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PURPOSE: Neoadjuvant chemotherapy has recently become the standard of care for borderline resectable pancreatic ductal adenocarcinoma (PDAC), and there have even been numerous reports evaluating its potential benefits in resectable PDAC. However, neoadjuvant therapy first requires a histological or cytological diagnosis. This study aimed to analyze the safety and diagnostic yield of CT-guided core needle biopsy (CNB). MATERIAL AND METHODS: A retrospective analysis of patients with pancreatic tumor requiring a CNB during the period 2015 to 2023 were included. Biopsies were performed with an 18-20 G Tru-Core needle using a coaxial system and automatic biopsy gun. Demographics, procedural variables, postoperative outcomes, and histological results were analyzed. RESULTS: A total of 43 pancreatic biopsies were performed in 42 patients. The mean age was 60 years (35 to 81 y), and 24 (56%) were males. Tumors were more frequently localized in the head (42%) and body (42%) of the pancreas. The mean size of the pancreatic lesions was 53.77 mm (17 to 181 mm) and the mean number of samples per biopsy was 4 (1 to 12). Most procedures were performed via direct access (81%). No major complications were observed. Histological diagnosis was obtained in 40 (93%) patients, with a sensitivity of 93%, specificity of 100% and an overall accuracy rate of 93%. The probability of performing a molecular diagnostic test increased with the year of biopsy (OR 3.34, 95% CI 1.33-8.40, P=0.01). CONCLUSIONS: CNB is an efficient and safe method for obtaining high-quality material. This approach could be essential as molecular profiling continues to improve the diagnosis, prognosis, and treatment of PDAC.
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PURPOSE: Rectum sheath hematoma (RSH) is a rare and often misdiagnosed disease. We aimed to determine outcomes of patients affected by RSH and identify variables associated with the need of prompt intervention. METHODS: Patients diagnosed with RSH during the period 2012-2020 were retrospectively identified. Demographics, diagnostic, and therapeutic variables were evaluated. RSH was classified with computed tomography (CT) according to the Berna system. An artificial neural network (ANN) model including 12 variables was used to identify patients that might require a prompt endovascular or surgical treatment. RESULTS: A total of 20 patients were included for analysis; mean age was 69 (35-98) years and 14 (70%) were females. Iatrogenic injury and forceful contraction of the abdominal wall were the leading causes of RSH. Eleven (55%) patients were anticoagulated or antiaggregated. There were 3 (15%) grade 1, 5 (25%) grade 2, and 12 (60%) grade 3 RSH; 6 (30%) were treated conservatively, 10 (50%) with artery embolization, and 4 (20%) with surgery. Overall morbidity was 45% and there was no mortality in the series. According to the ANN, patients at high risk of requiring an invasive treatment were those with active extravasation on CT angiography, Berna grade III, age ≥ 65 years, hemodynamic instability, chronic use of corticosteroids, hematoma volume ≥ 1000 mL, and/or transfusion of ≥ 4 units of red blood cells. CONCLUSION: Conservative treatment might be effective in selected patients with RSH. Our artificial neural network analysis might help selecting patients who require endovascular or surgical treatment.
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Anticoagulantes , Reto do Abdome , Idoso , Anticoagulantes/uso terapêutico , Feminino , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Redes Neurais de Computação , Reto do Abdome/diagnóstico por imagem , Estudos RetrospectivosRESUMO
BACKGROUND: The objective of this study was to explore the usefulness of virtual models and three-dimensional (3D) printing technologies for planning complex non-congenital cardiovascular surgery. METHODS: Between July 2018 and December 2019, adult patients with different cardiovascular structural diseases were included in a clinical protocol to explore the usefulness of Standard Tessellation Language (STL)-based virtual models and 3D printing for prospectively planning surgery. A qualitative descriptive analysis from the surgeon's viewpoint was done based on the characteristics, advantages and usefulness of 3D models for guiding, planning and simulating the surgical procedures. RESULTS: A total of 14 custom 3D-printed heart and great vessel replicas with their corresponding 3D virtual models were created for preoperative surgical planning. Six of 14 models helped to redefine the surgical approach, 3 were useful to verify device delivery, while the rest did not change the surgical decision. In all open surgery cases, cardiac and vascular anatomy accuracy of virtual and physical 3D replicas was validated by direct visualisation of the organs during surgery. Printing was achieved through an external provider associated with the Hospital, who printed the final prototype in 5-7 days. Printed production cost was between 100 and 500 USD per model. CONCLUSIONS: In the current study, the selected 3D printed models presented different advantages (visual, tactile, and instrumental) over the traditional flat anatomical images when simulating and planning some complex types of surgery. Notwithstanding 3D printing advantages, STL-based virtual models were pre-printing useful tools when instrumentation on a physical replica was not required.
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Imageamento Tridimensional , Impressão Tridimensional , Adulto , Coração , HumanosRESUMO
Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.
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Cateterismo Venoso Central/métodos , Doença de Crohn/tratamento farmacológico , Oclusão de Enxerto Vascular/prevenção & controle , Fígado/irrigação sanguínea , Angioplastia com Balão , Cateteres de Demora , Meios de Contraste , Embolização Terapêutica/métodos , Feminino , Oclusão de Enxerto Vascular/diagnóstico , Humanos , Pescoço , Punções , Radiografia Intervencionista , Ultrassonografia de Intervenção , Adulto JovemRESUMO
Propósito: Describir los hallazgos radiológicos distintivos en resonancia magnética de las espondilodiscitis fúngicas (Candida albicans) y su importancia en el diagnóstico temprano de estas entidades. Se reporta el caso de un paciente masculino de 51 años de edad, inmunocomprometido, que consulta por fiebre y dolor lumbar. La RM con gadolinio demostró en secuencias T2 hipointensidad de la médula ósea en los cuerpos vertebrales afectados, asociados a cambios en la señal discal y realce intenso discovertebral. Ante un paciente inmunocomprometido con dolor lumbar que presenta modificaciones disco vertebrales atípicas en la resonancia magnética, debe considerarse la infección micótica dentro de las posibilidades diagnósticas. El diagnóstico de certeza requiere la toma de biopsia del tejido afectado mediante punción aspiración y posterior análisis microbiológico. El tratamiento médico es el de elección, aunque en algunos casos se plantea el drenaje quirúrgico. El reconocimiento de las características radiológicas distintivas evita retardos en el diagnóstico y el tratamiento.
Purpose: To describe Candida albicans spondylodiscitis distinctive imaging findings and treatment. The authors reported a 51 years old, male inmunocompromised patient with fever and lumbar pain. MR findings include bone marrow hypointense signal intensity in T2 weighted of affected vertebral bodies and intense discovertebral enhancement. Candida albicans spondylodiscitis should be considered as one of the differential diagnosis of an inmunocompromised patient with lumbar pain and lumbar atypical findings at MR. Biopsy sample is required in order to reach final diagnosis. The first choice treatment is antyfungal drugs although in certain cases surgery is required. Rapid recognition of distinctive imaging findings avoid missdiagnosis and treatment delays.
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Propósito: Realizar una revisión del síndrome de leucoencefalopatía posterior reversible, destacando los hallazgos imagenológicos atípicos del mismo. Materiales y métodos: Se estudiaron retrospectivamente 10 casos (n=10), 6 mujeres y 4 varones con edades comprendidas entre 7 y 84 años (media 40.6 años), con un tomógrafo multicorte (Sistemens Sensation 16, Erlangen, Germany) y dos resonadores (Magnetom Symphony 1.5T y Magnetom Impact 1T) entre octubre del año 2000 y mayo del 2007. Resultados: En nuestra casuística, el 40% (n=4) de los pacientes presentó edema citotóxico (hiperintensidad en Difusión); el 70% (n=7), compromiso del circuito anterior; el 29% (n=2) presentó sangrado, y el 10% (n=1), afectación del tronco del encéfalo. Conclusión: En la mayoría de los pacientes con diagnóstico de leucoencefalopatía posterior reversible se evidencia señal hiperintensa en secuencias T2 y FLAIR en la sustancia blanca de lóbulos occipitales y parietales, sin representación en la secuencia de difusión. Sin embargo, puede afectar otros territorios, presentar edema citotóxico, hemorragia y no ser reversible. Estos hallazgos atípicos conllevan un peor pronóstico y por ende una mayor mortalidad. Un adecuado análisis de las imágenes es importante para confirmar la sospecha clínica y establecer una terapéutica precoz.
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Encefalopatia Hipertensiva/diagnóstico , Encefalopatia Hipertensiva/etiologia , Síndrome da Leucoencefalopatia Posterior , Diagnóstico por Imagem , Espectroscopia de Ressonância Magnética/instrumentaçãoRESUMO
Percutaneous pediculoplasty is a vertebroplasty-complementary technique that can be carried out with one needle for each single approach. This report describes five cases of osteoporotic vertebral and pedicular compression fractures that were treated with percutaneous vertebroplasty and bilateral pediculoplasty with use of polymethylmethacrylate and high-quality fluoroscopic guidance. All patients reported complete pain relief. This is a safe, fast, and effective treatment for osteoporotic compression fractures with pedicle compromise.
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Fraturas por Compressão/cirurgia , Vértebras Lombares/cirurgia , Osteoporose/complicações , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos , Terapia Combinada , Feminino , Seguimentos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Polimetil Metacrilato/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
La paniculitis lúpica (PL) es una entidad benigna. Según nuestra investigación, la PL no ha sido comunicada en la literatura radiológica. A diferencia de artículos previos que no han sido enfocados en métodos de diagnóstico por imágenes, nuestro objetivo es describir los hallazgos imagenológicos. TC y RM permiten demostrar la lipoatrofia y las áreas de actividad inflamatoria en el tejido subcutáneo
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Humanos , Feminino , Adulto , Paniculite de Lúpus Eritematoso , Espectroscopia de Ressonância Magnética , Imageamento por Ressonância Magnética , Paniculite de Lúpus EritematosoRESUMO
La paniculitis lúpica (PL) es una entidad benigna. Según nuestra investigación, la PL no ha sido comunicada en la literatura radiológica. A diferencia de artículos previos que no han sido enfocados en métodos de diagnóstico por imágenes, nuestro objetivo es describir los hallazgos imagenológicos. TC y RM permiten demostrar la lipoatrofia y las áreas de actividad inflamatoria en el tejido subcutáneo (AU)
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Humanos , Feminino , Adulto , Paniculite de Lúpus Eritematoso/diagnóstico , Paniculite de Lúpus Eritematoso/epidemiologia , Paniculite de Lúpus Eritematoso/patologia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética/diagnósticoRESUMO
Propósito: valorar el potencial de medición de la intensidad de la señal postgadolinio en tiempos tardíos, por medio de curvas graficadas para diagnosticar adenomas versus no adenomas suprarrenales y compararlo con técnicas de Desplazamiento Químico con Resonancia Magnética (RM) y Tomografía Computada (TC) sin y con contraste endovenoso en tiempos tardíos. Material y métodos: nueve masas adrenales fueron evaluadas con TC sin y con contraste endovenoso en tiempos tardíos, RM con técnica de Desplazamiento Químico y Scan Dinámico con tiempos de 5, 15 y 30 minutos o más, con graficación de curvas. Las imágenes en fase fueron comparadas con la fase opuesta. Resultados: los adenomas mostraron caída de la curva a los 30 minutos de la inyección del contraste. Los no adenomas mantuvieron dicha curva en ascenso. Conclusión: las masas adrenales pueden caracterizarse como adenomas o no adenomas con RM contrastada en tiempos tardíos y se constituyen en variante diagnóstica complementaria
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Neoplasias das Glândulas Suprarrenais , Adenoma Adrenocortical , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Gadolínio DTPARESUMO
Propósito: valorar el potencial de medición de la intensidad de la señal postgadolinio en tiempos tardíos, por medio de curvas graficadas para diagnosticar adenomas versus no adenomas suprarrenales y compararlo con técnicas de Desplazamiento Químico con Resonancia Magnética (RM) y Tomografía Computada (TC) sin y con contraste endovenoso en tiempos tardíos. Material y métodos: nueve masas adrenales fueron evaluadas con TC sin y con contraste endovenoso en tiempos tardíos, RM con técnica de Desplazamiento Químico y Scan Dinámico con tiempos de 5, 15 y 30 minutos o más, con graficación de curvas. Las imágenes en fase fueron comparadas con la fase opuesta. Resultados: los adenomas mostraron caída de la curva a los 30 minutos de la inyección del contraste. Los no adenomas mantuvieron dicha curva en ascenso. Conclusión: las masas adrenales pueden caracterizarse como adenomas o no adenomas con RM contrastada en tiempos tardíos y se constituyen en variante diagnóstica complementaria (AU)