Thiago Giansante Abud

Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer.

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.

Relationship between Intestinal Parasitic Infection in Children and Soil Contamination in an Urban Slum

PURPOSE Urban slums are well known for their high infant mortality and morbidity rates, and parasitic infections seem to be a common problem among these children. The aim of the present study was to determine protozoa and nematodes prevalence among children of a selected community located in São Paulo, Brazil, and access the relation between soil and children infection. METHODS Soil contamination samples from 15 strategic locations in the slum area as well as stool samples (examined for protozoa and nematodes through five different methods) from 120 children aged 2-14 years (49% M: 51% F, mean +/- SD = 7.9 +/- 3.8 years) were assessed in a cross-sectional study. Childrens domicile locations were determined, and a comparative analysis was undertaken to correlate children and soil infection. RESULTS Overall infection rate was 30.8% (n = 37), without difference between genders. The most frequent intestinal protozoa were Endolimax nana (20.8%), Entamoeba coli (15.8%) and Giardia lamblia (16.7%). Frequencies of Ascaris lumbricoides and Enterobius vermicularis in stool samples were 2.5 and 1.7%, respectively. No cases of hookworms, Schistosoma mansoni or Tricuris trichiura were identified. Polyparasitism occurred in 10.8% of the children, while 69.2% were free of parasitic infections. Out of the 15 soil samples analyzed, Ascaris sp. eggs were found in 20% and hookworm eggs in 6.7%. CONCLUSION Helminth infection is not as prevalent as previously reported in urban slums in São Paulo, neither as clinical disease nor in soil samples. Protozoa intestinal infection, however, is still frequent in some marginalized populations in São Paulo. Improvement in living standards, mostly sanitation might decrease the prevalence of these diseases.

New Trends in Diffusion-Weighted Magnetic Resonance Imaging as a Tool in Differentiation of Serous Cystadenoma and Mucinous Cystic Tumor: A Prospective Study

Background/Aims: Pancreatic cystic lesions are increasingly being recognized. Magnetic resonance imaging (MRI) is the method that brings the greatest amount of information about the morphologic features of pancreatic cystic lesions. To establish if diffusion-weighted MRI (DW-MRI) can be used as a tool to differentiate mucinous from nonmucinous lesions. Methods: Fifty-six patients with pancreatic cystic lesions (benign, n = 46; malignant, n = 10) were prospectively evaluated with DW-MRI in order to differentiate mucinous from nonmucinous lesions. Final diagnosis was obtained by follow-up (n = 31), surgery (n = 16) or endoscopic ultrasound-guided fine needle aspiration (n = 9). Serous cystadenoma was identified in 32 (57%) patients. Results: The threshold value established for the differentiation of mucinous from nonmucinous lesions was 2,230.06 s/mm2 for ADC of 700. DWI-MRI behavior between mucinous and nonmucinous groups revealed sensitivity, specificity, positive predictive value, negative predictive value and accuracy to be 80, 98, 92, 93 and 93%, respectively (p < 0.01, power of sample = 1.0). In the comparison of the diffusion behavior between mucinous (n = 13) and serous (n = 32) lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100, 97, 92, 100 and 98%, respectively (p < 0.01, power of sample = 1.0). The results of endoscopic ultrasound-guided fine needle aspiration were similar to those of DW-MRI. Conclusions: DW-MRI can be included as part of the array of tools to differentiate mucinous from nonmucinous lesions and can help in the management of pancreatic cystic lesions.

Análise radiológica das alterações gastrintestinais após 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%), gastroesophageal reflux disease (19.5%) and sliding of the silastic ring (4.8%). Least frequent findings have been the following: enterocutaneous fistula (2.4%), stenosis of the gastric pouch outlet (2.4%), bezoar (2.4%), and non-visualization of the silastic ring caused by its removal due to patient intolerance (2.4%). 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.

Flow Diverters for Treatment of 160 Ophthalmic Segment Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort

BACKGROUND: Treatment of ophthalmic segment aneurysms (OSA) remains challenging. Flow diverter stents (FDS) have evolved as a promising endovascular treatment option for aneurysms of the internal carotid artery and are associated with high occlusion rates and a favorable morbidity and mortality profile. OBJECTIVE: To determine safety and efficacy of FDS for OSA in a large, multicenter cohort. METHODS: A retrospective analysis of prospectively maintained databases of 127 consecutive patients harboring 160 OSA treated with FDS was performed. Aneurysms were classified based on location and morphology. Follow‐up with digital subtraction angiography (DSA) was performed 6 to 18 months after treatment. RESULTS: Follow‐up DSA was available for 101 (63.1%) aneurysms with a mean follow‐up of 18 months. Complete occlusion was observed in 90 aneurysms (89.1%), near‐complete occlusion (>95%) in 3 (3%), and incomplete occlusion (<95%) in 8 aneurysms (7.9%). One aneurysm was retreated with another FDS (0.9%). No risk factors for incomplete occlusion were identified. The OA was occluded at the latest follow‐up in 6 cases (7.1%). Permanent morbidity occurred in 4 patients (3.1%), and there was no mortality related to the FDS procedure. CONCLUSION: Treatment of OSA with FDS was found to be safe and effective. The retreatment rate was extremely low and aneurysms that occluded did not reanalyze.

Linfoma Burkitt-símile cerebral mimetizando cisto coloide intraventricular

1. Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil. Mailing address: Dr. Felipe Welter Langer. Department of Radiology and Imaging Diagnosis, University Hospital of Santa Maria, Federal University of Santa Maria. Avenida Roraima, 1000, Camobi. Santa Maria, RS, Brazil, 97105900. E-mail: felipewlanger@gmail.com. with high local invasion, rapid growth, and early distant metastasis unless they are excised in a timely manner. The most common locations for MPNST in neurofibromatosis patients are the extremities, head, and neck. Thoracic involvement, however, is remarkably rare, few cases having been reported. According to the size and location of the intrathoracic tumor, compressive manifestations such as pain, dyspnea, dysphagia, and superior vena cava syndrome may be the presenting manifestations, as seen in our patient, who reported dyspnea as the sole symptom related to his MPNST. The identification of MPNST in neurofibromatosis patients may be troublesome for several reasons. First, the existence of multiple benign neurofibromas may delay the identification of changes in plexiform neurofibromas. In addition, because superficial cutaneous neurofibromas do not undergo malignant transformation, MPNSTs often remain undetected until they reach a moderate size or cause compressive symptoms. Furthermore, CT and magnetic resonance imaging might not be accurate enough to differentiate benign from malignant lesions with any degree of reliability in the very early stages, although advances have been made in the area of positron emission tomography. Therefore, any suspicious lesions should generally prompt histological sampling. Although the mainstay of successful treatment of an MPNST is surgical excision after disease staging, neoadjuvant chemotherapy may be employed in order to reduce its dimensions beforehand, especially in patients with lesions surrounding vital organs. Radiotherapy might also delay recurrence, although it has not been shown to improve survival in MPNST patients. REFERENCES

Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram

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 Rezendes 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 Rezendes 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.

Patologias do compartimento iliopsoas: avaliação radiológica

The iliopsoas compartment, a posterior boundary of the retroperitoneum, is comprised of the psoas major, psoas minor and iliac muscles. The symptoms picture in patients presenting with pathological involvement of this compartment may show a wide range of nonspecific clinical presentations that may lead to delayed diagnosis. However, in the search of an etiological diagnosis, it is already known that inflammation, tumors, and hemorrhages account for almost all the lesions affecting the iliopsoas compartment. By means of a retrospective analysis of radiological studies in patients with iliopsoas compartment lesions whose diagnosis was confirmed by anatomopathological evaluation or clinical follow-up, we have reviewed its anatomy as well as the main forms of involvement, with the purpose of identifying radiological signs that may help to narrow down the potential differential diagnoses. As each lesion is approached we will discuss the main radiological findings such as presence of gas in pyogenic abscesses, bone destruction and other bone changes of vertebral bodies in lesions secondary to tuberculosis, involvement of fascial planes in cases of neoplasms, and differences in signal density and intensity of hematomas secondary to hemoglobin degradation, among others. So, we have tried to present cases depicting the most frequent lesions involving the iliopsoas compartment, with emphasis on those signs that can lead us to a more specific etiological diagnosis.Limite posterior do retroperitonio, o compartimento iliopsoas localiza-se externamente ao mesmo, sendo composto dos musculos psoas maior, psoas menor e iliaco. O quadro de sintomas dos pacientes com acometimento patologico deste compartimento e amplo e inespecifico, podendo haver importante atraso no diagnostico. Entretanto, na busca do diagnostico etiologico das alteracoes do compartimento iliopsoas, sabemos que as infeccoes, os tumores e as hemorragias respondem pela quase totalidade das lesoes. Por meio da avaliacao retrospectiva de exames radiologicos de pacientes com patologias do iliopsoas e que tiveram o diagnostico confirmado por exame anatomopatologico ou acompanhamento clinico, revisamos a anatomia deste compartimento, assim como as suas principais formas de acometimento, identificando sinais que auxiliem na diferenciacao dos potenciais diagnosticos diferenciais. Na abordagem de cada patologia discutiremos os principais sinais radiologicos, como a presenca de gas em abscessos piogenicos, alteracoes osseas em corpos vertebrais nas lesoes secundarias a tuberculose, comprometimento dos planos fasciais nas lesoes tumorais e diferencas na densidade e intensidade de sinal dos hematomas nas diferentes fases de degradacao da hemoglobina, entre outros. Dessa forma, procuramos apresentar casos que exemplifiquem as doencas mais frequentes do compartimento iliopsoas, destacando a importância dos seus diferentes sinais, aproximando-nos de um diagnostico etiologico especifico.

Concomitant pulmonary and central nervous system paracoccidioidomycosis with cerebellar abscess

A 59-year-old man with no previous diagnosis was admitted to hospital with a history of headache, ataxia, and cough. Computed tomography (CT) of the chest showed groundglass attenuation, consolidation, nodules, cavitations, and fi brotic lesions in both lungs, strongly suggesting the possibility of a granulomatous process (Figure A). These radiological fi ndings are commonly seen in fungal disease, supporting a diagnosis of a chronic form of pulmonary paracoccidioidomycosis(1). The contrast-enhanced coronal T1-weighted magnetic resonance image (MRI) of the brain showed a ring-enhancing mass in the left cerebellar hemisphere, suggesting a necrotic lesion (Figure B). A hypersignal in the cavity on the axial diffusion-weighted image (Figure C) was interpreted as reduced water molecule movement (restricted diffusion) and refl ected a high viscosity of the proteinaceous fl uid with a high concentration of infl ammatory cells. Although these features are not pathognomonic, they are extremely characteristic of an abscess(2). The patient underwent surgical drainage of the cerebellar lesion. The histopathological findings were leveduriform structures of Paracoccidioides brasiliensis. Paracoccidioidomycosis (PCM) is one of the most common fungal diseases and can compromise one or multiple organs(3). Diagnosis can be confi rmed by biopsy, immunological assay, culture, or direct microscopy. Recommended pharmacological treatment includes itraconazole, sulfamethoxazole + trimethoprim, and amphotericin B. Thus, the combination of chest CT fi ndings, suggesting a granulomatous infectious process, and MRI, showing a probable encephalic abscess, should lead to a diagnosis of PCM with concomitant involvement of the central nervous system and lungs, allowing early initiation of specifi c treatment and reduction of the associated morbimortality.

Cysticerci located in the fourth ventricle causing obstructive hydrocephalus: a radiological emergency requiring prompt diagnosis

[1]. Divisão de Neurorradiologia, Documenta Hospital São Francisco, Ribeirão Preto, São Paulo, Brasil. [2]. Divisão de Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil. [3]. Divisão de Neurorradiologia, MED Hospital São Lucas, Ribeirão Preto, São Paulo, Brasil. [4]. Divisão de Neurocirurgia, Hospital Santa Casa, Ribeirão Preto, São Paulo, Brasil. [5]. Divisão de Radiologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.