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Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option

World Journal of Gastroenterology 2015年第20期21卷 6391-6397页

作者： Guilherme Lopes P Martins Joao Paulo G Bernardes Marcello S Rovella Raphael G Andrade Publio Cesar C Viana Paulo Herman Giovanni Guido Cerri Marcos Roberto Menezes Radiology and Image-Guided Intervention Service Instituto do Cancer do Estado de Sao PauloUniversity of Sao Paulo Sao Paulo 01415-000 Brazil department of Gastroenterology University of Sao Paulo Sao Paulo 01246-903 Brazil Instituto de Radiologia do Hospital das Clinicas da FMUSP Sao Paulo 05403-900 Brazil

We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation(RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.

关键词： Portal hypertension Thrombocytopenia Hypersplenism Percutaneous radiofrequency ablation Splenic ablation

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Rheumatoid arthritis: Nuclear medicine state-of-the-art imaging

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World Journal of Orthopedics 2014年第3期5卷 312-318页

作者： Paulo Henrique Rosado-de-Castro Sergio Augusto Lopes de Souza Dangelo Alexandre Lea Mirian Barbosa da Fonseca Bianca Gutfilen departamento de radiologia Hospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de Janeiro 21941-913Brazil instituto Nacional de Traumatologia e Ortopedia Rio de Janeiro 20940-070Brazil

Rheumatoid arthritis(RA)is an autoimmune disease,which is associated with systemic and chronic inflammation of the joints,resulting in synovitis and pannus formation.For several decades,the assessment of RA has been limited to conventional radiography,assisting in the diagnosis and monitoring of disease.Nevertheless,conventional radiography has poor sensitivity in the detection of the inflammatory process that happens in the initial stages of RA.In the past years,new drugs that significantly decrease the progression of RA have allowed a more efficient treatment.Nuclear Medicine provides functional assessment of physiological processes and therefore has significant potential for timely diagnosis and adequate follow-up of RA.Several single photon emission computed tomography(SPECT)and positron emission tomography(PET)radiopharmaceuti-cals have been developed and applied in this field.The use of hybrid imaging,which permits computed tomography(CT)and nuclear medicine data to be acquired and fused,has increased even more the diagnostic accuracy of Nuclear Medicine by providing anatomical localization in SPECT/CT and PET/CT studies.More recently,fusion of PET with magnetic resonance imaging(PET/MRI)was introduced in some centers and demonstrated great potential.In this article,we will review studies that have been published using Nuclear Medicine for RA and examine key topics in the area.

关键词： Rheumatoid arthritis Nuclear medicine Scintigraphy Single photon emission computed tomography Positron emission tomography

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Hepatobiliary phases in magnetic resonance imaging using liverspecific contrast for focal lesions in clinical practice

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World Journal of Hepatology 2022年第7期14卷 1459-1469页

作者： Daniel Alvarenga Fernandes Eduardo Andreazza Dal Lago Felipe Aguera Oliver Bruna Melo Coelho Loureiro Daniel Lahan Martins Thiago José Penachim Ricardo Hoelz de Oliveira Barros José de ArimatéiaBatista Araújo Filho Larissa Bastos Eloy da Costa Áurea Maria Oliveira da Silva Elaine Cristina de Ataíde Ilka de Fátima Santana Ferreira Boin Nelson Marcio Gomes Caserta department of Radiology School of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazi department of Radiology Medical SchoolSão Paulo State University-UNESPBotucatu 18618-970São PauloBrazil Instituto de Radiologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo-InRad/HC-FMUSPSão Paulo 05403-010SPBrazil department of Radiology Sírio-Libanês HospitalSão Paulo 05652-900SPBrazil department of Pathology School of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil Liver Transplant Unit Department of SurgerySchool of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil

BACKGROUND Challenging lesions,difficult to diagnose through non-invasive methods,constitute an important emotional burden for each patient regarding a still uncertain diagnosis(malignant x benign).In addition,from a therapeutic and prognostic point of view,delay in a definitive diagnosis can lead to worse outcomes.One of the main innovative trends currently is the use of molecular and functional methods to diagnosis.Numerous liver-specific contrast agents havebeen developed and studied in recent years to improve the performance of liver magnetic resonance imaging(MRI).More recently,one of the contrast agents introduced in clinical practice is gadoxetic acid(gadoxetate disodium).AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions(FLL)in clinical practice.METHODS Overall,302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL.Two radiologists independently reviewed the MRI exams using four stages,and categorized them on a 6-point scale,from 0(lesion not detected)to 5(definitely malignant).The stages were:stage 1-images without contrast,stage 2-addition of dynamic phases after contrast(analogous to usual extracellular contrasts),stage 3-addition of hepatobiliary phase after 10 min(HBP 10’),stage 4-hepatobiliary phase after 20 min(HBP 20’)in addition to stage 2.RESULTS The interobserver agreement was high(weighted Kappa coefficient:0.81-1)at all stages in the characterization of benign and malignant FLL.The diagnostic weighted accuracy(Az)was 0.80 in stage 1 and was increased to 0.90 in stage 2.Addition of the hepatobiliary phase increased Az to 0.98 in stage 3,which was also 0.98 in stage 4.CONCLUSION The hepatobiliary sequences improve diagnostic accuracy.With growing potential in the era of precision medicine,the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.

关键词： Liver Liver neoplasms Liver transplantation Medical oncology Diagnostic imaging Magnetic resonance imaging

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