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OBJECTIVE: The objective of our study was to evaluate the effectiveness of MRI in the detection of possible residual lesions after radiofrequency ablation (RFA) in the treatment of breast cancer. SUBJECTS AND METHODS: We prospectively evaluated 14 patients who had undergone ultrasound-guided core biopsies diagnostic of invasive ductal carcinoma (IDC; range of diameters, 1.0-3.0 cm) and then ultrasound-guided percutaneous RFA with sentinel node biopsy as the primary treatment. Breast MRI was performed 1 week before RFA to evaluate tumor extension and again 3 weeks after RFA to verify the presence of possible residual lesions. Conventional surgical resection of the tumors was performed 1 week after RFA. The MRI findings were compared with histopathologic analyses to confirm the presence or absence of residual tumor. RESULTS: There was no residual enhancement in seven lesions on the postablation breast MRI scans. These findings were confirmed by negative histopathologic findings in the surgical specimens. The MRI scans of five patients showed small areas of irregular enhancement that corresponded to residual lesions. In the two remaining patients, we observed enhancement of almost the entire lesion, indicating that RFA had failed. CONCLUSION: Breast MRI is effective in detecting residual lesions after RFA in patients with IDC.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Ablación por Catéter/métodos , Imagen por Resonancia Magnética/métodos , Neoplasia Residual/patología , Adulto , Anciano , Ablación por Catéter/instrumentación , Medios de Contraste , Electrodos , Diseño de Equipo , Femenino , Humanos , Meglumina , Persona de Mediana Edad , Compuestos Organometálicos , Estudios Prospectivos , Biopsia del Ganglio Linfático Centinela , Ultrasonografía IntervencionalRESUMEN
OBJECTIVE: To develop an abbreviated breast magnetic resonance imaging protocol (FAST) and to compare it with the complete protocol (FULL) to determine its diagnostic accuracy for detecting malignant or suspicious lesions (BI-RADS 4, 5 and 6) and the time required for image interpretation using BI-RADS categorization. METHODS: Retrospective study with 100 consecutive women who underwent breast magnetic resonance imaging between January and February 2014. All patients were submitted to a complete breast magnetic resonance imaging protocol, which was then compared with an abbreviated protocol (pre-contrast sequence, second post-contrast sequence and subtraction of pre- from post-contrast images). RESULTS: Of 100 patients, 4 were classified as BI-RADS 5 or 6 and 16 as BI-RADS 4. In these 20 patients, there was full agreement among readers regarding the final BI-RADS categorization in both (FAST and FULL) protocols. CONCLUSION: The FAST protocol reduces interpretation time without compromising the accuracy of the method for detection of malignant or suspicious lesions.
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Neoplasias de la Mama , Mama/diagnóstico por imagen , Mama/patología , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Medios de Contraste , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
ABSTRACT Objective To develop an abbreviated breast magnetic resonance imaging protocol (FAST) and to compare it with the complete protocol (FULL) to determine its diagnostic accuracy for detecting malignant or suspicious lesions (BI-RADS 4, 5 and 6) and the time required for image interpretation using BI-RADS categorization. Methods Retrospective study with 100 consecutive women who underwent breast magnetic resonance imaging between January and February 2014. All patients were submitted to a complete breast magnetic resonance imaging protocol, which was then compared with an abbreviated protocol (pre-contrast sequence, second post-contrast sequence and subtraction of pre- from post-contrast images). Results Of 100 patients, 4 were classified as BI-RADS 5 or 6 and 16 as BI-RADS 4. In these 20 patients, there was full agreement among readers regarding the final BI-RADS categorization in both (FAST and FULL) protocols. Conclusion The FAST protocol reduces interpretation time without compromising the accuracy of the method for detection of malignant or suspicious lesions.
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OBJECTIVE: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. MATERIALS AND METHODS: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. RESULTS: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. CONCLUSION: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.
OBJETIVO: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. MATERIAIS E MÉTODOS: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. RESULTADOS: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. CONCLUSÃO: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.
RESUMEN
Abstract Objective: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. Materials and Methods: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. Results: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. Conclusion: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.
Resumo Objetivo: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. Materiais e Métodos: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. Resultados: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. Conclusão: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.
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A válvula de uretra posterior é a principal causa de obstrução do fluxo urinário na infância. Relatamos um caso de válvula de uretra posterior diagnosticada por uretrocistografia e ultra-sonografia, cuja função renal foi poupada devido a incomuns mecanismos redutores das pressões endovesicais.Seu diagnóstico e tratamento precoces foram decisivos no prognóstico do paciente.
The posterior urethral valve is the main cause of urinal flow obstructionin childhood. Here we report a case of a posterior urethral valve diagnosed by urethrocystography and ultrasonography,whose renal function was saved due to unusual reducing mechanisms of endovesical pressures. The diagnosis and early treatment were decisive in the prognosis of the patient.
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Humanos , Masculino , Recién Nacido , Abdomen , Ascitis/orina , Obstrucción Uretral/diagnóstico , Uretra , Urinoma/diagnóstico , PronósticoRESUMEN
OBJETIVO: Estudar os achados radiológicos encontrados na seriografia digestiva alta no pós-operatório tardio de cirurgia de Fobi-Capella. MATERIAIS E MÉTODOS: Estudo radiológico de 41 pacientes realizado seis a nove meses após a cirurgia de Fobi-Capella. RESULTADOS: As alterações encontradas foram hérnia hiatal (17 por cento), refluxo gastroesofágico (19,5 por cento) e deslizamento do anel (4,8 por cento). Os achados menos freqüentes foram fístula enterocutânea (2,4 por cento), estenose da anastomose gastrojejunal (2,4 por cento), bezoar (2,4 por cento) e não-visualização do anel em decorrência da sua retirada por intolerância (2,4 por cento). As alterações anatômicas da cirurgia foram claramente demonstradas. CONCLUSÃO: O estudo foi capaz de demonstrar as alterações anatômicas e as complicações da cirurgia de Fobi-Capella.
OBJECTIVE: The present study was aimed at evaluating radiological findings of delayed postoperative upper gastrointestinal series in patients submitted to Fobi-Capella surgery. MATERIALS AND METHODS: Radiological studies of 41 patients, six to nine months following the surgery. RESULTS: The following pathological alterations have been found: hiatal hernia (17 percent), gastroesophageal reflux disease (19.5 percent) and sliding of the silastic ring (4.8 percent). Least frequent findings have been the following: enterocutaneous fistula (2.4 percent), stenosis of the gastric pouch outlet (2.4 percent), bezoar (2.4 percent), and non-visualization of the silastic ring caused by its removal due to patient intolerance (2.4 percent). Anatomical alterations resulting from the surgery have been clearly demonstrated. CONCLUSION: The present study could demonstrate anatomical alterations and complications resulting from Fobi-Capella surgery.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cirugía Bariátrica , Cirugía Bariátrica/efectos adversos , Complicaciones Posoperatorias , Técnicas de Diagnóstico del Sistema Digestivo , Cirugía Bariátrica/rehabilitación , Gastroplastia , Obesidad Mórbida/complicaciones , Obesidad Mórbida/fisiopatologíaRESUMEN
Nos últimos três anos foram realizadas 30.000 mamografias no Departamento de Diagnóstico por Imagem da Universidade Federal de São Paulo/Escola Paulista de Medicina, sendo que em 0,23% delas foi observado tecido mamário acessório. Relatamos um caso de paciente de 44 anos de idade, feminina, que apresentava nódulo endurecido, aderido ao subcutâneo, em topografia inframamária à direita. À ultra-sonografia observou-se imagem nodular sólida hipoecogênica, com contornos irregulares, medindo 1,4 cm. À ressonância magnética visualizou-se curva de realce tipo II (platô). Após biópsia, foi diagnosticado denocarcinoma mamário. O carcinoma nas mamas acessórias costuma apresentar aspecto histopatológico indiferenciado e disseminação mais precoce, determinando pior prognóstico. Por este motivo, é de fundamental importância sua detecção nos estágios iniciais, permitindo, dessa forma, a instituição precoce do tratamento e possibilitando maiores chances de cura.
Over the last three years 30,000 mammograms were performed in the Department of Diagnostic Imaging of Universidade Federal de São Paulo/Escola Paulista de Medicina. Accessory breast tissue was observed in 0.23% of the individuals. We report a case of a 44-year-old woman presenting a hard nodule adhered to the subcutaneous tissue in right inframammary topography. At ultrasonography, a hypoechogenic solid nodule with irregular contour measuring 1.4 cm was observed. Magnetic resonance imaging showed type II (plateau) dynamic curve. Breast adenocarcinoma was subsequently diagnosed by biopsy. Accessory breast carcinomas generally present with an ill-defined histopathological aspectand early dissemination. Early detection is essential to begin treatment in the initial stages, with better chances of cure.
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Humanos , Femenino , Adulto , Adenocarcinoma , Coristoma , Espectroscopía de Resonancia Magnética , Mamografía , Neoplasias de la MamaRESUMEN
A reconstrucão mamária com retalho miocutâneo tem sido amplamente utilizada em pacientes submetidas a mastectomia radical modificada por câncer de mama, com melhora significativa na auto-estima dessas pacientes, minimizando o sentimento de mutilacão e melhorando a estética, sem promover alteracão no prognóstico da doenca. Inicialmente acreditava-se não haver risco de recorrência do câncer na mama reconstruída devido à remocão completa do tecido mamário. Porém, exames histológicos têm demonstrado que pode restar pequena quantidade de tecido mamário local após a mastectomia, tendo este tecido remanescente alto potencial de malignidade. Tem-se preconizado o acompanhamento clínico dessas pacientes, uma vez que a maioria das lesões recidivantes se situa nos pontos de insercão do retalho e elas são passíveis de serem detectadas pela palpacão. No entanto, tem-se discutido a inclusão da mamografia e da ultra-sonografia no controle dessas pacientes, uma vez que estes métodos podem contribuir para o diagnóstico de lesão recorrente antes de esta tornar-se palpável.