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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 por cento) 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 por cento), seguida de tórax e cabeça e pescoço (n = 4; 25,0 por cento 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 por cento) 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 percent) 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 percent), followed by chest and head and neck (n = 4; 25.0 percent each). Imaging findings included adenopathy, mediastinal, pulmonary and mesenteric masses, bowel wall thickening and hepatic and renal nodules. Four children (25.0 percent) 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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OBJECTIVES: To evaluate the impact of the inclusion of computed tomographic colonography (CTC) involving faecal tagging and no laxatives on the computed tomography (CT) study routinely used in staging patients with colorectal cancer. METHODS: CTC was performed on 25 patients who had a diagnosis of colorectal carcinoma, with pathological correlation. Researchers recorded the accuracy of the CTC for staging colorectal cancer, as well as any changes to the plans for surgery based on this exam. The patients' tolerance of the preparation required and the quality of the exams was also evaluated. RESULTS: All exams were well-tolerated, and only one had unsatisfactory quality. CTC identified all the carcinomas and had an overall accuracy of 80%, 60.1% and 100% for the evaluation of tumour depth, lymph nodes and metastases respectively. CTC identified all polyps greater than 9 mm. Following CTC, changes to surgical plans were observed in 20.8% of the cases, all with incomplete optical colonoscopies. CONCLUSIONS: CTC proved useful for the pre-operative evaluation of patients with a diagnosis of colorectal carcinoma, affecting plans for surgery in a expressive number of patients with an incomplete colonoscopy.

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Biópsia percutânea dirigida por tomografia computadorizada tem sido amplamente utilizada como um procedimento efetivo e seguro para obtenção de diagnóstico histológico em muitas situações clínicas e em diversos órgãos. No pulmão, a biópsia percutânea tornou-se uma das principais escolhas para investigação de nódulos e massas. Sua versatilidade permite o acesso de lesões nas diversas localizações do pulmão, podendo ser utilizada para lesões periféricas e profundas mesmo de pequenas dimensões. Discutiremos as indicações, os aspectos técnicos do procedimento e os índices esperados de sucesso e complicação das biópsias percutâneas de nódulos e massas pulmonares.

Computed tomography-guided needle biopsy has been widely utilized as an effective and safe diagnostic procedure in many clinical settings. In the lungs, transthoracic needle biopsy has become one of the primary choices to investigate nodules and mass lesions. The procedure versatility allows access to either peripheral or central lesions at almost any site, even in cases of small nodules. In this article, indications, technical aspects of the procedure, expected success and complication rates of computed tomography-guided transthoracic needle biopsy of pulmonary nodules and masses are discussed.

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OBJECTIVE: To report oncological cases (excluding those related to breast cancer) for which radioguided surgery has been used in combination with the Radioguided Occult Lesion Localization technique. INTRODUCTION: Radioguided surgery enables a surgeon to identify lesions or tissues that have been preoperatively marked with radioactive substances. The Radioguided Occult Lesion Localization technique has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. METHODOLOGY: In all cases, injection of Technecium-99m sulfur colloid was performed, directly inside or near by the suspicious lesion, guided by ultrasound or computed tomography, up to 36 hours prior to the surgical procedure. Intraoperative lesion detection was carried out using a gamma-probe. RESULTS: We report five oncology cases in which preoperative markings of the lesions were carried out using the Radioguided Occult Lesion Localization technique. The patients presented with the following: recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. CONCLUSIONS: Radioguided surgery has proven to be a safe and effective alternative for the management of oncology patients. The Radioguided Occult Lesion Localization technique can be useful in selected cases where suspect lesions may be difficult to identify intraoperatively, due to their dimensions or anatomical location. The procedure allows for more conservative excisions and reduces the surgery-related morbidity.

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OBJECTIVE: To report oncological cases (excluding those related to breast cancer) for which radioguided surgery has been used in combination with the Radioguided Occult Lesion Localization technique. INTRODUCTION: Radioguided surgery enables a surgeon to identify lesions or tissues that have been preoperatively marked with radioactive substances. The Radioguided Occult Lesion Localization technique has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. METHODOLOGY: In all cases, injection of Technecium-99m sulfur colloid was performed, directly inside or near by the suspicious lesion, guided by ultrasound or computed tomography, up to 36 hours prior to the surgical procedure. Intraoperative lesion detection was carried out using a gamma-probe. RESULTS: We report five oncology cases in which preoperative markings of the lesions were carried out using the Radioguided Occult Lesion Localization technique. The patients presented with the following: recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. CONCLUSIONS: Radioguided surgery has proven to be a safe and effective alternative for the management of oncology patients. The Radioguided Occult Lesion Localization technique can be useful in selected cases where suspect lesions may be difficult to identify intraoperatively, due to their dimensions or anatomical location. The procedure allows for more conservative excisions and reduces the surgery-related morbidity.

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Objetivo: O propósito desse estudo randomizado foi avaliar o efeito de três diferentes preparos. Casuística e Método: Os exames do abdome foram realizados no mesmo equipamento (Philip HDI 5000), por três radiologistas experientes, de forma prospectiva em 611 pacientes ambulatoriais, no Departamento de Imagem do Hospital do Câncer de São Paulo. Esses pacientes foram alocados em três grupos. No protocolo III os pacientes realizaram apenas jejum e receberam água. No protocolo II os pacientes receberam ainda adicionalmente medicação antifisética. E no protocolo I, os pacientes receberam ainda além de todas as recomendações dos grupos II e III e mais medicação laxativa. Resultados: Não houve diferença significativa entre a qualidade dos exames entre os pacientes com ou sem medicação (p=0,562). Houve melhora significativa na visualização da região mesogástrica nos pacientes do protocolo I (p=0,003). Nos protocolos II e III houve menor freqüência de efeitos colaterais (p=0,003). A obesidade e espessura aumentada da parede abdominal apresentaram impacto significativo na imagem (p<0,001). Conclusão: Em conclusão, esse estudo demonstrou que a visualização dos órgãos abdominais foi satisfatório mesmo nos pacientes que realizaram apenas o jejum e receberam água. Esse fato ilustra que o uso de medicação laxativa ou antifisética antes da ultrasonografia do abdome, se torna dispensável

Purpose: The aim of this study was to evaluate the effect of three different patient preparations. Patients and Methods: Sonograms of the abdomen were prospectively evaluated by three experient radiolgists in 611 ambulatory adult patients in Radiology Department of Cancer Hospital in Sao Paulo. They were randomly enrolled in three groups. In Protocol III patients fasted at least six hours, and received water, In Protocol II patients who received additional antifoaming agent, and Protocol I patients that received additional laxative medication. Results: No significant difference was found between the examinations quality from medicated and nomedicated patients (p=0,562). There was significant improvememt in visualization of the mesogastric region in Protocol I patients (P>0,003). On the other hand, larger frequency of side effects was reported in this group (p=0,003). The obesity and the abdominal wall thickness had significant impact on the image quality (p<0,001). Conclusion: In conclusion, this study has shown that visibility of abdominal organs were satisfactory in Protocol I (no-medicated patients), who fasted and received only water. It illustrates the fact that using laxative medication or antifoaming agent before abdominal ultrasound examinations is not necessary

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