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Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications
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Amoedo, Mauricio Kauark

; Tyng, Chiang Jeng

; Barbosa, Paula Nicole Vieira Pinto

; Melo, Rayssa Araruna Bezerra de

; Almeida, Maria Fernanda Arruda

; Chojniak, Rubens

; Bitencourt, Almir Galvão Vieira

Radiologia Brasileira

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oct 2021, Volume 54 N. 5 Pages 295 - 302

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Avaliar a técnica, eficácia e segurança das biópsias percutâneas guiadas por tomografia computadorizada (TC) de lesões de cabeça e pescoço. Materiais e Métodos: Este estudo retrospectivo e unicêntrico incluiu pacientes submetidos a biópsia percutânea guiada por TC de lesões de cabeça e pescoço. Para avaliação da acurácia diagnóstica, os resultados da biópsia foram comparados com o diagnóstico final determinado por avaliação histológica ou acompanhamento clínico. Resultados: Foram avaliadas 74 biópsias realizadas em 68 pacientes. A média de idade dos pacientes foi de 55,6 anos. A maioria das lesões (79,7%) estava localizada na região supra-hioide e o maior diâmetro variou de 11 a 128 mm. Os acessos mais comuns utilizados foram paramaxilar (32,4%), retromandibular (21,6%) e periorbital (14,9%). Cinco pacientes (6,8%) desenvolveram complicações menores e não houve associação estatisticamente significante entre a presença de complicações e fatores clínicos, radiológicos ou relacionados ao procedimento. Foi obtido material suficiente para análise histológica em todos os casos. Trinta e oito biópsias (51,4%) tiveram diagnóstico histológico de malignidade. Houve três (8,3%) resultados falso-negativos e nenhum falso-positivo, demonstrando sensibilidade de 92,7%, especificidade de 100% e acurácia de 96,0%. Conclusão: Nossos resultados demonstram que a biópsia percutânea guiada por TC de lesões de cabeça e pescoço é um procedimento seguro e efetivo para obter material para análise histológica.

Abstract Objective: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. Materials and Methods: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. Results: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. Conclusion: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

https://doi.org/10.1590/0100-3984.2020.0100 108 downloads

Tomographic score (RAD-Covid Score) to assess the clinical severity of the novel coronavirus infection
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Ribeiro, Tatiana Figueiredo Guimarães

; Rstom, Ricardo Arroyo

; Barbosa, Paula Nicole Vieira Pinto

; Almeida, Maria Fernanda Arruda

; Costa, Marina Martini

; Oliveira Filho, Edivaldo Nery de

; Barros, André Santos

; Pereira, Talita Rombaldi

; Velludo, Silvio Fontana

; Machado, Fabrício Próspero

Brazilian Journal of Infectious Diseases

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2021, Volume 25 N. 4 elocation 101599

Abstract: En | Text: En | PDF: En

ABSTRACT Objectives: The severity of pulmonary Covid-19 infection can be assessed by the pattern and extent of parenchymal involvement observed in computed tomography (CT), and it is important to standardize the analysis through objective, practical, and reproducible systems. We propose a method for stratifying the radiological severity of pulmonary disease, the Radiological Severity Score (RAD-Covid Score), in Covid-19 patients by quantifying infiltrate in chest CT, including assessment of its accuracy in predicting disease severity. Methods: This retrospective, single-center study analyzed patients with a confirmed diagnosis of Covid-19 infection by real-time reverse-transcriptase polymerase chain reaction, who underwent chest CT at hospital admission between March 6 and April 6, 2020. CT scans were classified as positive, negative, or equivocal, and a radiological severity score (RAD-Covid Score) was assigned. Clinical severity was also assessed upon hospital admission. Results: 658 patients were included. Agreement beyond chance (kappa statistic) for the RAD-Covid Score was almost perfect among observers (0.833), with an overall agreement of 89.5%. The RAD-Covid Score was positively correlated with clinical severity and death, i.e., the higher the RAD-Covid Score, the greater the clinical severity and mortality. This association proved independent of age and comorbidities. Accuracy of this score was 66.9%. Conclusions: The RAD-Covid Score showed good accuracy in predicting clinical severity at hospital admission and mortality in patients with confirmed Covid-19 infection and was an independent predictor of severity.

https://doi.org/10.1016/j.bjid.2021.101599 33 downloads

Chest CT accuracy in the diagnosis of SARS-CoV-2 infection: initial experience in a cancer center
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Barbosa, Paula Nicole Vieira Pinto

; Bitencourt, Almir Galvão Vieira

; Miranda, Gabriel Diaz de

; Almeida, Maria Fernanda Arruda

; Chojniak, Rubens

Radiologia Brasileira

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aug 2020, Volume 53 N. 4 Pages 211 - 215

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Avaliar a acurácia da tomografia computadorizada (TC) de tórax em pacientes com suspeita de infecção por SARS-CoV-2 em um centro oncológico. Materiais e Métodos: Estudo retrospectivo e unicêntrico que selecionou 91 pacientes que realizaram TC de tórax e teste RT-PCR no mesmo dia. Os resultados da TC foram classificados em negativos, achados típicos, indeterminados ou atípicos. Acurácia diagnóstica, sensibilidade e especificidade foram calculadas para dois cenários: no primeiro, apenas TC com achados típicos foi considerada positiva; no segundo, achados típicos ou indeterminados foram considerados positivos. Resultados: A média de idade dos pacientes foi de 58,2 anos, sendo a maioria homens (60,4%) e com história de câncer prévio (85,7%). TC demonstrou achados típicos em 28,6%, indeterminados em 24,2% e atípicos em 26,4%. Resultados da RT-PCR foram positivos para SARS-CoV-2 em 27,5%. Sensibilidade, especificidade e acurácia no primeiro e segundo cenários foram, respectivamente, de 64,0%, 84,8% e 79,1%, e 92,0%, 62,1% e 70,3%. Conclusão: A TC tem alta acurácia para o diagnóstico de infecção por SARS-CoV-2. Diferentes critérios de interpretação fornecem maior sensibilidade ou especificidade. A TC deve ser integrada como um teste de triagem em ambientes com recursos limitados durante a pandemia, para ajudar na otimização da utilização de testes de PCR, leitos de isolamento e unidades de terapia intensiva.

Abstract Objective: To evaluate the accuracy of chest computed tomography (CT) in patients with suspected severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection at a cancer center. Materials and Methods: This retrospective single-center study selected 91 patients who had chest CT and real-time polymerase chain reaction (RT-PCR) test collected at the same day. CT results were classified in negative, typical, indeterminate or atypical findings. Diagnostic accuracy, sensitivity and specificity were calculated for two different scenarios: in the first, only typical findings on CT were considered positive; in the second, both typical and indeterminate findings were considered positive. Results: Mean patients’ age was 58.2 years, most were male (60.4%) and had prior diagnosis of cancer (85.7%). CT showed typical findings in 28.6%, indeterminate findings in 24.2% and atypical findings in 26.4%. RT-PCR results were positive for SARS-CoV-2 in 27.5%. The sensitivity, specificity and accuracy in the first and second scenarios were respectively 64.0%, 84.8% and 79.1%, and 92.0%, 62.1% and 70.3%. Conclusion: CT has a high accuracy for the diagnosis of SARS-CoV-2 infection. Different interpretation criteria can provide either high sensitivity or high specificity. CT should be integrated as a triage test in resource-constrained environments during the pandemic to assist in the optimization of PCR-tests, isolation beds and intensive care units.

https://doi.org/10.1590/0100-3984.2020.0040 1035 downloads

[SciELO Preprints] - Chest CT accuracy in the diagnosis of SARS-CoV-2 infection: initial experience in a cancer center
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Barbosa, Paula Nicole Vieira Pinto Bitencourt, Almir Galvão Vieira Miranda, Gabriel Diaz de Almeida, Maria Fernanda Arruda Chojniak, Rubens

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Publication date: 2020-04-28

Abstract: En Pt

Objective: To evaluate the accuracy of chest computed tomography (CT) in patients with suspected severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection at a cancer center. Materials and Methods: This retrospective single-center study selected 91 patients who had chest CT and real-time polymerase chain reaction (RT-PCR) test collected at the same day. CT results were classified in negative, typical, indeterminate or atypical findings. Diagnostic accuracy, sensitivity and specificity were calculated for two different scenarios: in the first, only typical findings on CT were considered positive; in the second, both typical and indeterminate findings were considered positive. Results: Mean patients’ age was 58.2 years, most were male (60.4%) and had prior diagnosis of cancer (85.7%). CT showed typical findings in 28.6%, indeterminate findings in 24.2% and atypical findings in 26.4%. RT-PCR results were positive for SARS-CoV-2 in 27.5%. The sensitivity, specificity and accuracy in the first and second scenarios were respectively 64.0%, 84.8% and 79.1%, and 92.0%, 62.1% and 70.3%. Conclusion: CT has a high accuracy for the diagnosis of SARS-CoV-2 infection. Different interpretation criteria can provide either high sensitivity or high specificity. CT should be integrated as a triage test in resource-constrained environments during the pandemic to assist in the optimization of PCR-tests, isolation beds and intensive care units.

Objetivo: Avaliar a acurácia da tomografia computadorizada (TC) de tórax em pacientes com suspeita de infecção por SARS-CoV-2 em um centro oncológico. Materiais e Métodos: Estudo retrospectivo e unicêntrico que selecionou 91 pacientes que realizaram TC de tórax e teste RT-PCR no mesmo dia. Os resultados da TC foram classificados em negativos, achados típicos, indeterminados ou atípicos. Acurácia diagnóstica, sensibilidade e especificidade foram calculadas para dois cenários: no primeiro, apenas TC com achados típicos foi considerada positiva; no segundo, achados típicos ou indeterminados foram considerados positivos. Resultados: A média de idade dos pacientes foi de 58,2 anos, sendo a maioria homens (60,4%) e com história de câncer prévio (85,7%). TC demonstrou achados típicos em 28,6%, indeterminados em 24,2% e atípicos em 26,4%. Resultados da RT-PCR foram positivos para SARS-CoV-2 em 27,5%. Sensibilidade, especificidade e acurácia no primeiro e segundo cenários foram, respectivamente, de 64,0%, 84,8% e 79,1%, e 92,0%, 62,1% e 70,3%. Conclusão: A TC tem alta acurácia para o diagnóstico de infecção por SARS-CoV-2. Diferentes critérios de interpretação fornecem maior sensibilidade ou especificidade. A TC deve ser integrada como um teste de triagem em ambientes com recursos limitados durante a pandemia, para ajudar na otimização da utilização de testes de PCR, leitos de isolamento e unidades de terapia intensiva.

https://doi.org/10.1590/0100-3984.2020.0040

Retrospective analysis of computed tomography-guided percutaneous nephrostomies in cancer patients
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Meira, Marcio dos Santos

; Barbosa, Paula Nicole Vieira Pinto

; Bitencourt, Almir Galvão Vieira

; Almeida, Maria Fernanda Arruda

; Tyng, Chiang Jeng

; Costa, Maria Alice Freitas

; Góes, Ana Carolina de Ataíde

; Chojniak, Rubens

Radiologia Brasileira

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jun 2019, Volume 52 N. 3 Pages 148 - 154

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Estabelecer o perfil da nefrostomia percutânea guiada por tomografia computadorizada (TC) em um centro de referência oncológico, conhecendo as características do paciente submetido a esta intervenção, indicações e especificidades técnicas do procedimento, além das complicações mais frequentes. Materiais e Métodos: Foi realizada revisão dos prontuários eletrônicos e das imagens de pacientes submetidos a nefrostomia percutânea guiada por TC entre os anos de 2014 e 2016 em um centro de referência oncológico. Resultados: Foram avaliados 201 procedimentos. As doenças neoplásicas malignas foram as principais causas da obstrução. Houve necessidade de reabordagem em 36,6% dos casos, em sua maioria para reposicionamento do cateter, e ocorreram complicações em 9,5% dos casos. Não houve associação estatisticamente significante entre as complicações pós-nefrostomia percutânea e o tipo de tratamento oncológico prévio, a técnica empregada, o calibre do dreno utilizado no procedimento, ou o grau de dilatação do sistema coletor prévio ao procedimento. Conclusão: A nefrostomia percutânea guiada por TC é eficaz em pacientes oncológicos, com taxas de sucesso e complicações semelhantes às observadas na população geral na literatura.

Abstract Objective: To establish an overview of computed tomography (CT)-guided percutaneous nephrostomy performed at a referral center for cancer, addressing the characteristics of patients submitted to this intervention, as well as the indications for it, the technical specificities of it, and its main complications. Materials and Methods: This was a retrospective study involving a review of the electronic medical records and images of patients submitted to CT-guided percutaneous nephrostomy at a referral center for cancer between 2014 and 2016. Results: A total of 201 procedures were evaluated. In most cases, the obstruction was caused by a malignant neoplasm. Complications occurred in 9.5% of the cases, and an additional intervention was required (typically for catheter repositioning) in 36.6%. Post-procedure complications were not found to be significantly associated with the type of previous cancer treatment, the technique used, the caliber of the drain used in the procedure, or the degree of dilatation of the collection system prior to the procedure. Conclusion: In cancer patients, CT-guided percutaneous nephrostomy is an effective treatment, with success rates and complication rates similar to those reported in the general population.

https://doi.org/10.1590/0100-3984.2018.0023 2960 downloads

Computed tomography with a stomach protocol and virtual gastroscopy in the staging of gastric cancer: an initial experience
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Almeida, Maria Fernanda Arruda

; Verza, Leonardo

; Bitencourt, Almir Galvão Vieira

; Boaventura, Camila Silva

; Barbosa, Paula Nicole Vieira Pinto

; Chojniak, Rubens

Radiologia Brasileira

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aug 2018, Volume 51 N. 4 Pages 211 - 217

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Avaliar a acurácia da tomografia computadorizada multidetectores com protocolo gástrico no estadiamento do câncer de estômago. Materiais e Métodos: Entre setembro de 2015 e dezembro de 2016, foram incluídos 14 pacientes com diagnóstico de adenocarcinoma gástrico que realizaram exame de tomografia computadorizada de 16 canais para estadiamento. As imagens foram analisadas por um mesmo radiologista, com experiência em imagem oncológica abdominal. Foram calculadas sensibilidade, especificidade e acurácia do método, comparando com o resultado anatomopatológico. Todos os pacientes foram submetidos a gastrectomia parcial ou total. Resultados: A idade média foi 61,5 anos, sendo 53,8% do sexo masculino. Em 35,7% dos casos as lesões gástricas foram classificadas como T1/T2, 28,5% como T3 e 35,7% como T4. Onze pacientes exibiam linfonodos suspeitos (N positivo), representando 68,7%. A acurácia do exame para estadiamento T1/T2, T3, T4 e linfonodal foi 85%, 78%, 90% e 78%, respectivamente. Os valores de sensibilidade e especificidade foram 71% e 100% para T1/T2, 66% e 81% para T3, 100% e 90% para T4 e 88% e 60% para linfonodos. Conclusão: A tomografia computadorizada multidetectores com protocolo gástrico associado ao estudo de gastroscopia virtual apresenta boa acurácia no estadiamento tumoral e linfonodal do adenocarcinoma gástrico.

Abstract Objective: To evaluate the accuracy of multidetector computed tomography with a stomach protocol in staging of gastric cancer. Materials and Methods: We evaluated 14 patients who underwent computed tomography in a 16-channel scanner for preoperative staging of gastric adenocarcinoma between September 2015 and December 2016. All images were analyzed by the same radiologist, who had extensive experience in abdominal cancer imaging. The sensitivity, specificity, and accuracy of the method were calculated by comparing it with the pathology result. All patients underwent partial or total gastrectomy. Results: The mean age was 61.5 years, and 53.8% of the patients were male. The gastric lesions were classified as T1/T2 in 35.7% of the cases, as T3 in 28.5%, and as T4 in 35.7%. Eleven patients (68.7%) had suspicious (N positive) lymph nodes. The accuracy of the T1/T2, T3, T4, and lymph node staging tests was 85%, 78%, 90%, and 78%, respectively. The respective sensitivity and specificity values were 71% and 100% for T1/T2, 66% and 81% for T3, 100% and 90% for T4, and 88% and 60% for lymph nodes. Conclusion: Multidetector computed tomography with a stomach protocol, used in conjunction with virtual gastroscopy, shows good accuracy in the tumor and lymph node staging of gastric adenocarcinoma.

https://doi.org/10.1590/0100-3984.2017.0097 12989 downloads

Computed tomography-guided preoperative localization of musculoskeletal lesions using the ROLL technique
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Tyng, Chiang Jeng

; Barbosa, Paula Nicole Vieira Pinto

; Bitencourt, Almir Galvão Vieira

; Amoedo, Maurício Kauark

; Almeida, Maria Fernanda Arruda

; Lima, Eduardo Nóbrega Pereira

; Chojniak, Rubens

Radiologia Brasileira

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jun 2018, Volume 51 N. 3 Pages 147 - 150

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Descrever a localização pré-operatória de lesões musculoesqueléticas utilizando a técnica radioguided occult lesion localization (ROLL). Materiais e Métodos: Em todos os casos foi realizada administração guiada por tomografia computadorizada de enxofre coloidal marcado com tecnécio-99m, diretamente no interior ou adjacente à lesão suspeita, até 36 horas antes do procedimento cirúrgico. As lesões foram localizadas no intraoperatório utilizando um gama-probe. Resultados: São descritos seis casos de pacientes submetidos a cirurgia radioguiada, sendo três pacientes com lesões ósseas suspeitas para metástase, dois pacientes com sarcoma recidivado e um paciente com lesão nodular na perna esquerda sem diagnóstico prévio. Os pacientes toleraram bem o procedimento e não ocorreram complicações. Todas as lesões foram identificadas adequadamente no intraoperatório e ressecadas com margens livres. Conclusão: A técnica ROLL foi efetiva na localização intraoperatória de lesões musculoesqueléticas ocultas, demonstrando que este procedimento é factível e promissor para facilitar a exploração cirúrgica em casos selecionados.

Abstract Objective: To describe the preoperative localization of musculoskeletal lesions with the radioguided occult lesion localization (ROLL) technique. Materials and Methods: In all cases, computed tomography-guided injection of technetium-99m sulfur colloid was performed, directly into or near the suspicious lesion, up to 36 hours before the surgical procedure. Lesions were detected intraoperatively with a gamma probe. Results: We report the cases of six patients submitted to radioguided surgery, including three patients with bone lesions suspicious for metastasis, two patients suspected of recurrent sarcoma, and one patient with no previous diagnosis who had a nodular lesion on the left leg. Patients tolerated the procedure well, and no complications were associated with the puncture. All marked lesions were easily identified intraoperatively and were excised with clear margins. Conclusion: The ROLL technique was effective in the intraoperative localization of occult musculoskeletal lesions, demonstrating that it is a feasible and promising technique for the surgical exploration of selected cases.

https://doi.org/10.1590/0100-3984.2017.0010 707 downloads

FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION
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COIMBRA, Felipe José Fernandez

; RIBEIRO, Heber Salvador de Castro

; MARQUES, Márcio Carmona

; HERMAN, Paulo

; CHOJNIAK, Rubens

; KALIL, Antonio Nocchi

; WIERMANN, Evanius Garcia

; CAVALLERO, Sandro Roberto de Araújo

; COELHO, Fabricio Ferreira

; FERNANDES, Paulo Henrique de Souza

; SILVESTRINI, Anderson Arantes

; ALMEIDA, Maria Fernanda Arruda

; ARAÚJO, Antônio Luis Eiras de

; PITOMBO, Marcos

; TEIXEIRA, Heberton Medeiros

; WAECHTER, Fábio Luiz

; FERREIRA, Fábio Gonçalves

; DINIZ, Alessandro Landskron

; D'IPPOLITO, Giuseppe

; BEGNAMI, Maria Dirlei F. de Sousa

; PROLLA, Gabriel

; BALZAN, Silvio Márcio Pegoraro

; OLIVEIRA, Thiago Bueno de

; SZULTAN, Luís Arnaldo

; LENDOIRE, Javier

; TORRES, Orlando Jorge Martins

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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dec 2015, Volume 28 N. 4 Pages 222 - 230

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Racional : As metástases hepáticas de câncer colorretal são evento frequente e potencialmente fatal na evolução de pacientes com estas neoplasias. Objetivo : Neste módulo procurou-se contextualizar esta situação clínica, bem como parametrizar dados epidemiológicos e de resultados das diversas modalidades de tratamento estabelecidas. Método : Foi realizada discussão sobre como detectar e estadiar o câncer colorretal metastático, bem como o emprego dos métodos de imagem na avaliação de resposta ao tratamento sistêmico instituído. Resultado : Fundamentou na definição de quais pacientes teriam suas metástases consideradas ressecáveis e de como se poderia ampliar a gama de pacientes submetidos às modalidades de tratamento ditas de intuito curativo. Conclusão : Foram apresentados os fatores prognósticos clínicos, patológicos e moleculares com validação para serem levados em consideração na prática clínica.

Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. Results : The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.

https://doi.org/10.1590/s0102-6720201500040002 5011 downloads

Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection
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Tyng, Chiang Jeng

; Bitencourt, Almir Galvão Vieira

; Almeida, Maria Fernanda Arruda

; Barbosa, Paula Nicole Vieira

; Martins, Eduardo Bruno Lobato

; Junior, João Paulo Kawaoka Matushita

; Chojniak, Rubens

; Coimbra, Felipe José Fernandez

Radiologia Brasileira

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jun 2013, Volume 46 N. 3 Pages 139 - 142

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo Descrever a técnica de biópsia percutânea de tumores pancreáticos guiada por tomografia computadorizada com pneumodissecção. Materiais e Métodos No período de junho de 2011 a maio de 2012, foram realizadas sete biópsias percutâneas de tumores pancreáticos guiadas por tomografia computadorizada utilizando a manobra de pneumodissecção em nossa instituição. Todas as biópsias foram realizadas utilizando pistola de disparo automático e sistema coaxial, com agulhas Tru-core. As amostras colhidas foram submetidas a avaliação histológica. Resultados Para todos os casos, não havia um acesso direto seguro pela tomografia computadorizada para atingir o tumor pancreático sem atravessar órgãos e estruturas importantes. A injeção de ar foi capaz de deslocar as estruturas adjacentes e criar uma nova rota de acesso, permitindo um trajeto seguro da agulha coaxial até a lesão, e a biópsia foi realizada com sucesso em todos os casos. Todas as biópsias forneceram material suficiente para análise histológica. Conclusão Esta técnica é segura, barata e tecnicamente fácil, podendo auxiliar na realização de biópsias percutâneas de tumores pancreáticos guiadas por tomografia computadorizada de casos selecionados em que não existe acesso direto à lesão.

Objective To describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and Methods In the period from June 2011 to May 2012, seven computed tomography-guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results In all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible.

https://doi.org/10.1590/S0100-39842013000300006 6711 downloads

10.

Incidência e aspectos de imagem do linfoma pós-transplante hepático em crianças
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Bitencourt, Almir Galvão Vieira

; Pinto, Paula Nicole Vieira

; Almeida, Maria Fernanda Arruda

; Cerqueira, Wagner Santana

; Assis, André Moreira de

; Rodrigues, Adriana Michiko da Silva Tanaka

; Chojniak, Rubens

Radiologia Brasileira

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feb 2012, Volume 45 N. 1 Pages 7 - 11

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar a incidência e os aspectos de imagem do linfoma pós-transplante hepático em crianças. MATERIAIS E MÉTODOS: Foram revisados os prontuários e exames de imagem de crianças submetidas a transplante hepático entre 2000 e 2008 em uma única instituição. RESULTADOS: De 241 crianças submetidas a transplante hepático, com seguimento médio de 41,4 ± 26,4 meses, 16 (6,6%) tiveram linfoma. A média de idade no transplante hepático das crianças que desenvolveram linfoma foi inferior à das crianças que não desenvolveram (23,9 ± 18,9 vs. 38,0 ± 48,9 meses; p = 0,02). O tempo entre o transplante e o desenvolvimento do linfoma variou de 6 a 103 meses. A apresentação clínica e radiológica foi variável e a localização mais comum do tumor foi no abdome (n = 13; 81,3%), seguida de tórax e cabeça e pescoço (n = 4; 25,0% cada). Os achados de imagem incluíram: linfonodomegalias, massas mediastinais, pulmonares e mesentéricas, espessamento parietal de alças intestinais e nódulos hepáticos e renais. Quatro crianças (25,0%) faleceram devido a complicações do linfoma. CONCLUSÃO: Linfomas são complicações relativamente incomuns e potencialmente fatais que podem acontecer a qualquer momento após o transplante hepático em crianças, e que têm diversas apresentações clínicas e de imagem.

OBJECTIVE: To evaluate the incidence and imaging findings of lymphoma after liver transplantation in children. MATERIALS AND METHODS: The authors reviewed records and imaging studies of children submitted to liver transplantation in the period between 2000 and 2008 in a single institution. RESULTS: Among 241 children submitted to liver transplantation, with a mean follow-up period of 41.4 ± 26.4 months, 16 (6.6%) had lymphoma. The mean age of the patients who developed lymphoma at the moment of transplantation was lower than in children who did not develop malignancy (23.9 ± 18.9 versus 38.0 ± 48.9 months; p = 0.02). The time interval between liver transplantation and the diagnosis of lymphoma ranged from 6 to 103 months. Clinical and radiological presentation was variable and the abdomen was the most common location of the tumor (n = 13; 81.3%), followed by chest and head and neck (n = 4; 25.0% each). Imaging findings included adenopathy, mediastinal, pulmonary and mesenteric masses, bowel wall thickening and hepatic and renal nodules. Four children (25.0%) died because of complications of lymphoma. CONCLUSION: Lymphomas are relatively uncommon and potentially fatal complications that may occur any time after pediatric liver transplantation, presenting different clinical and imaging findings.

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