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1.
Einstein (Säo Paulo) ; 20: eRC5584, 2022. graf
Article in English | LILACS | ID: biblio-1360405

ABSTRACT

ABSTRACT A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.


Subject(s)
Humans , Female , Child, Preschool , Child , Omentum/surgery , Omentum/diagnostic imaging , Lipoma/surgery , Lipoma/diagnostic imaging , Magnetic Resonance Imaging , Ultrasonography
2.
Einstein (Säo Paulo) ; 20: eAO6747, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375324

ABSTRACT

ABSTRACT Objective To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification. Methods Thyroid nodules (566) subclassified as ACR-TIRADS 3 or 4 were divided into three size categories according to American Thyroid Association guidelines. The frequency of different Bethesda categories in each size range within ACR-TIRADS 3 and 4 classifications was analyzed. Results Most nodules in both ACR-TIRADS classifications fell in the Bethesda 2 category, regardless of size (90.8% and 68.6%, ACR-TIRADS 3 and 4 respectively). The prevalence of Bethesda 6 nodules in the ACR-TIRADS 4 group was 14 times higher than in the ACR-TIRADS 3 group. There were no significant differences between nodule size and fine needle aspiration biopsy classification in any of the ACR-TIRADS categories. Conclusion Size does not appear to be an important criterion for indication of fine needle aspiration biopsy in thyroid nodules with a high suspicion of malignancy on ultrasound examination.

3.
Einstein (Säo Paulo) ; 20: eAO6665, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375331

ABSTRACT

ABSTRACT Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.

4.
Einstein (Säo Paulo) ; 19: eAO6069, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286308

ABSTRACT

ABSTRACT Objective To evaluate the ability of blood-oxygen-level-dependent (BOLD) magnetic resonance imaging at 3 Tesla to measure tissue oxygen bioavailability based on R2* values, and to differentiate between acute tubular necrosis and acute rejection compared to renal biopsy (gold standard). Methods A prospective, single-center study, with patients submitted to renal transplantation between 2013 and 2014, who developed graft dysfunction less than 4 weeks after transplantation. All patients were submitted to abdominal magnetic resonance imaging at 3 Tesla using the same protocol, followed by two BOLD sequences and kidney biopsy. Results Twelve male (68.75%) and three female (31.25%) patients were included. A total of 19 percutaneous renal biopsies were performed (four patients required a second biopsy due to changes in clinical findings). Pathological findings revealed ten cases of acute tubular necrosis, four cases of acute rejection, and five cases with other (miscellaneous) diagnoses. Comparison between the four groups of interest failed to reveal significant differences (p=0.177) in cortical R2* values, whereas medullary R2* values differed significantly (p=0.033), with lower values in the miscellaneous diagnoses and the acute tubular necrosis group. Conclusion BOLD magnetic resonance imaging at 3 Tesla is a feasible technique that uses indirect tissue oxygen level measurements to differentiate between acute rejection and acute tubular necrosis in renal grafts.


RESUMO Objetivo Avaliar a sequência de ressonância magnética blood-oxygen-level-dependent (BOLD) realizada em um equipamento 3 Tesla para medir a biodisponibilidade do oxigênio do tecido pelo valor de R2* na diferenciação de necrose tubular aguda e rejeição aguda, comparando à biópsia renal (padrão-ouro). Métodos Estudo unicêntrico, prospectivo, com pacientes submetidos a transplante renal de 2013 a 2014, que desenvolveram disfunção do enxerto menos de 4 semanas após o transplante. Todos os pacientes foram submetidos à ressonância magnética abdominal 3 Tesla com o mesmo protocolo, seguida de duas sequências BOLD e biópsia renal. Resultados Foram incluídos 12 homens (68,75%) e três mulheres (31,25%). Foram realizadas 19 biópsias renais percutâneas (quatro pacientes necessitaram de segunda biópsia devido à alteração nos achados clínicos). Os resultados histopatológicos incluíram dez casos de necrose tubular aguda, quatro de rejeição aguda e cinco casos de outros diagnósticos (miscelânea). A comparação entre os quatro grupos de interesse não mostrou diferenças significativas em relação ao R2* no córtex (p=0,177). Quanto ao R2* da medula, observaram-se diferenças significativas (p=0,033), com miscelânea e necrose tubular aguda apresentando valores mais baixos quando comparados aos demais. Conclusão A ressonância magnética BOLD 3 Tesla é uma técnica viável que indiretamente utiliza a concentração de oxigênio no tecido em enxertos renais e pode ser usada para a diferenciação entre rejeição aguda e necrose tubular aguda.


Subject(s)
Humans , Male , Female , Kidney Transplantation , Oxygen , Biopsy , Prospective Studies , Allografts
5.
Einstein (Säo Paulo) ; 18: eRC4990, 2020. graf
Article in English | LILACS | ID: biblio-1090070

ABSTRACT

ABSTRACT Transarterial radioembolization (TARE) with yttrium-90 microspheres is a palliative locoregional treatment, minimally invasive for liver tumors. The neoadjuvant aim of this treatment is still controversial, however, selected cases with lesions initially considered unresectable have been enframed as candidates for curative therapy after hepatic transarterial radioembolization. We report three cases in which the hepatic transarterial radioembolization was used as neoadjuvant therapy in an effective way, allowing posterior potentially curative therapies.


RESUMO A radioembolização transarterial hepática com microesferas de ítrio-90 é uma modalidade paliativa de tratamento locorregional minimamente invasiva. O objetivo neoadjuvante deste tratamento ainda é controverso, mas casos selecionados de lesões consideradas inicialmente irressecáveis reenquadram-se como candidatos à terapia curativa após a radioembolização transarterial hepática. Relatamos três casos em que a radioembolização transarterial hepática foi utilizada como terapia neoadjuvante de forma efetiva possibilitando aplicação posterior de terapias potencialmente curativas.


Subject(s)
Humans , Male , Female , Adult , Aged , Bile Duct Neoplasms/therapy , Chemoembolization, Therapeutic/methods , Cholangiocarcinoma/therapy , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/therapy , Yttrium Radioisotopes , Treatment Outcome , Disease Progression , Neoadjuvant Therapy/methods , Middle Aged
6.
Einstein (Säo Paulo) ; 18: eRC4934, 2020. graf
Article in English | LILACS | ID: biblio-1056036

ABSTRACT

ABSTRACT Varicose gastrointestinal bleeding is one of the major causes of morbidity and mortality in patients with chronic liver disease. Endoscopic treatment is the first therapeutic line for these patients, however, for those whom this therapeutic modality fail, a broad knowledge of alternative treatment options may improve the prognosis. We describe a case of a patient who were successfully embolized from gastroesophageal varices via transsplenic access.


RESUMO O sangramento gastrointestinal varicoso está entre as maiores causas de morbimortalidade nos paciente com doença hepática crônica. O tratamento endoscópico é a primeira linha terapêutica neste pacientes, porém naqueles que apresentam falha nesta modalidade terapêutica, o amplo conhecimento de opções alternativas de tratamento pode melhorar o prognóstico. Descrevemos um caso de paciente submetido à embolização com sucesso de varizes gastresofágicas por acesso transesplênico.


Subject(s)
Humans , Female , Adult , Splenic Vein/surgery , Esophageal and Gastric Varices/surgery , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/surgery , Portal Vein/surgery , Splenic Vein/diagnostic imaging , Angiography/methods , Esophageal and Gastric Varices/diagnostic imaging , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler/methods , Venous Thrombosis/surgery , Gastrointestinal Hemorrhage/diagnostic imaging
7.
Einstein (Säo Paulo) ; 18: eRC5415, 2020. graf
Article in English | LILACS | ID: biblio-1142881

ABSTRACT

ABSTRACT A 34-years-old pregnant woman admitted in the emergency unit complaining about worsening right iliac fossa pain for 2 days. Acute appendicitis was the suspected diagnosis. Laboratory exams were ordered and results were within normal limits for infectious and inflammatory aspects. Ultrasound scan revealed a pregnancy in course without alterations and a thickness of the appendix wall without inflammatory signs in the surrounding tissue. Because the suspicion of acute appendicitis remained, a magnetic resonance was done and confirmed the diagnosis of a cecal appendix lipomatosis.


RESUMO Paciente de 34 anos, do sexo feminino, grávida, chega ao pronto-socorro com queixa de dor na fossa ilíaca direita piorando nos últimos 2 dias com suspeita de apendicite aguda. Foram solicitados exames laboratoriais, que estavam dentro dos limites de normalidade para aspectos infecciosos e inflamatórios. Exame de imagem também foi solicitado, sendo a ultrassonografia o método de escolha, que revelou gravidez em curso sem alterações e espessura da parede do apêndice sem sinais inflamatórios. Ainda com suspeita de apendicite aguda, foi realizada ressonância magnética, confirmando a hipótese de lipomatose do apêndice cecal.


Subject(s)
Humans , Female , Adult , Appendicitis/diagnostic imaging , Appendix/diagnostic imaging , Lipomatosis , Acute Disease , Ultrasonography , Diagnosis, Differential
8.
Einstein (Säo Paulo) ; 17(4): eRC4668, 2019. graf
Article in English | LILACS | ID: biblio-1012008

ABSTRACT

ABSTRACT Endovascular aneurysm repair is an established technique for treating many infrarenal aortic aneurysms. Infection is one of the most serious complications of this technique, and although percutaneous treatment has been well established for intra-abdominal collections, its use to treat peri-prosthetic fluid collections has not been well determined. In this article we describe a small series of three patients who were treated with percutaneous drainage, with good clinical and imaging responses. Percutaneous drainage is a safe, effective and minimally invasive approach for treating this potentially fatal complication.


RESUMO O reparo endovascular de aneurisma é uma técnica para tratamento de diversos aneurismas infrarrenais da aorta. A infecção é uma das complicações mais sérias desse tratamento, e a abordagem percutânea tem sido adotada para coleções intra-abdominais, mas seu uso para tratamento de coleções protéticas vasculares não está bem estabelecido. Descreve-se, neste trabalho, pequena série de três pacientes tratados com drenagem percutânea, que apresentaram boa resposta clínica e de imagem. A drenagem percutânea mostrou-se abordagem segura, efetiva e minimamente invasiva para tratamento desta complicação, que é potencialmente fatal.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Aorta, Abdominal/surgery , Prosthesis-Related Infections/surgery , Endovascular Procedures/adverse effects , Aorta, Abdominal/anatomy & histology , Tomography, X-Ray Computed , Drainage/methods , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnostic imaging , Endovascular Procedures/methods
9.
Int. braz. j. urol ; 44(6): 1106-1113, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975665

ABSTRACT

ABSTRACT Purpose: Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. Materials and Methods: A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. Results: In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. −0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 - 6.28]; p=0.024). Conclusions: US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/diagnostic imaging , Ultrasonography, Interventional , Magnetic Resonance Imaging, Interventional , Image-Guided Biopsy/methods , Prostatectomy , Prostatic Neoplasms/pathology , Retrospective Studies , Cohort Studies , Neoplasm Grading , Middle Aged
10.
Int. braz. j. urol ; 44(6): 1129-1138, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975650

ABSTRACT

ABSTRACT Background: Dynamic-contrast enhanced (DCE) sequence is used to increase detection of small lesions, based on increased vascularization. However, literature is controversy about the real incremental value of DCE in detection of clinically significant (CS) prostate cancer (PCa), since absence of enhancement does not exclude cancer, and enhancement alone is not definitive for tumor. Purpose: To test the hypothesis that DCE images do not increase CS PCa detection on MRI prior to biopsy, comparing exams without and with contrast sequences. Material and Materials and Methods: All men who come to our institution to perform MRI on a 3T scanner without a prior diagnosis of CS PCa were invited to participate in this study. Reference standard was transrectal prostate US with systematic biopsy and MRI/US fusion biopsy of suspicious areas. Radiologists read the MRI images prospectively and independently (first only sequences without contrast, and subsequently the entire exam) and graded them on 5-points scale of cancer suspicion. Results: 102 patients were included. Overall detection on biopsy showed CS cancer in 43 patients (42.2%), clinically non-significant cancer in 11 (10.8%) and negative results in 48 patients (47%). Positivities for CS PCa ranged from 8.9% to 9.8% for low suspicion and 75.0% to 88.9% for very high suspicion. There was no statistical difference regarding detection of CS PCa (no statistical difference was found when compared accuracies, sensitivities, specificities, PPV and NPV in both types of exams). Inter-reader agreement was 0.59. Conclusion: Exams with and without contrast-enhanced sequences were similar for detection of CS PCa on MRI.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Contrast Media/administration & dosage , Predictive Value of Tests , Sensitivity and Specificity , Middle Aged
11.
Radiol. bras ; 51(4): 231-235, July-Aug. 2018. graf
Article in English | LILACS-Express | LILACS | ID: biblio-956274

ABSTRACT

Abstract Objective: To analyze the efficacy of recombinant tissue plasminogen activator (r-TPA) injection in the evolution of percutaneous drainage of thick collections. Materials and Methods: This was a single-center study involving the retrospective analysis of hospitalized patients undergoing percutaneous drainage of thick (superficial or intracavitary) fluid collections, followed by injection of a fibrinolytic agent (r-TPA) into the affected space. Results: A total of 53 percutaneous drainage procedures, with r-TPA injection, were performed in 51 patients. Abdominal and pelvic collections were the most common, being seen in 38 (73%) of the procedures; in 35 (66%), the etiology of the collection was attributed to postoperative complications. A total of 61 catheters were used in order to drain the 53 collections. Of those 61 catheters, 52 (85%) were large (12-16 Fr) and 9 (15%) were small (4-10 Fr). The mean r-TPA dose was 5.7 mg/collection per day, and the mean time from r-TPA injection to drain removal was 7.7 days. Percutaneous drainage in combination with r-TPA injection was successful in 96% of the cases. None of the patients showed coagulation changes during the study period. Conclusion: The use of once-daily, low-dose r-TPA for up to three consecutive days, as an adjunct to percutaneous drainage of thick collections, with or without loculation, appears to be an effective technique.


Resumo Objetivo: Analisar a eficácia da injeção do agente fibrinolítico ativador tissular de plasminogênio (r-TPA) na evolução da drenagem percutânea de coleções espessas. Materiais e Métodos: Estudo unicêntrico com análise retrospectiva de pacientes internados submetidos a drenagem percutânea de coleções espessas, superficiais ou intracavitárias, seguida da injeção de agente fibrinolítico (r-TPA) no interior da coleção. Resultados: Foram realizadas 53 drenagens percutâneas com injeção de r-TPA em 51 pacientes. Coleções intra-abdominais e pélvicas foram as mais frequentes (n = 38; 73%) e a causa predominante foi complicação pós-operatória (n = 35; 66%). Foram utilizados 61 drenos para acessar as 53 coleções, dos quais 52 (85%) foram drenos mais calibrosos (12-16 Fr) e 9 (15%) de pequeno calibre (4-10 Fr). A dose média de r-TPA empregada foi 5,7 mg/coleção/dia, o tempo médio entre a injeção de r-TPA e a retirada do dreno foi 7.7 dias e o sucesso da drenagem percutânea em associação com agente fibrinolítico foi observado em 96% dos casos. Alterações de coagulação não foram observadas nos pacientes durante o estudo. Conclusão: O uso de baixas doses diárias de r-TPA por até três dias consecutivos, como adjuvante terapêutico na drenagem percutânea de coleções espessas e/ou loculadas, demonstrou ser uma técnica efetiva.

12.
J. bras. pneumol ; 44(4): 307-314, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-975920

ABSTRACT

ABSTRACT Objective: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.


RESUMO Objetivo: Avaliar a precisão diagnóstica da biópsia percutânea com agulha grossa, guiada por TC - doravante denominada BAG-TC - de nódulos pulmonares ≤ 2 cm, bem como identificar fatores que influenciam a precisão do procedimento e sua morbidade. Métodos: Estudo retrospectivo, realizado em um único centro, com 170 pacientes consecutivos submetidos a BAG-TC de nódulos pulmonares pequenos (≤ 2 cm) entre janeiro de 2010 e agosto de 2015. Resultados: Do total de biópsias, 156 resultaram em diagnóstico definitivo, com precisão diagnóstica global de 92,3%. Lesões maiores estiveram relacionadas com maior precisão global (OR = 1,30; p = 0,007). A presença de hemorragia parenquimatosa durante o procedimento resultou em menor precisão (OR = 0,13; p = 0,022). Pneumotórax foi a complicação mais comum. Uma distância > 3 cm entre a lesão e a pleura foi identificada como fator de risco de pneumotórax (OR = 16,94), ao passo que a realização de tampão sanguíneo após a biópsia foi um fator de proteção contra o pneumotórax (OR = 0,18). Conclusões: O diagnóstico de nódulos pequenos (< 2 cm) é um desafio do ponto de vista técnico. A BAG-TC é uma excelente ferramenta diagnóstica, cuja precisão é alta.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumothorax/etiology , Multiple Pulmonary Nodules/pathology , Biopsy, Large-Core Needle/methods , Image-Guided Biopsy/methods , Lung Neoplasms/pathology , Tomography, X-Ray Computed , Retrospective Studies , Risk Factors , Solitary Pulmonary Nodule/pathology , Biopsy, Large-Core Needle/adverse effects , Image-Guided Biopsy/adverse effects , Hemorrhage/etiology
13.
Radiol. bras ; 51(2): 102-105, Mar.-Apr. 2018. graf
Article in English | LILACS-Express | LILACS | ID: biblio-956233

ABSTRACT

Abstract Objective: To describe the technique of injecting hemostatic matrix, as well as the experience of our interventional radiology department in its application. Materials and Methods: We conducted a single-center study with retrospective analysis of the experience of our group in the use of hemostatic gelatin matrix in percutaneous biopsies. Results: In a total of 73 biopsies in different organs, such as the liver, kidney, and spleen, hemostatic gelatin matrix was introduced into the coaxial needle. The only complication observed was migration of the hemostatic matrix to the left kidney collecting system, and that was resolved with clinical treatment. There were no cases of bleeding after the injection of hemostatic matrix. Conclusion: The use of hemostatic matrices in the path of percutaneous biopsies is another tool available for consideration in minimally invasive procedures.


Resumo Objetivo: Descrever a técnica de injeção de matrizes hemostáticas e a experiência do nosso serviço de radiologia intervencionista na sua aplicação. Materiais e Métodos: Foi realizado estudo unicêntrico com análise retrospectiva da experiência do nosso grupo na utilização de matriz hemostática gelatinosa em biópsias percutâneas. Resultados: Foram realizadas 73 biópsias com utilização de matriz hemostática gelatinosa no trajeto da agulha coaxial em diferentes órgãos, como fígado, rim, baço, entre outros. A única complicação observada foi a migração da matriz hemostática para o sistema coletor do rim esquerdo, sendo solucionada com tratamento clínico. Não foram observados casos de sangramento no trajeto das biópsias após a injeção de matrizes hemostáticas. Conclusão: O uso de matrizes hemostáticas no trajeto de biópsias percutâneas é mais uma ferramenta disponível a ser considerada nos procedimentos minimamente invasivos.

14.
Int. braz. j. urol ; 44(1): 192-195, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-892936

ABSTRACT

ABSTRACT The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites. An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA-68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence. The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously. High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques.


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Ultrasonography, Interventional/methods , Image-Guided Biopsy/methods , Neoplasm Recurrence, Local/diagnostic imaging , Prostatectomy , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Magnetic Resonance Imaging , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Tomography, X-Ray Computed , Ultrasonography , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/pathology
15.
Einstein (Säo Paulo) ; 16(1): eRC4015, 2018. graf
Article in English | LILACS | ID: biblio-891460

ABSTRACT

ABSTRACT Transarterial selective internal radiation therapy with yttrium-90, also known as radioembolization, is a therapy based on the administration of resin or glass microspheres loaded with the radioisotope yttrium-90, via selective arterial catheterization of tumor-feeding vessels. It is classified as a type of locoregional therapy and its main goal is to treat patients with primary or secondary hepatic lesions that are unresectable and not responsive to other therapies. Since it is a new technology still restricted to very few hospitals in Brazil, but used in patients throughout the country, it is necessary to demonstrate the main aspects of hepatic lesions treated with selective internal radiation therapy found in magnetic resonance imaging, and to make specific considerations on interpretation of these images. The objective of this report is to demonstrate the main aspects of magnetic resonance imaging of unresectable primary or secondary hepatic lesions, in patients submitted to transarterial selective internal radiation therapy.


RESUMO A radioterapia interna seletiva transarterial com ítrio-90, também conhecida como radioembolização, é uma terapia baseada na administração de microesferas de resina ou vidro carregadas com o radioisótopo ítrio-90, via cateterismo arterial seletivo dos vasos nutridores do tumor. É classificada como um tipo de terapia locorregional e seu principal objetivo é tratar pacientes portadores de lesões hepáticas primárias ou secundárias irressecáveis e não responsivas a outras terapias. Por se tratar de uma nova tecnologia, portanto ainda restrita a pouquíssimos hospitais no Brasil (ainda que utilizada em todo país), é necessário demonstrar os principais aspectos de imagem das lesões hepáticas tratadas com radioterapia interna seletiva transarterial encontrados em exame de ressonância magnética, além de delinear considerações específicas de interpretação destas imagens. O objetivo deste relato é demonstrar os principais aspectos encontrados em ressonância magnética de lesões hepáticas irressecáveis, primárias ou secundárias, de pacientes submetidos à radioterapia interna seletiva transarterial.


Subject(s)
Humans , Male , Female , Aged , Yttrium Radioisotopes/therapeutic use , Radiosurgery/methods , Embolization, Therapeutic/methods , Liver Neoplasms/therapy , Magnetic Resonance Imaging , Treatment Outcome , Liver Neoplasms/diagnostic imaging , Middle Aged
16.
Einstein (Säo Paulo) ; 16(3): eRC4254, 2018. tab, graf
Article in English | LILACS | ID: biblio-953171

ABSTRACT

ABSTRACT The aim of this study were to describe the technique of percutaneous drainage of iliopsoas abscess, and to discuss the benefits of using this minimally-invasive tool. A single center study with retrospective analysis of patients with psoas abscess confirmed by imaging scans, sent to the interventional medicine center and submitted to computed tomography and ultrasound-guided percutaneous drainage, from November 2013 to August 2016. Seven patients underwent percutaneous drainage of psoas abscess in this period. The mean initial drained volume was 61.4±50.7mL (ranging from 10 to 130mL), and the mean drainage duration was 8.3±2.8 days (ranging from 4 to 12 days). The success rate of the percutaneous procedures was 71.5%, and two patients required re-intervention. Image-guided percutaneous drainage of iliopsoas abscess is a minimally invasive, efficient and safe procedure, and an extremely valuable technique, especially for patients who are not suitable for surgical repair.


RESUMO Os objetivos deste estudo foram descrever a técnica de drenagem percutânea de abscesso de iliopsoas e discutir os benefícios do uso desta ferramenta minimamente invasiva. Trata-se de estudo unicêntrico com análise retrospectiva de pacientes com abscesso de psoas confirmado por exames de imagem, encaminhados a um centro de medicina intervencionista e submetidos à drenagem percutânea guiada por tomografia computadorizada e ultrassonografia, de novembro de 2013 a agosto de 2016. Sete pacientes foram submetidos à drenagem percutânea de abscesso de psoas no período avaliado. O volume drenado inicial médio foi 61,4±50,7mL (variação de 10 a 130mL), e a duração média da drenagem foi de 8,3±2,8 dias (variação de 4 a 12 dias). A taxa de sucesso dos procedimentos percutâneos foi 71,5%, e dois pacientes necessitaram de reintervenção. A drenagem percutânea guiada por imagem de abscesso de iliopsoas é um procedimento minimamente invasivo, eficiente e seguro, além de ser uma técnica muito valiosa, especialmente em pacientes que não são candidatos à abordagem cirúrgica.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Drainage/methods , Psoas Abscess/therapy , Pseudomonas aeruginosa/isolation & purification , Tomography, X-Ray Computed , Drainage/instrumentation , Retrospective Studies , Treatment Outcome , Psoas Abscess/diagnostic imaging , Ultrasonography, Interventional , Minimally Invasive Surgical Procedures/methods , Middle Aged
17.
Einstein (Säo Paulo) ; 16(4): eAO4279, 2018. tab, graf
Article in English | LILACS | ID: biblio-975095

ABSTRACT

ABSTRACT Objective To evaluate safety and effectiveness of nodule volume reduction and thyroid function after percutaneous laser ablation treatment in patients with benign nonfunctioning thyroid nodules. Methods Prospective single-center study, from January 2011 to October 2012, which evaluated 30 euthyroid and thyroid antibodies negative patients with benign solitary or dominant nodule with indication of treatment due to compressive symptoms and aesthetic disturbances. The clinical and laboratory (thyroid ultrasound, TSH, FT4, TG, TG-Ab, TPO-Ab and TRAb levels) evaluations were performed before the procedure, and periodically 1 week, 3 months and 6 months after. The ablation technique was performed under local anesthesia and sedation. In each treatment, one to three 21G spinal needle were inserted into the thyroid nodule. The laser fiber was positioned through the needle, which was then withdrawn 10mm to leave the tip in direct contact with the nodule tissue. Patients were treated with a ND: Yag-laser output power of 4W and 1,500 to 2,000J per fiber per treatment. The entire procedure was performed under US guidance. Results Thirty patients, with a total of 31 nodules submitted to laser ablation were evaluated. The median volumetric reduction of the nodule was approximately 60% after 12 months. No statistical significance was observed on thyroid function and antibodies levels. There was a peak on the level of thyroglobulin after the procedure due to tissue destruction (p<0.0001). No adverse effects were observed. Conclusion Percutaneous laser ablation is a promising outpatient minimally invasive treatment of benign thyroid nodule.


RESUMO Objetivo Avaliar a segurança e a efetividade da redução de volume nodular e função tireoidiana após tratamento com ablação percutânea por laser em pacientes com nódulos tireoidianos benignos não funcionantes. Métodos Estudo unicêntrico prospectivo, de janeiro de 2011 a outubro de 2012, que avaliou 30 pacientes eutireoideos (com anticorpos antitireoide negativos), com nódulo solitário ou dominante benigno, com indicação de tratamento devido a sintomas de compressão e distúrbios estéticos. As avaliações clínica e laboratorial (ultrassonografia de tireoide, TSH, FT4, TG, TG-Ab, TPO-Ab e TRAb) foram realizada antes do procedimento e periodicamente − 1 semana, 3 meses e 6 meses depois. A técnica de ablação consistiu em procedimento realizado sob a anestesia local e sedação. Em cada tratamento, uma a três agulhas espinhais 21G foram inseridas no nódulo tireoidiano. A fibra laser foi posicionada através da agulha que foi, então, retirada 10mm, para deixar a ponta em contato direto com o nódulo. Os pacientes foram tratados com uma potência de saída ND: Yag-laser de 4W e 1.500 a 2.000J por fibra por tratamento. Todo o procedimento foi guiado por ultrassonografia. Resultados Foram avaliados 30 pacientes, com total de 31 nódulos submetidos à ablação a laser. A redução média volumétrica do nódulo foi de aproximadamente 60% após 12 meses. Não foi observada significância estatística na função da tireoide e nem nos níveis de anticorpos. Houve pico no nível de tiroglobulina após o procedimento devido à destruição do tecido (p<0,0001). Nenhum efeito adverso foi observado. Conclusão A ablação com laser é um tratamento minimamente invasivo promissor para tratamento do nódulo benigno da tireoide.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Thyroid Nodule/surgery , Laser Therapy/methods , Organ Size , Pain, Postoperative , Autoantibodies/blood , Thyroxine/blood , Calcitonin/blood , Thyrotropin/blood , Prospective Studies , Follow-Up Studies , Treatment Outcome , Thyroid Nodule/pathology , Thyroid Nodule/blood , Laser Therapy/adverse effects
19.
J. bras. pneumol ; 42(5): 387-390, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: lil-797948

ABSTRACT

ABSTRACT The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.


RESUMO O conceito de sala híbrida traduz a união de um aparato cirúrgico de alta complexidade com recursos radiológicos de última geração (ultrassom, TC, radioscopia e/ou ressonância magnética), visando a realização de procedimentos minimamente invasivos e altamente eficazes. Apesar de bem estabelecido em outras especialidades, como neurocirurgia e cirurgia cardiovascular, o uso da sala hibrida ainda é pouco explorado na cirurgia torácica. Nosso objetivo foi discutir as aplicações e as possibilidades abertas por essa tecnologia na cirurgia torácica através do relato de três casos.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Adenocarcinoma/surgery , Carcinoma, Squamous Cell/surgery , Lung Neoplasms/surgery , Operating Rooms/organization & administration , Thoracic Surgery, Video-Assisted/instrumentation , Catheter Ablation/instrumentation , Image-Guided Biopsy/instrumentation , Lymph Nodes/pathology , Lymph Nodes/surgery , Operating Rooms/methods , Thoracotomy/instrumentation
20.
Int. braz. j. urol ; 42(5): 897-905, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-796878

ABSTRACT

ABSTRACT Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria. Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes). Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.


Subject(s)
Humans , Male , Prostatic Neoplasms/pathology , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Image-Guided Biopsy/methods , Prostate/pathology , Prostate/diagnostic imaging , Magnetic Resonance Imaging/instrumentation , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Prostate-Specific Antigen/blood , Ultrasonography, Interventional/methods , Statistics, Nonparametric , Neoplasm Grading , Middle Aged
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