OBJECTIVE: To evaluate the reproducibility of magnetic resonance imaging and the agreement between ultrasound and magnetic resonance imaging in the classification of periportal fibrosis in patients with schistosomiasis based on Niamey's qualitative criteria. MATERIALS AND METHODS: A prospective, double-blinded study was conducted between February 2005 and June 2006 with 20 patients (10 men and 10 women, with ages ranging between 24 and 60 years, mean age 42.7 years) diagnosed with schistosomiasis mansoni. Both ultrasound and magnetic resonance images were independently evaluated by two experienced observers. Interobserver agreement was evaluated for findings of periportal fibrosis on magnetic resonance images and in a comparison between magnetic resonance and ultrasound images. RESULTS: The analysis of magnetic resonance images showed total interobserver agreement in 14 patients (70%). The comparison between ultrasound and magnetic resonance imaging showed agreement between images in only six cases (30%) by observer 1, and in eight cases (40%) by observer 2. CONCLUSION: Magnetic resonance imaging presents a good reproducibility in the evaluation of periportal fibrosis in later stages of schistosomiasis, however, the correlation between magnetic resonance imaging and ultrasound is poor.

Keywords: Schistosomiasis, Periportal fibrosis, Ultrasound, Magnetic resonance imaging

OBJECTIVE: To evaluate sonographic features associated with morbidity in patients with chronic clinical presentations of schistosomiasis mansoni, according to the protocol proposed by the World Health Organization (WHO). Materials and Methods: Two distinctive populations were evaluated: a) patients from an endemic area, and b) patients from a tertiary institution, with histopathologically confirmed periportal fibrosis. INCLUSION CRITERIA: diagnosis confirmed by parasitological stool examination for Schistosoma mansoni (Kato-Katz method). EXCLUSION CRITERIA: positive serology for HIV, HTLV-1, HBV or HCV. The Niamey protocol on ultrasonography proposed by the WHO was utilized. RESULTS:As the measures of periportal spaces were isolatedly evaluated, no alteration was observed in 21% of the tertiary institution patients with advanced disease. As all parameters of the Niamey protocol were considered, 100% of patients from the tertiary institution, with severe disease, presented advanced periportal fibrosis. In hepatosplenic patients from endemic areas, fibrosis was not identified at ultrasonography. CONCLUSION: The sonographic protocol proposed by the WHO can detect advanced periportal fibrosis in patients with severe form of disease with higher sensitivity than the isolated measurement of periportal space. The complexity involved in the sonographic identification of early stages of periportal fibrosis in endemic areas may give rise to the field of diagnostic supplementation and to a continued improvement of sonographic protocols in these areas.

Keywords: Schistosomiasis mansoni; Morbidity; Periportal fibrosis; Ultrasonography.