ABSTRACT
Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.
ABSTRACT
Resumo Objetivo: Avaliar o desempenho diagnóstico da biópsia pulmonar percutânea transtorácica (BPPT) guiada por fluoroscopia associada a tomografia computadorizada (FTC) em nódulos pulmonares ≤ 10 mm no período de pandemia de COVID-19. Materiais e Métodos: No período de 1º de janeiro de 2020 a 30 de abril de 2022, 359 BPPTs guiadas por FTC foram realizadas em um centro terciário de radiologia intervencionista. As lesões pulmonares mediam entre 2 mm e 108 mm. Dessas 359 BPPTs, 27 (7,5%) foram realizadas com agulha 18G em nódulos de 2 mm a 10 mm. Resultados: Das 27 BPPTs realizadas nos nódulos ≤ 10 mm, quatro lesões tinham dimensões menores que 5 mm e 23 lesões mediam entre 5 e 10 mm. Sensibilidade e acurácia diagnóstica das BPPTs guiadas por FTC foram de 100% e 92,3%, respectivamente. A dose média de radiação ionizante para os pacientes durante o procedimento de BPPT guiada por FTC foi de 581,33 mGy*cm, variando de 303 a 1129 mGy*cm. A média de tempo dos procedimentos de biópsia foi de 6,6 minutos, variando de 2 a 12 minutos. Nas 27 BPPTs, nenhuma complicação maior foi descrita. Conclusão: A BBPT guiada por FTC resultou em alto rendimento diagnóstico e baixas taxas de complicações.
Abstract Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.
ABSTRACT
The lungs have great importance in patients with paracoccidioidomycosis since they are the portal of entry for the infecting fungi, the site of quiescent foci, and one of the most frequently affected organs. Although they have been the subject of many studies with different approaches, the severity classification of the pulmonary involvement, using imaging procedures, has not been carried out yet. This study aimed to classify the active and the residual pulmonary damage using radiographic and tomographic evaluations, according to the area involved and types of lesions.
ABSTRACT
The image-guided gastrostomy techniques, as transoral and transabdominal, can be performed when there is a failure of the endoscopic procedure or in some specific clinical scenarios. This pictorial essay intends to show the percutaneous gastrostomy techniques, indications, technical approaches, post-procedure care, and complications.
As técnicas de gastrostomia guiadas por imagem, por via transoral e transabdominal podem ser realizadas quando há falha na técnica endoscópica ou em cenários clínicos em que a endoscopia não pode ser realizada. Este ensaio iconográfico pretende mostrar as técnicas de gastrostomia percutânea, suas indicações, aspectos técnicos, cuidados pós-procedimento e complicações.
ABSTRACT
The differential diagnosis between benign and malignant biliary strictures is challenging and requires a multidisciplinary approach with the use of serum biomarkers, imaging techniques, and several modalities of endoscopic or percutaneous tissue sampling. The diagnosis of biliary strictures consists of laboratory markers, and invasive and non-invasive imaging examinations such as computed tomography (CT), contrast-enhanced magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (EUS). Nevertheless, invasive imaging modalities combined with tissue sampling are usually required to confirm the diagnosis of suspected malignant biliary strictures, while pathological diagnosis is mandatory to decide the optimal therapeutic strategy. Although EUS-guided fine-needle aspiration biopsy is currently the standard procedure for tissue sampling of solid pancreatic mass lesions, its diagnostic value in intraductal infiltrating type of cholangiocarcinoma remains limited. Moreover, the "endobiliary approach" using novel slim biopsy forceps, transpapillary and percutaneous cholangioscopy, and intraductal ultrasound-guided biopsy, is gaining ground on traditional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography endobiliary forceps biopsy. This review focuses on the available endobiliary techniques currently used to perform biliary strictures biopsy, comparing the diagnostic performance of endoscopic and percutaneous approaches.
ABSTRACT
Resumo As técnicas de gastrostomia guiadas por imagem, por via transoral e transabdominal podem ser realizadas quando há falha na técnica endoscópica ou em cenários clínicos em que a endoscopia não pode ser realizada. Este ensaio iconográfico pretende mostrar as técnicas de gastrostomia percutânea, suas indicações, aspectos técnicos, cuidados pós-procedimento e complicações.
Abstract The image-guided gastrostomy techniques, as transoral and transabdominal, can be performed when there is a failure of the endoscopic procedure or in some specific clinical scenarios. This pictorial essay intends to show the percutaneous gastrostomy techniques, indications, technical approaches, post-procedure care, and complications.
ABSTRACT
Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication-a small dehiscence of the anastomosis-which extended the catheter dwell time. Minor complications occurred in two cases-one small perihepatic hematoma and one segmental thrombosis of the left portal branch-neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.
Objetivo: Descrever o procedimento, avaliar a viabilidade e perviedade em longo prazo da dilatação biliar trans-hepática percutânea usando a técnica de dilatação por balão superdimensionado para o tratamento em uma única etapa de estenose biliar anastomótica benigna após cirurgia hepatobiliar. Materiais e Métodos: Este estudo retrospectivo de dois centros incluiu 16 casos consecutivos de estenoses bilioentéricas benignas sintomáticas. A dilatação das estenoses com superdimensionamento do balão de 40-50% foi realizada após avaliação pré-procedimento do diâmetro do ducto biliar por tomografia computadorizada ou ressonância magnética e um dreno externo foi colocado. Os sintomas clínicos e exames laboratoriais foram avaliados a cada três meses após a remoção do dreno, enquanto o acompanhamento radiológico foi realizado com ressonância magnética em 30 dias e tomografia computadorizada em 6 e 12 meses. Resultados: O tempo médio de seguimento foi de 31,8 ± 8,15 meses. As estimativas de perviedade em um, dois e três anos foram 88,2%, 82,4% e 82,4%; respectivamente. Houve uma complicação importante, com pequena deiscência da anastomose biliodigestiva, que exigiu prolongamento do tempo de permanência do dreno externo. Complicações menores ocorreram em dois casos, um pequeno hematoma peri-hepático e uma trombose segmentar do ramo portal esquerdo e nenhum deles necessitou de intervenção adicional. Conclusão: A técnica de dilatação com balão superdimensionado para o tratamento de estenoses biliares anastomóticas benignas foi viável para o tratamento de estenoses anastomóticas bilioentéricas benignas. A técnica parece estar associada a altas taxas de perviedade e de sucesso clínico no longo prazo.
ABSTRACT
Abstract Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication—a small dehiscence of the anastomosis—which extended the catheter dwell time. Minor complications occurred in two cases—one small perihepatic hematoma and one segmental thrombosis of the left portal branch—neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.
Resumo Objetivo: Descrever o procedimento, avaliar a viabilidade e perviedade em longo prazo da dilatação biliar trans-hepática percutânea usando a técnica de dilatação por balão superdimensionado para o tratamento em uma única etapa de estenose biliar anastomótica benigna após cirurgia hepatobiliar. Materiais e Métodos: Este estudo retrospectivo de dois centros incluiu 16 casos consecutivos de estenoses bilioentéricas benignas sintomáticas. A dilatação das estenoses com superdimensionamento do balão de 40-50% foi realizada após avaliação pré-procedimento do diâmetro do ducto biliar por tomografia computadorizada ou ressonância magnética e um dreno externo foi colocado. Os sintomas clínicos e exames laboratoriais foram avaliados a cada três meses após a remoção do dreno, enquanto o acompanhamento radiológico foi realizado com ressonância magnética em 30 dias e tomografia computadorizada em 6 e 12 meses. Resultados: O tempo médio de seguimento foi de 31,8 ± 8,15 meses. As estimativas de perviedade em um, dois e três anos foram 88,2%, 82,4% e 82,4%; respectivamente. Houve uma complicação importante, com pequena deiscência da anastomose biliodigestiva, que exigiu prolongamento do tempo de permanência do dreno externo. Complicações menores ocorreram em dois casos, um pequeno hematoma peri-hepático e uma trombose segmentar do ramo portal esquerdo e nenhum deles necessitou de intervenção adicional. Conclusão: A técnica de dilatação com balão superdimensionado para o tratamento de estenoses biliares anastomóticas benignas foi viável para o tratamento de estenoses anastomóticas bilioentéricas benignas. A técnica parece estar associada a altas taxas de perviedade e de sucesso clínico no longo prazo.
ABSTRACT
The lungs have great importance in patients with paracoccidioidomycosis since they are the portal of entry for the infecting fungi, the site of quiescent foci, and one of the most frequently affected organs. Although they have been the subject of many studies with different approaches, the severity classification of the pulmonary involvement, using imaging procedures, has not been carried out yet. This study aimed to classify the active and the residual pulmonary damage using radiographic and tomographic evaluations, according to the area involved and types of lesions.
Subject(s)
Humans , Paracoccidioidomycosis/diagnostic imaging , Severity of Illness Index , Lung/microbiology , Lung Diseases/microbiology , Radiography, Thoracic , TomographyABSTRACT
Objetivos: Descrever o conhecimento sobre exposição à radiação ionizante de uma população não-médica e avaliar as relações entre a compreensão sobre esses conceitos e os riscos subsequentes. Material e Métodos: A pesquisa se constituiu em onze perguntas, e avaliou o conhecimento sobre quais exames utilizam radiação ionizante, exposição à radiação a partir de imagens médicas e malignidades subsequentes induzidas por radiação. Dados sociodemográficos também foram coletados. Resultados: 88 respostas foram obtidas. 84% dos pacientes possuíam curso superior completo e 98% já havia realizado algum tipo de exame de imagem na vida. Sobre quais métodos acham que utilizam radiação ionizante: 73% responderam ressonância magnética e 21% ultrassonografia. Quando foi comprado a TC com radiografia de tórax, apenas 11% indicaram que a TC tem 100 vezes a quantidade de radiação e maioria (23%) responderam que tem pouco menos. Em relação à ressonância magnética, quando questionados a quantidade de radiação que uma RM de abdome tem em comparação com uma TC de abdome, a maioria dos participantes (28%) respondeu a mesma quantidade. Sobre o conhecimento da indução de malignidade por radiação, 36% expressaram discordância, sem certeza, com a afirmação verdadeira "pessoa que faz 3-5 TCs tem um risco maior de desenvolver câncer ao longo da vida" e 20% discordaram totalmente. Conclusão: Os participantes do estudo não demonstraram uma compreensão sobre quais exames utilizam radiação ionizante, a dose de radiação e o risco associado às imagens de TC. Além disso, eles não entendiam que a ressonância magnética e a ultrassonografia não os expõem à radiação ionizante. O fato de possuírem ensino superior completo não demonstrou melhorar a compreensão dos conceitos sobre radiação. [au]
Objectives: To describe the knowledge of ionizing radiation exposure in a non-medical population and evaluate the relationship between the understanding of these concepts and the subsequent risks. Materials and Methods: The survey consisted in eleven questions, and assessed knowledge about which tests use ionizing radiation, radiation exposure from medical imaging, and subsequent radiation-induced malignancies. Sociodemographic data were also collected. Results: 88 responses were obtained. 84% of patients had completed higher education and 98% had already undergone some type of imaging exam in their lifetime. About which methods they think use ionizing radiation: 73% responded MRI and 21% ultrasonography. When chest X-ray was compared with CT, only 11% indicated that CT had 100 times the amount of radiation and the majority (23%) responded that it had a little less. Regarding MRI, when asked the amount of radiation that an MRI of abdomen has compared to a CT of abdomen, most participants (28%) responded the same amount. About the knowledge of radiation induction of malignancy, 36% expressed disagreement, without certainty, with the true statement "person who undergoes 3-5 CTs has a higher risk of developing cancer throughout life" and 20% totally disagreed. Conclusion: Study participants did not demonstrate an understanding of which tests use ionizing radiation, the radiation dose, and the risk associated with CT imaging. In addition, they did not understand that MRI and ultrasonography does not expose them to ionizing radiation. The fact of having completed higher education has not been shown to improve understanding of radiation concepts. [au]
ABSTRACT
OBJECTIVE: To present our clinical experience with percutaneous antegrade ureteral stenting. MATERIALS AND METHODS: This was a single-center retrospective study in which we reviewed the electronic medical records of patients who underwent percutaneous image-guided antegrade ureteral stenting between January 2016 and August 2020. We evaluated 90 patients (48 men). The mean age was 61.4 ± 15 years (range, 30-94 years). Patients were divided into two main groups: those with malignant neoplasms; and those with non-neoplastic disease. Technical and clinical success of the procedure were defined, respectively, as maintenance of the patency of the urinary tract, with a reduction in the degree of hydronephrosis, and as a reduction in the level of nitrogenous waste. Postprocedural complications were categorized as major or minor according to the CIRSE classification. RESULTS: The study sample comprised 150 antegrade stenting procedures performed in 90 patients, most of whom had previously undergone retrograde stenting that was unsuccessful. The stenting was bilateral in 60 patients and unilateral in 30. Technical success was achieved in 143 (95.3%) of the procedures, whereas seven procedures (4.6%) were unsuccessful. Failed procedures were characterized by inability to place a stent or migration of a stent after its placement. Complications occurred in 12 (8.0%) of the procedures. Of those 12 complications, two were classified as major (bleeding) and 10 were classified as minor (lumbar pain or infection). The most common techniques used were the over-the-wire technique and the modified technique (in 58.0% and 42.0% of the cases, respectively). In seven cases (4.7%), a nephrostomy tube was inserted. CONCLUSION: Percutaneous antegrade ureteral stenting is a safe, effective method for the management of ureteral injuries and obstructions, due to malignant or benign causes, when the retrograde approach has failed.
OBJETIVO: Apresentar os resultados clínicos de 150 casos de inserção anterógrada de cateter duplo J.Materiais e Métodos: Foram revisados os prontuários eletrônicos de pacientes submetidos a inserção percutânea de cateter duplo J guiada por imagem entre janeiro de 2016 e agosto de 2020. Um total de 90 pacientes (48 homens e 42 mulheres; faixa etária, 30-94 anos; idade média, 61,4 ± 15 anos) foi incluído no estudo. Os pacientes foram classificados em dois grupos principais: neoplasia maligna e doença não neoplásica. O sucesso técnico e clínico do procedimento foi definido como a manutenção da perviedade da via urinária com redução do grau de hidronefrose e redução dos níveis das escórias nitrogenadas. As complicações pós-procedimento foram classificadas em maiores e menores, de acordo com o sistema de classificação CIRSE. RESULTADOS: Foram realizados 150 procedimentos (90 pacientes) no período, sendo bilateral em 60 pacientes e unilateral em 30. Houve sucesso técnico em 143 casos (95,3%) e falhas em sete (4,7%), caracterizadas por migração e não progressão do cateter. Nossas taxas de complicações foram de 8,0% (12 casos), sendo dois maiores (sangramento) e 10 menores (principalmente dor lombar). As técnicas mais utilizadas para a inserção foram over the wire (58,0%) e modificada (42,0%). Em sete pacientes (4,7%) foi realizada nefrostomia percutânea. CONCLUSÃO: A inserção anterógrada do cateter duplo J é um método seguro e eficaz para o tratamento de obstruções uretéricas devidas a causas e lesões malignas e benignas, quando há uma falha na abordagem cistoscópica (retrógrada).
ABSTRACT
Abstract Objective: To present our clinical experience with percutaneous antegrade ureteral stenting. Materials and Methods This was a single-center retrospective study in which we reviewed the electronic medical records of patients who underwent percutaneous image-guided antegrade ureteral stenting between January 2016 and August 2020. We evaluated 90 patients (48 men). The mean age was 61.4 ± 15 years (range, 30-94 years). Patients were divided into two main groups: those with malignant neoplasms; and those with non-neoplastic disease. Technical and clinical success of the procedure were defined, respectively, as maintenance of the patency of the urinary tract, with a reduction in the degree of hydronephrosis, and as a reduction in the level of nitrogenous waste. Postprocedural complications were categorized as major or minor according to the CIRSE classification. Results: The study sample comprised 150 antegrade stenting procedures performed in 90 patients, most of whom had previously undergone retrograde stenting that was unsuccessful. The stenting was bilateral in 60 patients and unilateral in 30. Technical success was achieved in 143 (95.3%) of the procedures, whereas seven procedures (4.6%) were unsuccessful. Failed procedures were characterized by inability to place a stent or migration of a stent after its placement. Complications occurred in 12 (8.0%) of the procedures. Of those 12 complications, two were classified as major (bleeding) and 10 were classified as minor (lumbar pain or infection). The most common techniques used were the over-the-wire technique and the modified technique (in 58.0% and 42.0% of the cases, respectively). In seven cases (4.7%), a nephrostomy tube was inserted. Conclusion: Percutaneous antegrade ureteral stenting is a safe, effective method for the management of ureteral injuries and obstructions, due to malignant or benign causes, when the retrograde approach has failed.
Resumo Objetivo: Apresentar os resultados clínicos de 150 casos de inserção anterógrada de cateter duplo J. Materiais e Métodos: Foram revisados os prontuários eletrônicos de pacientes submetidos a inserção percutânea de cateter duplo J guiada por imagem entre janeiro de 2016 e agosto de 2020. Um total de 90 pacientes (48 homens e 42 mulheres; faixa etária, 30-94 anos; idade média, 61,4 ± 15 anos) foi incluído no estudo. Os pacientes foram classificados em dois grupos principais: neoplasia maligna e doença não neoplásica. O sucesso técnico e clínico do procedimento foi definido como a manutenção da perviedade da via urinária com redução do grau de hidronefrose e redução dos níveis das escórias nitrogenadas. As complicações pós-procedimento foram classificadas em maiores e menores, de acordo com o sistema de classificação CIRSE. Resultados: Foram realizados 150 procedimentos (90 pacientes) no período, sendo bilateral em 60 pacientes e unilateral em 30. Houve sucesso técnico em 143 casos (95,3%) e falhas em sete (4,7%), caracterizadas por migração e não progressão do cateter. Nossas taxas de complicações foram de 8,0% (12 casos), sendo dois maiores (sangramento) e 10 menores (principalmente dor lombar). As técnicas mais utilizadas para a inserção foram over the wire (58,0%) e modificada (42,0%). Em sete pacientes (4,7%) foi realizada nefrostomia percutânea. Conclusão: A inserção anterógrada do cateter duplo J é um método seguro e eficaz para o tratamento de obstruções uretéricas devidas a causas e lesões malignas e benignas, quando há uma falha na abordagem cistoscópica (retrógrada).
