Dimensão fractal na quantificação do grau de rejeição celular miocárdica pós-transplante cardíaco
Carregando...
Data
2011-06-01
Autores
Moreira, Roberto Douglas
Moriel, Antonio Roberto
Murta Junior, Luiz Otávio
Neves, Leandro Alves [UNESP]
Godoy, Moacir Fernandes de
Título da Revista
ISSN da Revista
Título de Volume
Editor
Sociedade Brasileira de Cirurgia Cardiovascular
Resumo
INTRODUÇÃO: O termo fractal é derivado do latim fractus, que significa irregular ou quebrado, considerando a estrutura observada como tendo uma dimensão não-inteira. Há muitos estudos que empregaram a Dimensão Fractal (DF) como uma ferramenta de diagnóstico. Um dos métodos mais comuns para o seu estudo é a Box-plot counting (Método de contagem de caixas). OBJETIVO: O objetivo do estudo foi tentar estabelecer a contribuição da DF na quantificação da rejeição celular miocárdica após o transplante cardíaco. MÉTODOS: Imagens microscópicas digitalizadas foram capturadas na resolução 800x600 (aumento de 100x). A DF foi calculada com auxílio do software ImageJ, com adaptações. A classificação dos graus de rejeição foi de acordo com a Sociedade Internacional de Transplante Cardíaco e Pulmonar (ISHLT 2004). O relatório final do grau de rejeição foi confirmado e redefinido após exaustiva revisão das lâminas por um patologista experiente externo. No total, 658 lâminas foram avaliadas, com a seguinte distribuição entre os graus de rejeição (R): 335 (0R), 214 (1R), 70 (2R), 39 (3R). Os dados foram analisados estatisticamente com os testes Kruskal-Wallis e curvas ROC sendo considerados significantes valores de P < 0,05. RESULTADOS: Houve diferença estatística significativa entre os diferentes graus de rejeição com exceção da 3R versus 2R. A mesma tendência foi observada na aplicação da curva ROC. CONCLUSÃO: ADF pode contribuir para a avaliação da rejeição celular do miocárdio. Os valores mais elevados estiveram diretamente associados com graus progressivamente maiores de rejeição. Isso pode ajudar na tomada de decisão em casos duvidosos e naqueles que possam necessitar de intensificação da medicação imunossupressora.
INTRODUCTION: The term Fractal is derived from the Latin fractus meaning irregular or broken considering the observed structure with a non-integer dimension. There are many studies which employed the Fractal Dimension (FD) as a diagnostic tool. One of the most common methods for its study is the Box Counting Method. OBJECTIVE: The aim of the present study was to try to establish the contribution of FD in the quantification of myocardial cellular rejection after cardiac transplantation. METHODS: Microscopic digital images were captured at 800x600 resolution (magnification 100x). FD was calculated with the aid of ImageJ software with adaptations. The classification of the degrees of rejection was in agreement with the International Society for Heart and Lung Transplantation (ISHLT 2004). The final report of the degree of rejection was confirmed and redefined after an exhaustive review of the slides by an external experienced pathologist. 658 slides were evaluated with the following distribution among the degrees of rejection (R): 335 (0R); 214 (1R); 70 (2R); 39 (3R). The data were statistically analyzed with Kruskal-Wallis tests and ROC curves being considered significant values of P < 0.05. RESULTS: There was significant statistical difference between the various degrees of rejection with the exception of R3 versus R2. The same trend was observed in applying the ROC curve. CONCLUSION: FD may contribute to the assessment of myocardial cellular rejection. Higher values are directly associated with progressively higher degrees of rejection. This may help in decision making of doubtful cases and those which contemplate the intensification of immunosuppressive medication.
INTRODUCTION: The term Fractal is derived from the Latin fractus meaning irregular or broken considering the observed structure with a non-integer dimension. There are many studies which employed the Fractal Dimension (FD) as a diagnostic tool. One of the most common methods for its study is the Box Counting Method. OBJECTIVE: The aim of the present study was to try to establish the contribution of FD in the quantification of myocardial cellular rejection after cardiac transplantation. METHODS: Microscopic digital images were captured at 800x600 resolution (magnification 100x). FD was calculated with the aid of ImageJ software with adaptations. The classification of the degrees of rejection was in agreement with the International Society for Heart and Lung Transplantation (ISHLT 2004). The final report of the degree of rejection was confirmed and redefined after an exhaustive review of the slides by an external experienced pathologist. 658 slides were evaluated with the following distribution among the degrees of rejection (R): 335 (0R); 214 (1R); 70 (2R); 39 (3R). The data were statistically analyzed with Kruskal-Wallis tests and ROC curves being considered significant values of P < 0.05. RESULTS: There was significant statistical difference between the various degrees of rejection with the exception of R3 versus R2. The same trend was observed in applying the ROC curve. CONCLUSION: FD may contribute to the assessment of myocardial cellular rejection. Higher values are directly associated with progressively higher degrees of rejection. This may help in decision making of doubtful cases and those which contemplate the intensification of immunosuppressive medication.
Descrição
Palavras-chave
Fractais, Rejeição de Enxerto, Transplante de Coração, Biópsia, Cardiac surgical procedures, Graft rejection, Heart transplantation, Biopsy
Como citar
Revista Brasileira de Cirurgia Cardiovascular. Sociedade Brasileira de Cirurgia Cardiovascular, v. 26, n. 2, p. 155-163, 2011.