IMAG - Comunicações e Conferências
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- Radiografia do tóraxPublication . Tereso, A
- Punção aspirativa com agulha fina de nódulos da tiróide: critérios ecográficos e interpretação dos resultadosPublication . Germano, A; Gasparinho, MG
- Abordagem multidisciplinar de lesão esplénica: um desafio diagnósticoPublication . Gomes, F; Schmitt, W; Branco, J; Aparício, D; Ferreira, M; Dutschmann, R
- Selection of colon cancer patients for neoadjuvant chemotherapy based on optimised preoperative MDCT A prospective multi-observer radiologic-pathologic agreement studyPublication . Rosado, E; Germano, A; Costa, A; Manso, RT; Gomes, A; Leichsenring, C; Santiago, IPURPOSE: Neoadjuvant chemotherapy (NACT) in potencially-resectable locally advanced colon cancer (LACC) is likely to prove superiority compared to standard treatment in the phase III FOXTROT Collaborative Group Trial. Thus, identification of LACC, defined as T3≥5 mm or T4, is fundamental and requires accurate noninvasive imaging. The value of optimized preoperative MDCT for that purpose is being assessed. METHODS AND MATERIALS: Observational, cross-sectional, prospective study including all patients with colon cancer refered to our Institution´s Radiology Department for preoperative staging between the 1st of October 2013 and the 6th of August 2014. Independent reading of optimized MDCT acquisitions using MPR was performed by 4 radiologists (3.6,15 and 20 years of experience in gastrointestinal imaging). Extramural tumour extension was graded as < 5 mm; ≥5 mm; invasion of peritoneum/fascia/adjacent organ. Surgical specimen analysis was performed by a single pathologist with 12 years of experience in gastrointestinal pathology. Radiologic-Pathologic agreement was assessed. RESULTS: 48 patients, 26 males and 22 females, with a median age of 74 years (min:45;max:89) were considered eligible. Median time to surgery was 30.5 days (min:1;max:117). Diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MDCT for the identification of LACC ranged between 0.64 and 0.82; 0.84 and 0.92; 0.5 and 0.7; 0.88 and 0.97; 0.75 and 0.88; respectively. Mean agreement between observers was 0.88 (SD:0.17) per patient. CONCLUSION: Preliminary results suggest that optimized MDCT is a specific, accurate and reproducible method for the selection of colon cancer patients who may benefit from NACT, with minimal risk of overtreatment of low-risk patients.
- Perturbación del drenaje venoso del territorio del tronco venoso braquiocefálico y ojo rojo en enfermo con insuficiencia renal crónica en hemodiálisisPublication . Coutinho, I; Santos, C; Penha, D; Ferreira, M; Madeira, C; Bernardo, MIntroducción: Pacientes en diálisis son más susceptibles a colocación de catéteres venosos centrales y en consecuencia la estenosis de vena central secundaria. Se relata un caso de un paciente en hemodiálisis con ojos rojos, que ha condicionado un diagnóstico diferencial con patologías que causan ojos rojos. Caso clínico: Hombre, 60 años, raza negra, con antecedentes de hipertensión y insuficiencia renal de etiología nefroesclerotica, en hemodiálisis desde hace 20 años. Historial de hiperemia conjuntival con 2 meses de evolución, asociado a un ligero malestar ocular. Negaba otras quejas oftalmológicas. Fue referenciado para consulta de oftalmología con un probable diagnóstico de epiescleritis. En el examen objetivo se ha observado edema de párpado y de la hemicara izquierda, asociado a ingurgitación de la vena yugular externa. Exoftalmia ligera del globo ocular izquierdo. Movimientos oculares conservados, no dolorosos y sin diplopía. Presión intraocular de 18mmHg en el ojo derecho y de 23mmHg en el izquierdo. Tortuosidad y ingurgitación de los vasos episclerales a la izquierda. Oftalmoscopia sin alteraciones. En relación a los exámenes complementarios de diagnóstico, Tomografía Axial Computarizada de cráneo y orbitas sin alteraciones. La ecografía doppler de los vasos del cuello mostró una vena yugular externa arterializada. La angiografía ha revelado estenosis del tronco venoso braquiocefálico y la vena subclavia izquierda. Realizó venoplastia con balón, verificándose mejoría del cuadro clínico. Conclusión: La obstrucción del drenaje venoso del globo ocular y órbita puede simular causas de ojo rojo y se debe siempre poner en duda en la presencia de exoftalmia, tortuosidad y dilatación de los vasos episclerales y en la subida de la presión intraocular. Esto caso reporta un caso estenosis de vena central, en que ojo rojo y edema facial eran las principiáis quejas, en un paciente en hemodiálisis con historia de catéter en la vena subclavia y en la vena yugular interna izquierda por trombosis de las fistulas arteriovenosas
- Radiação ionizante: efeitos biológicosPublication . Schmitt, W; Germano, A; Aleluia, C
- Cystic lesions of the liverPublication . Rosado, E; Pereira, J; Bouchaibi, S; Bali, MLEARNING OBJECTIVES: To present the CT and MRI features of the cystic liver lesions, with emphasis on the differential diagnosis. BACKGROUND: Cystic liver lesions are a frequent finding in abdominal imaging and may represent a broad spectrum of entities, ranging from benign developmental cysts to malignant neoplasms. Radiological features of various cystic liver lesions frequently overlap. Therefore, it is necessary to integrate imaging with clinical and laboratorial findings. The most important clinical parameters include age, clinical history and symptoms. Still, a histologic diagnosis is often required. Fine needle aspiration biopsy under image guidance is the preferred diagnostic method. It can be performed percutaneously or endoscopically providing adequate tissue samples. IMAGING FINDINGS: The appearance of the cystic lesion at CT and MRI, concerning the size, the thickness of the wall, the presence or absence of septa, calcifications or internal nodules and the enhancing patterns allows the classification of the lesion as probably benign or malignant and, in most cases, a specific diagnosis can be suggested. Liver lesions with typical imaging features include simple cysts, autosomal dominant polycystic liver disease, biliary hamartomas, Caroli disease, cavernous hemangiomas, peribiliary cysts in cirrhotic patients, biliary cystadenoma and cystadenocarcinoma, cystic subtypes of hepatocellular carcinoma, cystic metastasis, pyogenic and amebic abscesses, hydatid cysts, extra-hepatic pseudocyst and intrahepatic biloma and hematoma. CONCLUSION: Cystic lesions of the liver are common findings. Imaging features together with clinical and laboratorial findings allow an accurate diagnosis and appropriate patient management. FNA is sometimes needed for definitive diagnosis.
- Sickle cell anemia: a review of the imaging findingsPublication . Rosado, E; Paixão, P; Schmitt, W; Penha, D; Carvalho, F; Tavares, ASickle cell anemia - a review of the imaging findings LEARNING OBJECTIVES: To review and describe the manifestations of sickle cell anemia, focusing on the typical imaging findings in the most frequent affected organs. BACKGROUND: Sickle cell anemia is an autosomal recessive genetic condition characterized by a defective form of hemoglobin (hemoglobin S), which promotes the aggregation and distortion of red blood cells. Anemia results from the rapid removal of the abnormal red blood cells by the reticuloendothelial system. Another consequence of the presence of abnormal circulating cells is the obstruction of microcirculation, producing ischemia and infarction. Infarcts are common in several organs and they are responsible for most clinical and radiological manifestations. IMAGING FINDINGS: Sickle cell anemia can affect several organs. The lungs are frequently involved, with infarcts, emboli and increased propensity to pneumonia. Bone infarcts are also common causing acute pain crisis. Osteomyelitis is a frequent complication and its diagnosis can be challenging. In the brain, infarcts occur at young ages, causing cognitive impairment and neurologic deficits. Splenic infarcts progress over time to autosplenectomy. An important splenic complication is the sequestration syndrome, which may be life-threatening. Liver and kidneys may experience infarction as well. Pigmented biliary stones are also a very common finding due to hemolysis. CONCLUSION: In patients with sickle cell anemia, most relevant clinical and radiological manifestations are caused by ischemic complications. Lungs, bones, brain, kidneys, liver and spleen are among the most affected organs, with important clinical consequences. We have reviewed the imaging appearances of those lesions and correlated it to the physiopathology and clinical manifestations of the disease.