Complication rates of transrectal and transperineal prostate fusion biopsies - is there a learning curve even in high volume interventional center?

ABSTRACT Purpose To analyze the learning curve regarding complication rates of transrectal prostate biopsy (TRPB) versus transperineal prostate biopsy (TPPB), using real time software-based magnetic resonance imaging ultrasound (MRI-US) fusion techniques, along with first year experience of transperineal approach. Materials and Methods retrospective unicentric cohort study at a quaternary care hospital. Medical records of all consecutive patients that underwent TPPB between March 2021 and February 2022, after the introduction of MRI-US fusion device, and those who underwent TRPB throughout the entire years of 2019 and 2020 were analyzed. All complications that occurred as consequences of the procedure were considered. Descriptive statistics, Chi-squared and Fisher tests were used to describe complications and compare the two groups. Results A total of 283 patients were included in the transperineal group and 513 in the transrectal group. The analysis of a learning curve for the transperineal method showed lower complications rates comparing the first six months of TPPB procedures (group 1); The complication rate for TPPB was lower than that of TRPB (55.1% versus 81.9%, respectively; p<0.01). TPPB showed specifically lower rates of hematuria (48.8% versus 66.3%;p<0.001) and rectal bleeding(3.5% versus 18.1%; p<0.001). There were no cases of prostatitis after transperineal biopsies and three cases (0.6%) after transrectal procedures. Conclusions We evidenced the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of TPPB and the absence of infectious prostatitis imply a safer procedure when compared to TRPB.

Transafferent nodal embolization for lymphocele treatment: case report

ABSTRACT Lymphoceles are collections of lymphatic fluid, mainly caused by major surgical approaches. Most lymphoceles are asymptomatic and limited, but some cases may require a medical management. Among the different techniques, transafferent nodal embolization has emerged as a minimally invasive option, with low morbidity and high resolubility, although it is not widespread in the Brazilian scenario. In this study, we report a case of lymphocele drained percutaneously, with maintenance of high output and requiring transafferent nodal embolization.

Ultrasound classification of thyroid nodules: does size matter?

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.

Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review

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.

Ultrasonographic evaluation of cecal appendix diameter in pediatric population

ABSTRACT Objective To stratify ultrasound samples in a pediatric population undergoing evaluation for acute appendicitis to examine the variability in cecal appendix diameter, in different age groups, and to determine whether there is a prevalent value for each age group. Methods A retrospective cross-sectional study with 196 children aged 0 to 15 years. Data were extracted from reports of ultrasound examinations carried out between 2008 and 2015. Children with sonographic diagnosis of appendicitis or other signs of periappendiceal inflammation were excluded. Results The evaluation of the anteroposterior measurement of the cecal appendix revealed a mean diameter of 4.14mm (standard deviation: 0.93mm; 95%CI: 3.86-4.14). Cecal appendix diameter did not differ significant between age groups. Conclusion Evaluation of the anteroposterior diameter of the cecal appendix in centimeters in a sample of 196 children aged 0 to15 years revealed a mean diameter of 4.14mm (standard deviation, 0.93mm. There were no significant differences in cecal appendix diameter following stratification by age. Results indicate a single value can be adopted for mean cecal appendix diameter in pediatric populations.

Omental lipoma in pediatric age group: clinical presentation, image findings and management

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.

Evaluation of the blood-oxygen-level-dependent (BOLD) sequence with 3 Tesla device in renal transplant patients in the assessment of early allograft disfunction, correlated with biopsy / Avaliação da sequência dependente do nível de oxigênio no sangue (BOLD) com dispositivo 3 Tesla em pacientes transplantados renais na avaliação da disfunção de enxerto precoce, correlacionada com biópsia

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.

Transarterial radioembolization for liver tumors as neoadjuvant therapy: three case reports / Radioembolização transarterial hepática como terapia neoadjuvante: relato de três casos

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.

Caecal appendix lipomatosis in a pregnant patient mimicking acute appendicitis / Lipomatose do apêndice cecal em paciente grávida mimetizando apendicite aguda

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.

Transesplenic access in the treatment of varicose gastrointestinal bleeding. Case and technical report / Uso do acesso transesplênico no tratamento do sangramento gastrointestinal varicoso. Relato de caso e técnica

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.

Peri-prosthetic infection in the postoperative period of endovascular abdominal aorta aneurysm repair: treatment by percutaneous drainage / Infecção periprótese no pós-operatório do reparo endovascular de aneurisma de aorta abdominal: tratamento por drenagem percutânea

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.

Comparison between multiparametric MRI with and without post - contrast sequences for clinically significant prostate cancer detection

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.

Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer

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.

CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy / Biópsia percutânea com agulha grossa, guiada por TC, de nódulos pulmonares menores que 2 cm: aspectos técnicos e fatores que influenciam a precisão

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.

Minimally invasive treatment of complex collections: safety and efficacy of recombinant tissue plasminogen activator as an adjuvant to percutaneous drainage / Tratamento minimamente invasivo de coleções complexas: segurança e eficácia do ativador tissular de plasminogênio no tratamento adjuvante nas drenagens percutâneas

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.

Injecting hemostatic matrix in the path of biopsies: efficacy, potential complications, and the management of such complications / Injeção de matrizes hemostáticas no trajeto de biópsias: eficácia, possíveis complicações e o manejo dessas complicações

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.

Prostate cancer recurrence in vas deferens - fusion image guide as an important tool in dignosis

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.

Aspects of images in magnetic resonance of liver tumors treated with transarterial selective internal radiotherapy with yttrium-90 / Aspectos de imagens em exames de ressonância magnética de tumores hepáticos tratados com radioterapia interna seletiva transarterial com ítrio-90

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.