O observador dependente da imagem perfeita

The Value of 2D Strain Imaging during Stress Testing
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Artigo gratuito.
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Stress echocardiography is increasingly used but its major limitation is the subjective interpretationof wall motion changes requiring experience. Speckle tracking enables simultaneous evaluation of radial, longitudinal, and circumferential myocardial deformation. Recently, two-dimensional (2D) strain has been found to be as reliable as sonomicrometry for the assessment of left ventricular (LV) regional function. In the presence of inducible ischemia, longitudinal and circumferential abnormalities preceed the decrease in radial deformation. Optimal cutoffs have been obtained from 2D strain rate (SR) at peak dobutamine stress to predict coronary artery disease. However, 2D strain rate does not yet provide incremental accuracy to visual interpretation by experts. Speckle tracking strain could be useful to better identify contractile reverse and biphasic response of viable myocardium but there are not yet clinical studies published in this setting.
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Artigo de 2009 explora a utilidade do Strain 2D na análise ao Stress.
E a busca pela imagem perfeita e independente do observador continua...
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O Strain 2D só fica bom em imagens nítidas, ás vezes, nem assim.
E quando as imagens são nítidas, qualquer residente iniciante acerta o Ecostress!
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Quando vejo um radiologista dar laudos em uma pilha de tomografias, vejo laudos examinador-dependentes.
Quando um médico nuclear regula o ganho na tela para comparar paredes justapostas, vejo laudos examinador-dependentes.
Quando a RM demora a rodar ( 8 quadros por segundo?) ou o realce tardio não foi adequado, vejo laudos examinador-dependentes.
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Infelizmente para alguns, ainda vivemos em um mundo médico-dependente.
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