Thiago Franchi Nunes

Radiofrequency Ablation of Functioning Adrenal Adenomas: Preliminary Clinical and Laboratory Findings

PURPOSE To evaluate clinical and laboratory findings in patients undergoing radiofrequency (RF) ablation for functioning adrenal adenomas. MATERIALS AND METHODS Eleven adult patients, nine with Conn syndrome and two with Cushing syndrome, underwent percutaneous computed tomography-guided RF ablation for benign adrenal neoplasms. Systolic, diastolic, and mean blood pressure and the number of classes of antihypertensive drugs used by each patient were analyzed before and 1, 4, and 12 weeks after the procedure. Serum hormone levels were analyzed within 30 days before and 12 weeks after the procedure. RESULTS Of the nine patients with Conn syndrome, eight showed normal serum aldosterone levels after the procedure and one patient had a nodule located very close to the inferior vena cava, resulting in incomplete ablation. The two patients with Cushing syndrome had normal serum and salivary cortisol levels after the procedure. Mean aldosterone concentration at baseline was 63.3 ng/dL ± 28.0 and decreased to 13.3 ng/dL ± 13.5 at 12 weeks postoperatively (P = .008). Systolic, diastolic, and mean blood pressures decreased significantly in the first week after the procedure (P < .001) and remained stable during further follow-up. CONCLUSIONS In patients with Conn syndrome or Cushing syndrome, percutaneous RF ablation of functioning adrenal adenomas may result in normalization of hormone secretion, improvement in blood pressure, and reduced need for antihypertensive drugs.

Enterografia por tomografia computadorizada: uma avaliação de diferentes contrastes orais neutros

OBJECTIVE: The purpose of this study was to assess the performance of neutral oral contrast agents, comparing intestinal distention, distinction of intestinal wall, acceptance and side effects. MATERIALS AND METHODS: Prospective, randomized, and double-blinded study involving 30 patients who underwent computed tomography of abdomen and pelvis with administration of neutral oral contrast agents, divided into three groups according the contrast agent type: milk, water, and polyethylene glycol. The images were consensually analyzed by two observers, considering the degree of bowel distention and intestinal wall distinction. The patients responded to a questionnaire regarding the taste of the ingested solution and on their side effects. Kruskal-Wallis and chi-square tests were employed for statistical analysis. RESULTS: Among 40 studied intestinal segments, appropriate bowel distension (intestinal loop diameter > 2 cm) was observed in 14 segments (35%) in the milk group, 10 segments (25%) in the water group and 23 segments (57%) in the polyethylene glycol group (p = 0.01). Preparation with polyethylene glycol resulted in the best bowel distention, but it presented the worst taste and highest incidence of diarrhea as reported by patients. CONCLUSION: Bowel preparation with oral polyethylene glycol results in higher degree of bowel distention than with water or milk, but presents worst acceptance related to its taste and frequency of diarrhea as a side effect.

Prevalence of simple liver cysts and hemangiomas in cirrhotic and non-cirrhotic patients submitted to magnetic resonance imaging

Objective To determine the prevalence of liver cysts and hemangiomas in the general population and in cirrhotic patients. Materials and Methods Retrospective, observational, and cross-sectional study selecting consecutive magnetic resonance imaging studies performed in the period from February to July 2011. A total of 303 patients (187 women and 116 men) with mean age of 53.3 years were included in the present study. Patients with previously known liver lesions were excluded. The images were consensually analyzed by two observers in the search for simple liver cysts and typical liver hemangiomas, according to universally accepted imaging criteria. Lesions prevalence, diameters and location were determined in both cirrhotic and non-cirrhotic individuals. Results The authors observed prevalence of 8.6% for hemangiomas and 14.5% for simple cysts. No statistically significant difference was observed in relation to prevalence of hemangiomas and cysts among cirrhotic and non-cirrhotic patients (p = 0.954; p = 0.472). Conclusion In the present study, the prevalence of cysts and hemangiomas was higher than the prevalence reported by autopsy series. No influence of cirrhosis was observed on the prevalence and appearance of such incidental lesions.

Transcatheter arterial embolization for unresectable symptomatic giant hepatic hemangiomas: single-center experience using a lipiodol-ethanol mixture.

Objective The present article is aimed at reporting the author’s experience with transcatheter arterial embolization using a lipiodol-ethanol mixture in three cases of unresectable symptomatic giant hepatic hemangiomas. Materials and Methods The cases of three patients with giant unresectable symptomatic hepatic hemangiomas embolized in the period 2009–2010 were retrospectively reviewed. In all the cases, transarterial embolization was performed with an ethanol-lipiodol mixture. Results Symptoms regression and quality of life improvement were observed in all the cases. No complications were observed and all the patients were discharged within 12 hours after the procedure. Conclusion Transcatheter arterial embolization using ethanol mixed with lipiodol was a safe and effective treatment for symptomatic giant hepatic hemangiomas in this small series of patients.

Aspectos comuns e pseudolesões na colonografia por tomografia computadorizada: ensaio iconográfico

Computed tomography colonography is a minimally invasive method for screening for polyps and colorectal cancer, with extremely unusual complications, increasingly used in the clinical practice. In the last decade, developments in bowel preparation, imaging, and in the training of investigators have determined a significant increase in the method sensitivity. Images interpretation is accomplished through a combined analysis of two-dimensional source images and several types of three-dimensional renderings, with sensitivity around 96% in the detection of lesions with dimensions equal or greater than 10 mm in size, when analyzed by experienced radiologists. The present pictorial essay includes examples of diseases and pseudolesions most frequently observed in this type of imaging study. The authors present examples of flat and polypoid lesions, benign and malignant lesions, diverticular disease of the colon, among other conditions, as well as pseudolesions, including those related to inappropriate bowel preparation and misinterpretation.

Isolated metachronous splenic metastasis from renal cell carcinoma after 5 years

Primary and metastatic tumours of the spleen are uncommon. The incidence of isolated metastasis from other organs is less than 1%. We report the case of a 55-year-old woman with clear cell carcinoma of the kidney, who underwent radical nephrectomy. After a 5-year follow-up period, a hypervascular nodule was detected in the spleen on MRI. Six months later, control MRI showed that its appearance had changed to a hypervascular mass with areas of central necrosis. A splenectomy was performed and histopathological examination of the spleen confirmed the presence of clear cell carcinoma with infiltration of the capsule. This is only the seventh case described in the literature of isolated splenic metastasis from clear cell carcinoma and the first such case containing MRI.

Percutaneous ablation of functioning adenoma in a patient with a single adrenal gland.

The conventional treatment of functioning adrenal adenomas is laparoscopic resection. Since the 1990s, radiofrequency ablation has been increasingly applied to the treatment of tumours of the liver, lungs and musculoskeletal system. However, the use of radiofrequency ablation to treat adrenal nodules is still an uncommon procedure, particularly in aldosterone-producing adenomas. We report the case of a 35-year-old male patient with resistant hypertension, hypokalaemia and aldosterone-producing adenoma in a single adrenal gland. The patient underwent CT-guided percutaneous radiofrequency ablation. Clinical, laboratory and MRI follow-up data indicated excellent response to treatment. This case report is the first in the literature to describe the use of CT-guided percutaneous radiofrequency ablation in the treatment of a functioning adrenal adenoma in a patient with a single adrenal gland.

Chemoembolisation combined with percutaneous radiofrequency ablation in the treatment of primary angiosarcoma of the liver.

Angiosarcoma of the liver is a rare disease; however, it ranks as the third most common primary liver malignancy. Diagnosis is difficult and prognosis is very poor. After the onset of clinical symptoms, the disease often progresses rapidly, decreasing the chances of curative treatment. We report the case of an 83-year-old male patient who presented with postprandial fullness. Upper abdominal ultrasound showed a hypervascular mass in segment 6 of the liver. The results of anatomopathological examination and immunohistochemistry were compatible with the diagnosis of primary angiosarcoma of the liver. Patient refused surgery (haepatectomy), and treatment was then initiated with transarterial chemoembolisation, followed by percutaneous radiofrequency ablation. The patient is currently cured based on clinical and radiological evidence. This case report is the first in the literature to describe the combined use of transarterial chemoembolisation with percutaneous radiofrequency ablation in the treatment of primary angiosarcoma of the liver.

Glutamine/Glutamate Metabolism Studied with Magnetic Resonance Spectroscopic Imaging for the Characterization of Adrenal Nodules and Masses

Purpose. To assess glutamine/glutamate (Glx) and lactate (Lac) metabolism using proton magnetic resonance spectroscopic imaging (1H-MRS) in order to differentiate between adrenal gland nodules and masses (adenomas, pheochromocytomas, carcinomas, and metastases). Materials and Methods. Institutional review board approval and informed consent were obtained. A total of 130 patients (47 men) with 132 adrenal nodules/masses were prospectively assessed (54 ± 14.8 years). A multivoxel system was used with a two-dimensional point-resolved spectroscopy/chemical-shift imaging sequence. Spectroscopic data were interpreted by visual inspection and peak amplitudes of lipids (Lip), choline (Cho), creatine (Cr), Lac, and Glx. Lac/Cr and Glx/Cr were calculated. Glx/Cr was assessed in relation to lesion size. Results. Statistically significant differences were observed in Glx/Cr results between adenomas and pheochromocytomas (P < 0.05), however, with a low positive predictive value (PPV). Glx levels were directly proportional to lesion size in carcinomas. A cutoff point of 1.44 was established for the differentiation between carcinomas larger versus smaller than 4 cm, with 75% sensitivity, 100% specificity, 100% PPV, and 80% accuracy. Lac/Cr results showed no differences across lesions. A cutoff point of −6.5 for Lac/Cr was established for carcinoma diagnosis. Conclusion. Glx levels are directly proportional to lesion size in carcinomas. A cutoff point of −6.5 Lac/Cr differentiates carcinomas from noncarcinomas.

Torção ovariana: ensaio iconográfico com enfoque em achados de ressonância magnética e tomografia computadorizada

O objetivo deste artigo e descrever os principais achados em tomografia computadorizada e ressonância magnetica da torcao ovariana. Dois examinadores em consenso selecionaram e analisaram casos ilustrativos, obtidos entre janeiro de 2010 e dezembro de 2011, de pacientes submetidas a tomografia computadorizada e ressonância magnetica, com dor abdominal aguda comprovadamente decorrente de torcao ovariana, destacando os principais aspectos de imagem. O crescente papel da tomografia computadorizada e da ressonância magnetica na avaliacao de paciente com abdome agudo de origem ginecologica requer que o radiologista se familiarize com os aspectos de imagem das suas principais causas, utilizando estas ferramentas diagnosticas em conjunto com a ultrassonografia.