquérito esquelético; datar as lesões e correlacionar com a história e o estágio motor da criança" ] }, { "status": null, "celulas": [ "BAIXA (inespecífica)", "Fratura de clavícula; fratura diafisária de osso longo; fratura linear simples de crânio", "Contextualizar — frequentes também em trauma acidental; não descartam abuso, mas não o sustentam sozinhas" ] }, { "status": null, "celulas": [ "Quando fazer o inquérito esquelético", "Toda criança < 2 anos com suspeita de abuso físico (o lactente não conta o que aconteceu e a fratura oculta é a regra)", "Protocolo completo, incidências dedicadas — nunca 'babygrama' de imagem única" ] }, { "status": null, "celulas": [ "Inquérito de controle", "Repetir em cerca de 2 semanas", "Revela fraturas ocultas que só aparecem com o calo ósseo (costelas e LMC, sobretudo)" ] } ] }, { "id": "rx_abdome_ped.c6", "grupo": "rx_abdome_ped", "nome": "Rickets — Thacher radiographic severity score (RSS)", "nota": null, "fonte": "Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Manaster BJ & Reading JC, 'Radiographic scoring method for the assessment of the severity of nutritional rickets', J Trop Pediatr 2000;46(3):132-9 (PMID 10893912; n=67) · confirmação radiográfica exigida pelo Consenso Global: Munns CF et al., J Clin Endocrinol Metab 2016;101:394-415 (PMID 26745253)", "colunas": [ "Site", "Maximum score", "What is graded" ], "linhas": [ { "status": null, "celulas": [ "Punho (AP — rádio e ulna distais)", "0–4 pontos", "Grau de desfiamento (fraying) e de taça (cupping) metafisários e a proporção da placa de crescimento acometida" ] }, { "status": null, "celulas": [ "Joelho (AP — fêmur distal e tíbia proximal)", "0–6 pontos", "Mesmos critérios, avaliados nas duas metáfises; pontua também o alargamento da placa" ] }, { "status": null, "celulas": [ "Total", "0–10 pontos, em incrementos de 0,5", "0 = normal; 10 = raquitismo grave" ] }, { "status": null, "celulas": [ "Reprodutibilidade (n=67, 4 observadores, 2 rodadas)", "Interobservador ≥ 0,84 (todos os pares) · Intraobservador ≥ 0,89 (cada observador)", "Correlação apenas moderada com fosfatase alcalina: r = 0,58" ] }, { "status": null, "celulas": [ "Achados de suporte (não pontuados)", "—", "Rosário raquítico (alargamento costocondral), sulco de Harrison, deformidade em varo/valgo, atraso de idade óssea, fratura em galho verde" ] } ] } ] } ] }