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Cervical traumatic neuromas (CTNs) are a non-neoplastic hyperplasia of damaged nerves and may be misinterpreted as metastatic lymph nodes during cervical ultrasound of patients with thyroid cancer after lateral neck dissection, resulting in unnecessary and painful fin-needle aspiration biopsy. The anatomy of the cervical plexus is challenging, and the correct identification and recognition of its neural roots and branches on ultrasound are key to the correct CTN diagnosis. This review outlines the US technique used to characterize CTNs in 10 standardized steps and describes the sonographic features of the cervical plexus, to assist the radiologist in the recognition of CTNs and their differentiation from lymph node metastases.

Objective: To evaluate acute and chronic changes seen on angiographic and histopathological studies of porcine rete mirabile, comparing those treated with the Menox liquid embolic system (LES) and those treated with the Onyx LES. Materials and Methods: Five pigs, each weighing approximately 35 kg, were submitted to rete mirabile embolization under general anesthesia and fluoroscopic guidance, with the Menox LES or Onyx LES. Four animals were treated with the Menox LES and underwent cerebral angiography, followed by euthanasia, at 1, 30, 60, and 90 days after embolization. One animal was treated with the Onyx LES underwent the same procedures at 30 days after embolization. In a subsequent histopathological analysis, we compared the Menox LES and Onyx LES in terms of the acute and chronic changes observed. Results: We observed no significant changes in blood pressure, heart rate, or electrocardiographic parameters that could be attributed to the super-selective infusion of dimethyl sulfoxide or the Menox embolic agent. Fluoroscopy showed adequate material opacity, appropriate progression to the center of the rete mirabile and complete unilateral embolization. Microcatheters were uneventfully detached from the embolized nidus. We observed mild to moderate intravascular and extravascular inflammatory responses, without histological evidence of necrotizing arteritis. There were no adverse neurovascular events. Conclusion: The Menox LES appears to be safe and effective, as well as being apparently equivalent to the Onyx LES in terms of the postprocedure angiographic and histopathological findings.

To assess the effectiveness of ultrasound (US)-guided laser ablation of benign thyroid nodules (TNs) under different amounts of applied energy.Thirty-four euthyroid patients with 5-18 ml TNs were enrolled: 21 (laser ablation) and 13 (clinical follow up) patients with a mean age of 56.2 ± 12.0 and 54.7 ± 14.7 years, respectively. The laser ablation protocol used a 1.064 mm wavelength diode laser source; 3.5 W output power; 1,100-1,500 J and 5-8 min/illumination; and one or two fibers/session. Clinical, laboratory, and US data were obtained immediately before treatment and at 6 and 12 months follow-up and were analyzed by Student's t test and Fisher's exact test. Low- and high-energy subgroups were subsequently defined, and the receiver operating characteristic (ROC) curves were calculated.Laser ablation follow-up showed an overall nodule volume reduction of more than 50%; improvement of symptoms and cosmetic complaints (P = 0.001); and stable laboratory data compared with the baseline and control groups. Minor complications were 9.5% ( n = 2). One or two fibers/session resulted in a similar nodule volume reduction among 10-18 ml nodules. Analysis of the applied energy suggested a 398.8 J/ml inferior cutoff (ROC curve: 0.889 sensitivity; 0.545 specificity) for the high-energy subgroup ( n = 14, mean 599.9 ± 136.5 J/ml) to reduce the nodule volume over time (-55.1% vs. -58.4%, P = 0.55). The low-energy subgroup ( n = 7, mean 240.2 ± 74.6 J/ml) did not show a persistent volume reduction ( P 0.05) from the 6- to 12-month follow-ups (-56.6% vs. -53.7%).Laser ablation of benign TNs achieved technique efficacy at 12 months posttreatment, with clinical improvement and few minor side effects. A single fiber in a single session with a high deployed energy (398.8 J/ml) may be associated with improved results, a finding to be confirmed with a larger series. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Introduction: Masses in adrenal topography are diagnosed frequently due to the increase in radiological imaging in clinical practice. Adrenal incidentalomas occur between 4% and 10% of the patients above 50 years undergoing abdominal imaging, and the majority are benign pathologies. Objective: To analyze the characteristics of the masses located in adrenal gland topography not originating from the adrenal gland. Methods: We retrospectively assessed patients from our tertiary hospital who underwent surgical treatment for masses in adrenal gland topography between 2006 and 2018. All patients had hormonal evaluations, according to the European and American Societies of Endocrinology guidelines. Two expert radiologists reviewed all images. Forty-six patients were included in the study, and the surgical specimens were analyzed by the same experienced pathologist. Patients with confirmed adrenocortical carcinoma (ACC) were excluded from this cohort. Results: Thirty-two (69.6%) patients were female. The median age was 49.5 years old (range 18-82yo). Abdominal or lumbar pain was the most frequent reason for medical investigation (43.5%). Adrenal incidentalomas represented 38.4% of the cohort. None of these patients had any clinical signs of adrenal hyperfunction, nor hormonal alteration. Twenty-four patients (52.17%) presented a mass on the left side, and only two cases presented bilateral adrenal masses. The median size was 8.6cm (1.3-18cm). The mean of Hounsfield Units (HU) on a non-contrasted CT was 25HU (0-50HU). Several etiologies were found: 8 cases (18%) of ganglioneuroma; 6 cases (13,5%) of adrenal cysts; 4 cases (9%) of leiomyosarcoma and adrenal hemorrhage; 3 cases (6.5%) of infectious disease; 2 cases (4.5%) of lymphangioma, schwannoma, and sarcoma. We also found single cases of renal cell carcinoma, poorly differentiated small cell neuroendocrine carcinoma, hepatocellular carcinoma, high grade dedifferentiated liposarcoma, epithelioid neoplasia, epithelial neoplasia with neuroendocrine differentiation, malignant peripheral nerve sheath tumor of the adrenal gland, poorly differentiated neuroblastoma, high grade lymphoma, myelolipoma, acute splenitis, arteriovenous malformation, and prostate cancer metastasis. Discussion and Conclusion: Ganglioneuroma was the most frequent diagnosis in adrenal incidentalomas in our cohort. In general, these conventional radiological exams could not differentiate lesions originated in the adrenal glands from lesions of other origins. In this large cohort, we could identify non-adrenal origin in approximately 45% of the patients with masses in the adrenal topography.

Background: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an unfavorable prognosis. Despite the poor prognosis in the majority of patients, no improvements in treatment strategies have been achieved, largely due to the rarity of these tumors. Therefore, the discovery of new prognostic biomarkers that could guide and improve the management of patients with ACC is of enormous interest. Sterol-O-Acyl Transferase 1 (SOAT1) is involved in cholesterol esterification in adrenocortical cells. Recently, it was demonstrated that SOAT1 inhibition leads to impaired steroidogenesis and cell viability in ACC [1]. There are no studies so far addressing the impact of SOAT1 protein expression in ACC prognosis and clinical outcomes. Methods: We evaluated SOAT1 protein expression by immunohistochemistry (ab39327; 1:4000; Abcam, EUA) in a tissue microarray of 107 adrenocortical carcinomas (Weiss score ≥ 3) from adult patients treated in a single tertiary center in Brazil. Immunohistochemistry results were evaluated through a semiquantitative approach by two independent pathologists. We aimed to evaluate the correlation of SOAT1 protein expression with clinical and biochemical parameters, surgical specimen histological characteristics, recurrence free-survival, progression free-survival and overall survival. Results: SOAT1 protein expression was heterogenous in this cohort; 38% of ACCs demonstrated strong SOAT1 protein expression while 62% demonstrated weak or absent SOAT1 protein expression. Strong SOAT1 protein expression correlates with known features of high aggressiveness in ACC, such as excessive tumor cortisol secretion (p= 0.007), advanced disease stage [ENSAT 3 and ENSAT 4 (p= 0.009)] and high Ki67 index (0.008). On multivariate analysis, strong SOAT1 protein expression was an independent predictor of lower overall survival (HR 1.71, CI 95% 1.05-2.92; p= 0.04) when considering all cases (n= 107) and of lower progression free survival (HR 3.05, CI 95% 1.05-8.85; p= 0.04) in patients with metastatic disease at diagnosis (n= 22). Conclusions: Our findings demonstrated that SOAT1 protein expression has prognostic value in ACC and reinforce the importance of investigating SOAT1 as a possible therapeutic target for patients with ACC. Multicentric prospective studies including a larger number of patients are needed in order to validate and consolidate the results found in this cohort. References: 1. Sbiera S, Leich E et al. Mitotane inhibits Sterol-O-Acyl Transferase 1 Triggering Lipid-Mediated Endoplasmic Reticulum Stress and Apoptosis in Adrenocortical Carcinoma Cells. Endocrinology. 2015; 156 (11):3895-908.

Summary Total thyroidectomy, radioiodine (RAI) therapy, and TSH suppression are the mainstay treatment for differentiated thyroid carcinomas (DTCs). Treatments for metastatic disease include surgery, external-beam radiotherapy, RAI, and kinase inhibitors for progressive iodine-refractory disease. Unresectable locoregional disease remains a challenge, as standard therapy with RAI becomes unfeasible. We report a case of a young patient who presented with unresectable papillary thyroid carcinoma (PTC), and treatment with sorafenib allowed total thyroidectomy and RAI therapy. A 20-year-old male presented with severe respiratory distress due to an enlarging cervical mass. Imaging studies revealed an enlarged multinodular thyroid gland, extensive cervical adenopathy, severe tracheal stenosis, and pulmonary micronodules. He required an urgent surgical intervention and underwent tracheostomy and partial left neck dissection, as the disease was deemed unresectable; pathology revealed PTC. Treatment with sorafenib was initiated, resulting in significant tumor reduction allowing near total thyroidectomy and bilateral neck dissection. Postoperatively, the patient underwent radiotherapy for residual tracheal lesion, followed by RAI therapy for avid cervical and pulmonary disease. The patient's disease remains stable 4 years after diagnosis. Sorafenib has been approved for progressive RAI-refractory metastatic DTCs. In this case report, we describe a patient with locally advanced PTC in whom treatment with sorafenib provided sufficient tumor reduction to allow thyroidectomy and RAI therapy, suggesting a potential role of sorafenib as an induction therapy of unresectable DTC.

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an unfavorable prognosis. Despite the poor prognosis in the majority of patients, no improvements in treatment strategies have been achieved. Therefore, the discovery of new prognostic biomarkers is of enormous interest. Sterol-O-acyl transferase 1 (SOAT1) is involved in cholesterol esterification and lipid droplet formation. Recently, it was demonstrated that SOAT1 inhibition leads to impaired steroidogenesis and cell viability in ACC. To date, no studies have addressed the impact of SOAT1 expression on ACC prognosis and clinical outcomes. We evaluated SOAT1 expression by quantitative real-time polymerase chain reaction and immunohistochemistry in a tissue microarray of 112 ACCs (Weiss score &ge, 3) from adults treated in a single tertiary center in Brazil. Two independent pathologists evaluated the immunohistochemistry results through a semiquantitative approach (0&ndash, 4). We aimed to evaluate the correlation between SOAT1 expression and clinical, biochemical and anatomopathological parameters, recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS). SOAT1 protein expression was heterogeneous in this cohort, 37.5% of the ACCs demonstrated a strong SOAT1 protein expression (score &gt, 2), while 62.5% demonstrated a weak or absent protein expression (score &le, 2). Strong SOAT1 protein expression correlated with features of high aggressiveness in ACC, such as excessive tumor cortisol secretion (p = 0.01), an advanced disease stage [European Network for the Study of Adrenal Tumors (ENSAT) staging system 3 and 4 (p = 0.011)] and a high Ki67 index (p = 0.002). In multivariate analysis, strong SOAT1 protein expression was an independent predictor of a reduced OS (hazard ratio (HR) 2.15, confidence interval (CI) 95% 1.26&ndash, 3.66, p = 0.005) in all patients (n = 112), and a reduced RFS (HR 2.1, CI 95% 1.09&ndash, 4.06, p = 0.027) in patients with localized disease at diagnosis (n = 83). Our findings demonstrated that SOAT1 protein expression has prognostic value in ACC and reinforced the importance of investigating SOAT1 as a possible therapeutic target for patients with ACC.

OBJECTIVES This study aimed to evaluate the echo texture of the parotid salivary glands before and after radioiodine therapy (RIT) using ultrasound (US) images in patients with differentiated thyroid cancer and to evaluate the correlations between post-RIT whole-body scintigraphy (WBS) images and US image patterns in salivary and cervical areas. METHODS A retrospective study was performed with data on demographic and clinical information, US examinations, and WBS images collected through medical recordings. RESULTS Comparing the US features before and after RIT, significant echo texture heterogeneity was found in 31.3% of all patients evaluated. When evaluated according to the level of iodine 131 (I-131) radioactivity (

Objective Hürthle cell carcinomas (HCCs) of the thyroid have been recently reclassified as a separate entity due to their distinct clinical and molecular profiles. Few studies have assessed the ability of preoperative characteristics in differentiating HCCs from Hürthle cell adenomas (HCAs) due to the low prevalence of both lesions. This study aimed to compare the preoperative features of HCCs and HCAs and evaluate the diagnostic performance of ultrasound in distinguishing between both. Subjetcs and methods Retrospective study including 101 patients (52 HCCs and 49 HCAs) who underwent thyroid surgery from 2000 to 2016. Clinical, ultrasonographic, and histological data were reviewed. Diagnostic performance of suspicious sonographic features was analyzed in 51 cases (24 HCCs and 27 HCAs). Results Hürthle cell neoplasms were predominant in females. Subjects ≥ 55 years represented 58% of the cases of HCCs and 53% of those of HCAs. Carcinomas were significantly larger (p < 0.001), and a tumor size ≥ 4 cm significantly increased the risk of malignancy (odds ratio 3.67). Other clinical, cytologic, and sonographic data were similar between HCCs and HCAs. Among the HCCs, the lesions were purely solid in 54.2%, hypoechoic in 37.5%, and had coarse calcifications in 12.5%, microcalcifications in 8.3%, irregular contours in 4.2%, and a taller-than-wide shape in 16.7%. Predominantly/exclusive intranodular vascularization was observed in 52.6%. Overall, 58% of the HCCs were classified as TI-RADS 4 or 5 compared with 48% of the HCAs. TI-RADS 4 or 5 had a specificity of only 51.8% and a positive likelihood ratio of 1.21. Conclusions Apart from the lesion size, no other preoperative feature adequately distinguished HCCs from HCAs. Sonographic characteristics raising suspicion for malignancy, which are mostly present in papillary carcinomas, were infrequent in HCCs. New tools must be developed to improve preoperative diagnosis and deferral of surgery in cases of adenomas.

Background: Adrenocortical carcinoma (ACC) is a rare and, in the vast majority of cases, aggressive neoplasia. Even in cases of localized disease at the diagnosis in which complete surgical resection of the tumor is performed, rates of local and distant recurrence are very high. Aim: To retrospectively analyze the management and outcomes of cases that presented localized disease (Group 1) and metastatic disease at diagnosis (Group 2) followed in a single Institution. Results: Group 1 was formed by 23 cases and group 2 by 7 cases. In group 1, adjuvant treatment was initiated in 17 patients: 9 received adjuvant radiotherapy (ARDT) associated with mitotane and 8 patients received mitotane alone; six patients have been followed expectantly. Recurrence of the disease was observed in 70% of the cases (n=16). All had distant metastasis and 6 out of 16 also had local recurrence. Most frequent sites of metastasis were lung, liver and peritoneum, including a rare case of heart metastasis. All patients with recurrence received systemic chemotherapy. No patient who was followed without adjuvant treatment has recurred so far. The median recurrence free survival (RFS) and overall survival (OS) were 13 and 30 months, respectively. In group 2, 5 patients had only one site of metastasis at diagnosis (all of them presented lung metastases) and the remaining cases had two (lung and liver) or three sites (lung, liver and bone). In only one case neoadjuvant chemotherapy was the treatment of choice. In the remaining patients, primary tumor was resected and systemic chemotherapy and mitotane started after surgery. The number of chemotherapy regimens ranged from one to four. Median progression free survival (PFS) was 2 months (range, 0.9 to 11 months) and OS was 11 months (range, 0.9 to 30 months). Patients who had more than one metastatic site at diagnosis had a lower survival rate and the patient who underwent neoadjuvant chemotherapy presented the longest PFS (11 months). Conclusions: Group 1 cases analysis reinforces the high rate of disease recurrence in patients with localized disease despite adjuvant treatment with ARDT and mitotane. These findings support the need for multicenter clinical trials to investigate the benefit of systemic chemotherapy in an adjuvant setting in patients at high risk of recurrence. Regarding the metastatic patients at diagnosis, we emphasize the importance of a greater experience with neoadjuvant chemotherapy.

Treatment of advanced medullary thyroid carcinoma (MTC) was recently improved with the approval of vandetanib and cabozantinib. However, there is still a need to explore sequential therapy with more than one tyrosine kinase inhibitor (TKI) and to explore alternative therapies when vandetanib and cabozantinib are not available. This study reports the authors' experience with sorafenib as a treatment for advanced MTC.This is a retrospective longitudinal study of 13 patients with progressive metastatic MTC treated with sorafenib 400 mg twice daily between December 2011 and January 2015. The primary endpoints were to evaluate response and progression-free survival (PFS) in patients treated with sorafenib outside a clinical trial. The secondary endpoint was an assessment of the toxicity profile. One patient was excluded because of a serious allergic skin rash one week after starting sorafenib.The analysis included 12 patients with metastatic MTC (median age 48 years), 10 with sporadic and 2 with hereditary disease. The median duration of treatment was 11 months, and the median follow-up was 15.5 months. At data cutoff, 2/12 (16%) patients were still on treatment for 16 and 34 months. According to Response Evaluation Criteria in Solid Tumors analysis, 10 (83.3%) patients showed stable disease, and two (16.6%) had progression of disease; no partial response was observed. The median PFS was nine months. However, three patients with extensive and rapidly progressive disease died within three months of sorafenib treatment. The median PFS excluding these three patients was 12 months. Adverse events (AE) occurred in nine (75%) patients. The main AEs were skin toxicity, weight loss, and fatigue. Five (41.6%) patients needed dose reduction, and one patient discontinued treatment because of toxicity.Treatment with sorafenib in progressive metastatic MTC is well tolerated and resulted in disease control and durable clinical benefit in 75% of patients. Sorafenib treatment could be considered when vandetanib and cabozantinib are not available or after failing these drugs.

Context Persistent disease after surgery is common in medullary thyroid cancer (MTC), requiring lifelong radiological surveillance. Staging workup includes imaging of neck, chest, abdomen, and bones. A study integrating all sites would be ideal. Despite the established use of gallium-68 (68Ga) positron emission tomography (PET)/CT with somatostatin analogues in most neuroendocrine tumors, its efficacy is controversial in MTC. Objective Evaluate the efficacy of 68Ga PET/CT in detecting MTC lesions and evaluate tumor expression of somatostatin receptors (SSTRs) associated with 68Ga PET/CT findings. Methods Prospective study evaluating 30 patients with MTC [group 1 (n = 16), biochemical disease; group 2 (n = 14), metastatic disease]. Patients underwent 68Ga PET/CT, bone scan, CT and ultrasound of the neck, CT of the chest, CT/MRI of the abdomen, and MRI of the spine. 68Ga PET/CT findings were analyzed by disease site as positive or negative and as concordant or discordant with conventional studies. Sensitivity and specificity were calculated using pathological or cytological analysis or unequivocal identification by standard imaging studies. Immunohistochemical analysis of SSTRs was compared with 68Ga PET/CT findings. Results In both groups, 68Ga PET/CT was inferior to currently used imaging studies except for bone scan. In group 2, 68Ga PET/CT sensitivities were 56%, 57%, and 9% for detecting neck lymph nodes, lung metastases, and liver metastases, respectively, and 100% for bone metastases, superior to the bone scan (44%). Expression of SSTRs, observed in 44% of tumors, was not associated with 68Ga-DOTATATE uptake. Conclusions 68Ga PET/CT does not provide optimal whole-body imaging as a single procedure in patients with MTC. However, it is highly sensitive in detecting bone lesions and could be a substitute for a bone scan and MRI.

INTRODUÇÃO: A criocirurgia (crioablação) percutânea em tecidos ósseos próximos da medula espinhal e sistema nervoso periférico tem sido feita na prática clínica, porém sem estudos experimentais que provem sua segurança e eficácia. O objetivo deste trabalho foi desenvolver um modelo experimental suíno in vivo de crioablação vertebral guiada por tomografia computadorizada de feixe cônico (TCFC). Um estudo preliminar de morfometria da coluna vertebral suína por imagens de TCFC foi realizado. Um protocolo específico de crioablação foi criado para adaptar a bola de gelo às dimensões da vértebra suína e testado em modelos in vitro, ex vivo e in vivo. MÉTODOS: O comitê institucional de cuidados com os animais aprovou este estudo. Dezesseis parâmetros anatômicos foram medidos em 36 vértebras lombares suínas e comparados às medidas aferidas nas imagens de TCFC e TC multidetectores (TCMD). Três simuladores in vitro / ex vivo foram desenvolvidos para o posicionamento de sensores de temperatura (termopares) em volta de uma sonda de congelamento. As isotermas foram obtidas durante um protocolo duplo de congelamento-descongelamento de 2-8 minutos. Vinte e duas crioablações vertebrais guiadas por TCFC foram realizadas em oito suínos, mediante termometria e dissecção por dióxido de carbono (CO2) no espaço epidural a fim de proteger os nervos. O seguimento clínico foi realizado até seis dias antes da eutanásia. Os dados clínicos e radiológicos foram correlacionados com o estudo histopatológico à microscopia de luz (n=20) ou eletrônica de transmissão (n=2). RESULTADOS: Na avaliação anatômica da coluna lombar suína a TCFC se mostrou um método de imagem comparável à TCMD e ao estudo anatômico, com correlação significativa (p < 0,05) em todas as variáveis, exceto aquelas que incluiu o tecido cartilaginoso dos planaltos vertebrais. As isotermas registradas foram mais frias no modelo ex vivo imerso em gel (-34 °C e -2 °C; -30 °C e 3 °C; -10 °C e 13 °C, respectivamente), do que nos modelos in vitro (-23 °C e 3 °C; -7 °C e 10 °C; 1 °C e 16 °C) ou ex vivo sem gel (-30 °C e 28 °C). No estudo in vivo, a demonstração das sondas de congelamento no corpo vertebral e do CO2 epidural pelas imagens de TCFC foi bem sucedida em todos os procedimentos. A taxa de complicação maior foi de 4,5%. A distância entre a sonda de congelamento e o canal vertebral (Cp-Sc) foi o parâmetro mais eficiente para categorizar as temperaturas do canal vertebral inferiores a 19 °C à análise do modelo de regressão logística (p < 0,004). Nenhum infiltrado inflamatório perineural foi identificado à microscopia de luz. O suíno cujas vertebras foram submetidas a análise ultraestrutural não apresentou déficit neurológico, embora tenha sido evidenciada a ruptura da bainha de mielina em algumas fibras neurais maiores. CONCLUSÕES: A TCFC foi validada como método de imagens para a análise de vértebras suínas. O modelo ex vivo em gel caracterizou melhor a preservação do frio no tecido ósseo. A combinação de um protocolo específico de congelamento associado a medidas de proteção epidural tornou viável e exequível a crioablação vertebral suína guiada por TCFC. A análise ultraestrutural mostrou modificações precoces das fibras nervosas, sem correlação clínica INTRODUCTION: Percutaneous spine cryosurgery (cryoablation) close to nerves and spinal cord has been performed in the clinical practice, however without experimental studies proving its safety and efficacy. The aim of this work was to develop an experimental swine model of in vivo cone beam computed tomography (CBCT) guided vertebral cryoablation. A preliminary morphometric study of the porcine spine by CBCT imaging was carried out. A specific cryoablation protocol was proposed to adapt the \"ice ball\" to the swine vertebrae dimensions. Subsequently, the protocol was tested in in vitro, ex vivo and in vivo models. METHODS: The institutional animal care committee approved this study. Sixteen anatomical parameters were measured in 36 lumbar swine vertebrae and compared to the same measurements of the CBCT and multidetector CT (MDCT). Three models of in vitro / ex vivo studies were developed for the positioning of thermocouples around the cryoprobe. Isotherms were obtained from measured temperatures for each minute during a 2-8 minutes double freezing-thawing protocol. Twenty -two CBCT-guided vertebral cryoablations were performed in eight pigs. Epidural thermocouples registered the temperatures while carbon dioxide (CO2) was injected in the epidural space to protect nerves. The clinical follow-up was carried out until six days before euthanasia. Clinical and radiologic data were correlated to the histopathology study with light microscopy (n=20) or electron transmission microscopy (n=2). RESULTS: CBCT was proven to be a comparable imaging method to MDCT with significant correlation (p < 0.05) in all variables, except in those including the cartilaginous tissue of the vertebral plateau. The registered isotherms were colder in the ex vivo model embedded in gel (-34 °C and -2 °C; -30 °C and 3 °C; -10 °C and 13 °C, respectively) than in the in vitro model (-23 °C and 3 °C; -7 °C and 10 °C; 1 °C and 16 °C) or the ex vivo model without gel (-30 °C and 28 °C). In the in vivo study the CBCT imaging was well succeeded to demonstrate the cryoprobes inserted in the vertebral body and the epidural CO2 in all procedures. The major complication rate was 4.5%. The distance between the cryoprobe and the spinal canal (Cp-Sc) was the most efficient parameter to categorize the vertebral canal temperatures below 19 °C in the logistic regression model analysis (p < 0.004). Perineural inflammatory infiltrate was not identified in the light microscopy analysis. One swine did not present neurological deficits, although the ultra-structural analysis has evidenced myelin sheath disruption in some large neural fibers. CONCLUSIONS: The CBCT imaging was validated as an imaging method for the swine vertebrae analysis. The ex vivo model embedded in gel featured better the cold preservation in the bone tissue. The combination of a specific freezing protocol associated with epidural protective measures allowed the feasibility of the CBCT-guided vertebral cryoablation in the swine model. The ultra-structural analysis showed early modifications of the nerve fibers

O objetivo deste trabalho foi comparar a tomografia computadorizada helicoidal com os métodos imaginológicos atualmente disponíveis para a abordagem dos pacientes com dor lombar aguda e revisar brevemente as características fisiopatológicas da urolitíase e a evolução da sua abordagem diagnóstica. Foi revista a literatura publicada nos últimos 30 anos, comparando os seguintes métodos: radiografia simples de abdome, urografia excretora, ultra-sonografia e tomografia computadorizada helicoidal. Esta última se mostrou método de alta sensibilidade e especificidade para o diagnóstico de urolitíase, sendo que, virtualmente, todos os cálculos são identificados por este método, exceto em pacientes em uso de indinavir. A radiografia simples de abdome associada à ultra-sonografia têm acurácia semelhante à tomografia computadorizada helicoidal, contudo, esta foi superior como método de avaliação isolado. A literatura sugere que a tomografia computadorizada helicoidal é útil na avaliação de pacientes com dor lombar aguda quando disponível, possibilitando também o diagnóstico diferencial entre as várias doenças que simulam os sintomas de urolitíase.The aim of this study is to compare helical computed tomography with imaging studies currently used to evaluate patients with acute low back pain. In addition, we briefly review the pathophysiology of urolithiasis. The literature published in the last 30 years was reviewed, and the following methods were discussed: plain abdominal radiographs, intravenous pielography, ultrasound of the urinary tract, and helical computed tomography. Helical computed tomography showed high sensitivity and specificity for detecting urolithiasis, virtually showing all stones, except in patients receiving indinavir. The accuracy of plain abdominal radiographs associated with ultrasound was similar to helical computed tomography, although the latter showed superiority as an isolated method. Data from literature suggest that whenever helical computed tomography is available, it is helpful in the evaluation of low back pain and also allows differential diagnosis between conditions that mimic the symptoms of urolithiasis.

This study was designed to present the feasibility of an in vivo image-guided percutaneous cryoablation of the porcine vertebral body.The institutional animal care committee approved this study. Cone-beam computed tomography (CBCT)-guided vertebral cryoablations (n = 22) were performed in eight pigs with short, 2-min, single or double-freezing protocols. Protective measures to nerves included dioxide carbon (CO2) epidural injections and spinal canal temperature monitoring. Clinical, radiological, and pathological data with light (n = 20) or transmission electron (n = 2) microscopic analyses were evaluated after 6 days of clinical follow-up and euthanasia.CBCT/fluoroscopic-guided transpedicular vertebral body cryoprobe positioning and CO2 epidural injection were successful in all procedures. No major complications were observed in seven animals (87.5 %, n = 8). A minor complication was observed in one pig (12.5 %, n = 1). Logistic regression model analysis showed the cryoprobe-spinal canal (Cp-Sc) distance as the most efficient parameter to categorize spinal canal temperatures lower than 19 °C (p0.004), with a significant Pearson's correlation test (p0.041) between the Cp-Sc distance and the lowest spinal canal temperatures. Ablation zones encompassed pedicles and the posterior wall of the vertebral bodies with an inflammatory rim, although no inflammatory infiltrate was depicted in the surrounding neural structures at light microscopy. Ultrastructural analyses evidenced myelin sheath disruption in some large nerve fibers, although neurological deficits were not observed.CBCT-guided vertebral cryoablation of the porcine spine is feasible under a combination of a short freezing protocol and protective measures to the surrounding nerves. Ultrastructural analyses may be helpful assess the early modifications of the nerve fibers.

Morphometric analysis of Schistosoma mansoni male worms obtained from AKR/J and Swiss mice was carried out. Rodents infected by the intraperitoneal route with 80 cercariae of the schistosome (LE strain) were killed by cervical dislocation at 45 and 60 days post-infection and both peritoneal lavage and perfusion of the portal system were performed for the recovery of adult worms. Characteristics including total body length, the distance between oral and ventral suckers, extension of testicular mass and the number of testes were considered in the morphological analysis. Changes that occurred in S. mansoni recovered from the peritoneal cavity or from the portal system of AKR/J and Swiss mice included total body length and reproductive characteristics. Significant morphometric alterations were also observed when worms recovered from the portal system of both strains of mice were compared with the schistosomes obtained from hamsters (Mesocricetus auratus), the vertebrate host in which the LE strain had been adapted and maintained by successive passages for more than four decades. The present results reinforce the idea that S. mansoni has high plastic potential and adaptive capacity.

New spinal interventions or implants have been tested on ex vivo or in vivo porcine spines, as they are readily available and have been accepted as a comparable model to human cadaver spines. Imaging-guided interventional procedures of the spine are mostly based on fluoroscopy or, still, on multidetector computed tomography (MDCT). Cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are also available methods to guide interventional procedures. Although some MDCT data from porcine spines are available in the literature, validation of the measurements on CBCT and MRI is lacking.To describe and compare the anatomical measurements accomplished with MDCT, CBCT, and MRI of lumbar porcine spines to determine if CBCT and MRI are also useful methods for experimental studies.An experimental descriptive-comparative study.Sixteen anatomical measurements of an individual vertebra from six lumbar porcine spines (n=36 vertebrae) were compared with their MDCT, CBCT, and MRI equivalents. Comparisons were made for the absolute values of the parameters.Similarities were found in all imaging methods. Significant correlation (p.05) was observed with all variables except those that included cartilaginous tissue from the end plates when the anatomical study was compared with the imaging methods.The CBCT and MRI provided imaging measurements of the lumbar porcine spines that were similar to the anatomical and MDCT data, and they can be useful for specific experimental research studies.

INTRODUCTION: The purpose of this study was to compare respiratory signs and symptoms between patients with and without chest X-ray abnormalities in order to establish the meaning of radiographic findings in pulmonary PCM diagnosis. METHODS: The epidemiological, clinical and radiological lung findings of 44 patients with paracoccidiodomycosis (PCM) were evaluated. Patients were divided into two groups of 23 and 21 individuals according to the presence (group 1) or absence (group 2) of chest X-ray abnormalities, respectively, and their clinical data was analyzed with the aid of statistical tools. RESULTS: As a general rule, patients were rural workers, young adult males and smokers - group 1 and 2, respectively: males (91.3% and 66.7%); mean age (44.4 and 27.9 year-old); smoking (34.7% and 71.4 %); acute/subacute presentation (38.1% and 21.7%); chronic presentation (61.9% and 78.3%). The most frequent respiratory manifestations were - group 1 and 2, respectively: cough (25% and 11.4%) and dyspnea (22.7% and 6.8%). No statistical difference was observed in pulmonary signs and symptoms between patients with or without radiographic abnormalities. The most frequent radiological finding was nodular (23.8%) or nodular-fibrous (19%), bilateral (90.5%) and diffuse infiltrates (85.7%). CONCLUSIONS: Absence of statistical difference in pulmonary signs and symptoms between these two groups of patients with PCM indicates clinical-radiological dissociation. A simplified classification of radiological lung PCM findings is suggested, based on correlation of these data and current literature review. INTRODUÇÃO: Comparar sinais e sintomas respiratórios entre pacientes com e sem alterações à radiografia de tórax para se estabelecer o significado dos achados radiográficos no diagnóstico da paracoccidioidomicose pulmonar. MÉTODOS: Os achados epidemiológicos, clínicos e radiológicos de 44 pacientes com paracoccidioidomicose (PCM) foram avaliados. Os pacientes foram divididos em dois grupos de 23 e 21 indivíduos de acordo com a presença (grupo 1) ou ausência (grupo 2) de anormalidades à radiografia de tórax, respectivamente, e seus dados clínicos foram analisados com auxílio de ferramentas estatísticas. RESULTADOS: Como regra geral, os pacientes eram trabalhadores rurais do sexo masculino, tabagistas e em idade adulta jovem - grupo 1 e 2, respectivamente: homens (91,3% e 66,7%); média de idade (44,4 e 27,9 anos); tabagismo (34,7% e 71,4 %); forma aguda/subaguda (38,1% e 21,7%); forma crônica (61,9% e 78,3%). As manifestações respiratórias mais frequentes foram - grupo 1 e 2, respectivamente: tosse (25% e 11,4%) e dispnéia (22,7% e 6,8%). Nenhuma diferença estatística foi observada nos sinais e sintomas respiratórios entre pacientes com ou sem anormalidades radiográficas. Os achados radiológicos mais frequentes foram o padrão nodular (23,8%) ou nodular-fibrótico (19%), bilateral (90,5%) e infiltrado difuso (85,7%). CONCLUSÕES: A ausência de diferença estatística nos sinais e sintomas pulmonares entre estes dois grupos de pacientes com PCM sugere dissociação clínico-radiológica. Uma classificação simplificada dos achados radiológicos pulmonares da PCM é sugerida, com base na correlação destes dados e revisão da literatura atual.

The short-term effects of pentoxifylline (PTX) on granulomatous lesions duringSchistosoma mansoniinfection in Swiss mice were evaluated. Drug administration was initiated 42 and 140 days post-infection (DPI) for the acute and chronic infection groups, respectively. Treatment was carried out daily with 200 mg/kg (subcutaneous route) of the drug for five consecutive days. Recovery of parasites and tissues was performed at 49 DPI and 147 DPI, respectively. Liver histological analysis showed a decrease in the inflammatory reaction and fibrous content of the granulomas studied, and a significant reduction (P S. mansonirecovered from the portal system was observed, and egg-laying kinetics was not notably modified by PTX treatment, and the immature stage distribution ofS. mansonieggs showed minor intrinsic variations with no statistical differences in the parameter second-stage/female/g among untreated mice and treated mice in acute and chronic infections, respectively, when evaluated by intestinal oograms. Data obtained indicate probable immunomodulatory effects of PTX in murine schistosomiasis both in acute and chronic infection.

Foram estudados 44 pacientes com paracoccidioidomicose (PCM) em seus aspectos clínico-radiológicos pulmonares. Resultaram da seleção inicial de 61 pacientes atendidos no Hospital das Clínicas da Universidade Federal de Minas Gerais dos quais foram excluídos 17pacientes com história atual ou pregressa de tuberculose, asma, Doença Pulmonar Obstrutiva Crônica (DPOC) ou pneumoconioses. Os 44 pacientes foram analisados quanto à presença ou ausência de alterações à telerradiografia do tórax, respectivamente em grupos de 23 e 21 indivíduos. Predominaram os pacientes do sexo masculino, adultos jovens, feodérmicos, tabagistas e trabalhadores do meio rural. As manifestações respiratórias mais frequentes foram a tosse produtiva e a dispnéia. A comparação dos sinais e sintomas de cada grupo pormeio do teste qui-quadrado não apresentou diferenças significativas entre os mesmos, indicando dissociação clínico-radiológica. As alterações radiológicas predominantes foram os infiltrados intersticiais nodulares, bilaterais e difusos. Os achados radiológicos observadosforam comparados aos dados existentes na literatura, o que resultou na sugestão de simplificação da classificação das alterações radiológicas na PCM. The clinical and radiologic pulmonary findings of forty-four patients withparacoccidiodomycosis (PCM) were investigated. The patients were selected from an initial group of 61 patients admitted to the University Hospital of Universidade Federal de Minas Gerais, between 1976 and 2005. Seventeen patients were excluded, either by current orprevious diagnosis of tuberculosis, asthma, chronic obstructive lung disease or pneumoconiosis. In general, they were predominantly males, young-adults, afro-descendents, smokers, and rural workers. The most frequent respiratory manifestations were productive cough and dyspnea. The patients were divided in two groups of 23 and 21 individualsaccording to the presence or absence of chest x-ray abnormalities, respectively, and their clinical signs and symptoms were compared. There were no significant differences between the two groups, as demonstrated by Q-square tests, suggesting clinical-radiologic dissociation. The most frequent radiologic findings were nodular, bilateral and diffuse interstitial infiltrates. Radiologic abnormalities were compared with the current literature, resulting in a simplified classification of radiologic lung PCM findings.

The lymphoabdominal involvement in the sub-acute form of paracoccidioidomycosis shows a wide variety of clinical manifestations, ranging from fever and lymph node enlargement to infiltration of all abdominal organs, which can lead to a situation of abdominal surgical emergency. This case report presents paracoccidioidomycosis mimicking carcinoma of the biliary tract, The purpose of this paper is to call the general physician's attention for this important differential diagnosis of abdominal masses. Although paracoccidioidomycosis is rarely encountered in the United States and Europe, it should be considered in patients who are suspected of having a fungal infection and have had previous exposure in an endemic area for this disease.

No. 456 Image-guided percutaneous treatment of aneurysmal bone cyst of the jaw with bone allograft and autologous bone marrow: a case report with five-year follow-up R. Freitas, K. Fonseca, R. Procopio, L. Lehman; Radiology, Universidade de Sao Paulo Medical School, Sao Paulo, Brazil; Oncology pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Interventional Radiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Buco-maxillo Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Purpose: A six-year old boy with an aneurysmal bone cyst of the jaw was treated by percutaneous injection of bone allograft particles mixed with autogenous bone marrow under computed tomography (CT) guidance and general anesthesia. Materials and Methods: A six-year old boy presented with a mass at the left angle of mandible, self-limited recurrent oral bleeding, pallor and severe pain partially controlled with opioids. Open surgical biopsy revealed a fibrous bone lesion with giant cells. A thin-walled 7 x 6 x 6 cm diameter (132 cc) expansible bone lesion at the left angle of mandible containing fluid-fluid levels was detected by X-ray plain film, CT scan, ultrasound, and magnetic resonance imaging. A diagnosis of an aneurysmal bone cyst was stated. A minimally invasive percutaneous approach was proposed after multidisciplinary review and an informed consent was obtained. Frozen dried bone allograft particles obtained from tissue bank were crushed, mixed with fresh autogenous bone marrow and injected into the lesion by a percutenous 11-gauge needle under CT and fluoroscopy guidance. No complications were observed. Results: The patient was discharged from the hospital the next day without symptoms. After two weeks he returned at consultation without bleeding or pain complaints. Normal serum hemoglobin was observed three months later. CT scans performed during five years of follow up showed progressive healing, ossification of the left branch of the jaw, tumor shrinking and remodeling. No pain or bleeding was reported since the percutaneous treatment. Conclusion: This case report shows excellent healing of a locally aggressive aneurysmal bone cyst after image-guided percutaneous injection of autogenous bone marrow mixed with elements of allograft bone matrix. Five years of follow-up showed excellent functional and cosmetic results. Further research is required to clarify the exact mechanisms of this potential treatment. Educational Exhibit Abstract No. 457 Ultrasound guided percutaneous tenotomy/ fasciotomy: indications, technique, and initial experience A.S. Johar, M.C. Switzer, A. Braun; Radiology, Maricopa Medical Center, Phoenix, AZ Learning Objectives: The objective of this poster is to 1) Discuss the pathophysiology of tendinosis and the common clinical presentations. 2) Review the US findings of chronic tendinopathy. 3) Describe the percutaneous tenotomy technique and its advantages over traditional tendinopathy treatments. 4) Outline our initial experience with outpatient ultrasound tenotomy. Background: Tendinopathy is a common and underdiagnosed pathology which often impairs daily and recreational activities. Given its debilitating nature, a range of treatment options exist, many of which are conservative and few of which provide durable complete symptom relief. Ultrasound guided percutaneous tenotomy is a relatively new and promising technique with the ability to remove pain causing diseased tendon tissue without damaging the adjacent healthy tendon tissue. This technique is gaining traction due to its minimally invasive nature, quick recovery time, low cost, low morbidity and durable positive outcomes. Clinical Findings/Procedure Details: We will demonstrate the findings of tendinopathy by presenting supporting US images from multiple cases. We will detail the percutaneous ultrasonic tendon cutting and debriding technique while describing pertinent pearls and pitfalls. Finally, we will discuss the outcomes from our cases. Conclusion and/or Teaching Points: After reviewing the poster, viewers will be familiar with the pathology, presentation and imaging findings of chronic tendinopathy. Viewers should appreciate US guided percutaneous tenotomy as a minimally invasive, fast and effective treatment option for tendinopathy pain. Educational Exhibit Abstract No. 458 Lymphangiography: not gone, not forgotten E. Lindgren, J. Friese, C.E. Bender; Radiology, Mayo Clinic, Rochester, MN JVIR ’ Posters and Exhibits S199

Purpose An experimental model of in vivo cryoablation of the spine is unknown. The aim of this study is to describe the technical aspects of a image-guided percutaneous cryoablation of the spine in a swine model. Material and methods Cone beam CT (CBCT)-guided percutaneous cryoablation was performed in five domestic female swines (14 lumbar vertebral bodies). A 1.7-mm cryoprobe was inserted by transpedicular route through 10 G vertebroplasty needles. Epidural thermosensor insertion and CO 2 injection were provided to help preventing spinal cord or nerve injuries. Modified freeze-thaw-freeze cycles were delivered. Clinical observation of the models was carried out for 6 days after ablation. Spine MRI was then performed before euthanasia followed by complete pathological analysis. Results Good quality images of the spine canal CO 2 distribution, as well as the needles inside vertebrae were obtained with CBCT . The five animals survived for their designated time of 6 days after spine cryoablation; the lowest temperatures recorded at the center of the cryolesion and at the spine canal were respectively −121 °C and 14 °C; only one animal presented with foot flexion limitation; no significant symptoms were registered in the other four animals. Conclusion This is the first report of an experimental image-guided percutaneous cryoablation of the spine in a swine model. The technique was feasible and good short-term clinical results were reported. Source of funding: FAPESP - Fundacao de Amparo a Pesquisa do Estado de Sao Paulo. Conflict of interest: None declared. ricardomcfreitas@gmail.com

The effects of ivermectin, a semi-synthetic drug widely used for treatment of livestock parasitic diseases, were observed on Culex quinquefasciatus larvae. Toxic effects and mortality evaluation were carried out after 5, 15, 30 and 60 minutes of exposure to 1, 5 or 10 ppm of ivermectin solutions. Observations were made 24 and 48 hours after the beginning of the experiment, and loss of mobility, progressive paralysis and high mortality of larvae were recorded. The observed effects of ivermectin on the mosquito larvae is probably correlated with chloride channel activation on cell membranes. Os efeitos da ivermectina, uma droga semi-sintética amplamente utilizada para o tratamento de doenças parasitárias do gado, foram observados em larvas de Culex quinquefasciatus. Os efeitos tóxicos e a avaliação da mortalidade foram investigados após 5, 15, 30 e 60 minutos de exposição a 1, 5 ou 10 ppm de solução de ivermectina. As observações foram realizadas 24 e 48 horas após o início do experimento, e perda de mobilidade, paralisia progressiva e alta mortalidade de larvas foram registradas. Os efeitos da ivermectina observados nas larvas de mosquito estão provavelmente correlacionados com a ativação de canais de Cloro em membranas celulares.

Introdução: Os neuromas traumáticos cervicais (NTCs) podem surgir após a abordagem cirúrgica de esvaziamento cervical lateral para o tratamento de metástases linfonodais do carcinoma de tireoide. Eventualmente, os NTCs podem ser confundidos com linfonodos (LNs) metastáticos durante a realização da ultrassonografia (US) de controle pós-operatório e resultar em indicações de punções aspirativas por agulha fina (PAAF) desnecessárias e dolorosas. Objetivos: Determinar o desempenho do US em distinguir os NTCs dos LNs metastáticos em pacientes com carcinoma de tireoide; Avaliar as características de US dos NTCs ao modo B, ao Doppler colorido e à elastografia shear-wave bidimensional (SWE-2D). Materiais e Métodos: Entre julho de 2016 e dezembro de 2017, um estudo transversal foi realizado para diagnosticar os NTCs e avaliar suas características de US (modo B, Doppler e SWE-2D). Um estudo retrospectivo de acurácia diagnóstica avaliou o desempenho do modo B e do Doppler colorido em distinguir NTCs de LNs metastáticos em pacientes com carcinoma de tireoide após esvaziamento cervical. Resultados: Sessenta e sete pacientes (52 [41-64] anos; 52 mulheres) foram incluídos no estudo, com um total de 86 nódulos cervicais avaliados, sendo 38 NTCs (grupo 1) e 48 LNs, sendo 32 LNs metastáticos e 16 LNs reacionais (grupo 2). As características ultrassonográficas com melhor acurácia em distinguir os NTCs dos LNs foram: continuidade com uma estrutura neural (98,8%), linhas internas hipoecogênicas (94,2%), razão eixo curto/longo 0,42 (91,9%), morfologia fusiforme (89,5%), ausência de vascularização ao Doppler (88,4%), e eixo curto 0,48 cm (86,1%). Os NTCs com citologia diagnóstica positiva (presença de células neurais fusiformes) apresentaram diferenças ultrassonográficas com relação aos NTCs com citologia inconclusiva (material acelular ou hemorrágico), notadamente a hiperecogenicidade (0% vs 55%; p = 0,008), eixo curto (0,39 cm vs 0,50 cm; p = 0,03), eixo transversal (0,74 vs 1,05; P = 0,005) e eixo longo (1,64 cm vs 2,35 cm; p = 0,021). A análise elastográfica (SWE-2D) revelou qualitativamente uma área dura < 45% (padrão 2) em 71% dos NTCs, velocidade média das ondas de cisalhamento de 3,3 ±0,7 m/s e um módulo de Young de 34,3 ± 15,5 kPa. Conclusão: A avaliação ultrassonográfica dos NTCs em pacientes com carcinoma de tireoide no pósoperatório de esvaziamento cervical lateral apresentou um bom desempenho na distinção diagnóstica dos NTCs e dos LNs (metastáticos e reacionais). A continuidade com uma estrutura nervosa e as linhas internas hipoecogênicas apresentaram maior acurácia para distinguir NTCs. A utilidade da SWE-2D para identificar e predizer neuromas ainda é incerta Introduction: Cervical traumatic neuromas (CTNs) can arise after lateral neck dissection for the treatment of lymph node (LNs) metastases of thyroid carcinoma. Occasionally, CTNs can be misdiagnosed as metastatic LNs during ultrasound (US) follow-up, generating unnecessary and painful fine-needle aspiration biopsy (FNAB). Purpose: To determine US performance in distinguishing CTNs from metastatic LNs in patients with thyroid carcinoma. To evaluate CTNs US features - B mode, color Doppler, and shear wave elastography two-dimensional (SWE-2D). Materials and Methods: Between July 2016 and December 2017, a cross-sectional study was performed to diagnose CTNs and evaluate their sonographic and elastography features. A retrospective diagnostic accuracy study assessed the B-mode and color Doppler US performance to distinguish CTNs from metastatic LNs in thyroid carcinoma patients after neck dissection. Results: Sixty-seven patients (52 [41-64] years; 52 women) were included in the study, with a total of 86 cervical nodules evaluated, of which 48 were CTNs (group 1) and 32 were LNs (group 2), being 32 metastatic LNs e 16 reactive LNs. The US features with the best accuracy to distinguish CTNs from LNs were continuity with a nervous structure (98.9%), hypoechogenic internal lines (94.2%); short/long axis ratio 0.42 (91.9%), fusiform morphology (89.5%), absent Doppler vascularization (88.4%), and short axis 0.48 cm (86.1%). CTNs with positive diagnostic cytology (presence of spindle neural cells) showed sonographic differences in relation to inconclusive cytology CTNs (acellular or hemorrhagic material), notably hyperechogenic (0% vs 55%; P = 0.008), short axis (0.39 cm vs 0.50 cm; P = 0.03), transversal axis (0.74 cm vs 1.05 cm; P = 0.005) and long axis (1.64 cm vs 2.35 cm; P = 0.021). The elastography analysis (SWE-2D) showed qualitatively a hard area

INTRODUÇÃO: O 18F-Fluoreto de sódio (18F-NaF) é um radiofármaco utilizado nos estudos de PET/CT para avaliação de metástases ósseas. Apesar da administração do 18F-NaF ocorrer na rotina clínica exclusivamente por via intravenosa, algumas pesquisas das décadas de 1960 e 1970 citam a possibilidade da realização da cintilografia óssea após a administração por via oral deste radiotraçador. OBJETIVOS: Comparar as vias de administração oral e intravenosa do 18F-NaF na realização de PET/CT em relação a detecção de lesões suspeitas de metástases ósseas em pacientes com neoplasia de mama ou de próstata. MÉTODOS: Estudo prospectivo incluindo 36 pacientes com neoplasia de mama (n=23) ou de próstata (n=13), com idades entre 36 e 86 anos, e com alto risco para metástases ósseas. Todos os pacientes foram submetidos a dois estudos de PET/CT, um após administração intravenosa e outro por via oral de 18F-NaF, e com intervalo de 2 a 21 dias. Realizado o cálculo do SUVmean de toda a matriz óssea (denominada SUVosso). Foram analisadas até cinco lesões suspeitas por paciente e calculados os SUVs das mesmas lesões em ambos os estudos. Denominado contraste da lesão a razão do SUVmax das lesões pelo SUVosso. Esses dados foram comparados entre o estudo IV e VO. Também foram analisadas as concordâncias entre dois médicos nucleares experientes (denominados observador 1 e 2) na definição do número de lesões. Adicionalmente, subgrupo de sete pacientes realizou a aquisição dinâmica das imagens durante 60 minutos imediatamente após a administração do radiofármaco, tanto no estudo IV quanto no VO. Foram delimitadas regiões de interesse (ROIs) no coração, fígado, osso e lesões ósseas para avaliação da captação através das curvas de atividade vs. tempo. RESULTADOS: Realizados trinta e seis pares de estudo por via oral e intravenosa (total de 72 exames), com 134 lesões suspeitas analisadas em cada etapa. O valor mediano do contraste da lesão foi de 10,33 (2,41 a 76,74) e 10,87 (2,81 a 90,55) para estudo IV e VO, respectivamente (P=0,212). O gráfico tipo Bland-Altman da análise da concordância do contraste da lesão entre os estudos IV e VO, demonstrou diferença média de -0,217 g/mL (IC 95% -5,71 e 5,28). Houve concordância quase perfeita na análise intra-observador na comparação entre os estudos intravenoso vs. oral\", com valores de Kappa ponderado de 1,0 (IC 95% 0,92- 1,0) e 0,92 (IC 95% 0,81-0,99) para os observadores 1 e 2, respectivamente. Na avaliação interobservador, os valores de Kappa ponderados foram 0,82 e 0,87 para oral vs. oral e intravenoso vs. intravenoso, respectivamente. No estudo dinâmico, foram analisados sete pares de exames por via oral e intravenosa (total de 14 exames). Observou-se nas curvas de atividade vs. tempo nos estudos VO e IV que a captação pela lesão e pelo osso apresentam uma curva com inclinação ascendente, contudo não atingindo o platô aos 60 min. Apesar disso, já nos primeiros minutos da aquisição dinâmica, a lesão apresenta captação elevada em relação ao osso normal em ambos os estudos. CONCLUSÕES: Nossos resultados sugerem que PET/CT com 18F-NaF realizado por via oral e intravenosa apresentam desempenho semelhante na detecção de metástases ósseas em pacientes com neoplasia de mama ou de próstata INTRODUCTION: 18F-Sodium fluoride ( 18F-NaF) is a radiotracer used in PET/CT studies to evaluate bone metastases. Although the administration of 18F-NaF occurs in clinical routine only by the intravenous route, some studies from the 1960s and 1970s mention the possibility of performing bone scintigraphy after the oral administration of this radiotracer. OBJECTIVES: To compare the routes of oral and intravenous administration of 18F-NaF PET/CT concerning the detection of suspicious bone metastatic lesions in patients with breast or prostate cancer. METHODS: Prospective study including 36 patients with breast cancer (n=23) or prostate cancer (n=13), aged between 36 and 86 years, and at high risk for bone metastases. All patients underwent two PET/CT studies (following intravenous and oral administration of 18F-NaF) with an interval of 2 to 21 days. The SUVmean of the entire bone matrix (named SUVbone) was calculated. Up to five suspicious lesions per patient were analyzed, and SUVs of the same lesions were calculated in both studies. The ratio of SUVmax lesions by SUVbone identified by lesion contrast. These data were compared between study IV and VO. Agreements among two experienced nuclear physicians (named observers 1 and 2) in defining the number of lesions in both studies were also analyzed. Additionally, subgroup of seven patients performed dynamic image acquisition for 60 minutes immediately after administration, both in the IV and VO study. Regions of interest (ROIs) were delimited in the heart, liver, bone, and bone lesions to assess uptake through activity vs. time curves. RESULTS: Thirty-six pairs of oral and intravenous studies were performed (a total of 72 exams), with 134 suspicious lesions analyzed in each phase. The median value of lesion contrast was 10.33 (2.41 to 76.74) and 10.87 (2.81 to 90.55) for study IV and VO, respectively (P=0.212). The Bland-Altman plot of the lesion contrast agreement analysis between IV and VO studies showed a mean difference of -0.217 g/mL (95% CI - 5.71 and 5.28). There was almost perfect agreement in the intra-observer analysis comparing the intravenous vs. oral\", with weighted Kappa values of 1.0 (95% CI 0.92-1.0) and 0.92 (95% CI 0.81-0.99) for observers 1 and 2, respectively. In the interobserver evaluation, the weighted Kappa values were 0.82 and 0.87 for oral vs. oral and intravenous vs. intravenous, respectively. In the dynamic study, we analyzed seven pairs of oral and intravenous exams (a total of 14 exams). It was observed in the activity vs. time in the VO and IV studies that the uptake by the lesion and by the bone present an upward slope curve, however, not reach the plateau at 60 min. Although, in both studies, the lesion presents a high uptake in the first minutes of normal bone. CONCLUSIONS: Our results suggest that 18F-NaF PET/CT performed orally and intravenously has similar performance in detecting bone metastases in patients with breast or prostate cancer

Introdução: Atualmente uma grande parte dos procedimentos cirúrgicos efetuados para o tratamento das mais diversas doenças são realizados com o emprego do vídeo. Apesar dos grandes avanços tecnológicos alguns problemas ainda atrapalham esta via de acesso. Um deles é o acúmulo de resíduos à frente da lente objetiva da óptica cirúrgica atrapalhando a visão do cirurgião. Para resolver o problema Abreu et al. (2015) desenvolveram um dispositivo, posteriormente chamado de LacrimaSurg, que funciona como um canal lacrimal da óptica prevenindo o embaçamento e acúmulo de resíduos na mesma, este dispositivo mostrou uma eficácia de 98,1% em estudo experimental ex vivo.Objetivos: Avaliar a viabilidade e a segurança do dispositivo em condições cirúrgicas reais. Métodos: Um estudo piloto in vivo incluiu 30 pacientes submetidos a procedimentos cirúrgicos torácicos empregando o LacrimaSurg. Os procedimentos foram gravados digitalmente para posterior análise pelos investigadores. As características dos pacientes (idade, sexo, índice de massa orporal, índice de comorbidades de Charlton), dados relativos ao ambiente cirúrgico (diferenças entre as temperaturas axilar do paciente e da sala cirúrgica) e dados inerentes ao procedimento em sí (tipo de cirurgia e tempo de duração de cada procedimento) foram registrados. Os investigadores assistiram aos vídeos cirúrgicos e registraram os eventos de sujeira e fogging da óptica que acarretaram em prejuízo da visão do cirurgião. Dados sobre o número de vezes que a óptica sujou, necessidade ou não de jatos de solução cristaloide e necessidade de limpeza mecânica da óptica foram coletados para a avaliação da eficácica. Dosagens séricas comparativas dos eletrólitos sódio e potássio pré e pósoperatórios foram registrados para a avaliação da segurança. Os dados foram organizados e analisados por meio de correlações lineares simples e teste t para as variáveis contínuas e teste exato de Fisher para as variáveis categóricas. Resultados: O uso do dispositivo permitiu que 97% dos procedimentos fossem realizados sem a necessidade de interrupção para limpeza mecânica da óptica. Não foram identificadas características inerentes aos pacientes ou aos procedimentos que colaborassem com o embaçamento ou sujeira da óptica. Não houve diferenças estatisticamente significativas entre os íons séricos pré e pós-operatórios dos pacientes, não foram observadas complicações pós-operatórias relacionadas ao uso do dispositivo. Conclusão: O dispositivo mostrou-se eficaz na prevenção de interrupções dos procedimentos cirúrgicos por sujeira ou embaçamento da óptica, seu uso foi considerado seguro não gerando complicações pós-operatórias. Introduction: Nowadays the great majority of the surgical procedures for the treatment of the most diverse kinds of diseases are video surgeries. Despite major technological advances, some problems still surgical modality. The buildup of residues in front of the lens hindering the surgeon\'s vision is one of this problems. To solve it, Abreu et al. (2015) developed a device called LacrimaSurg, which works as a lacrimal duct in the optics preventing fogging and residues buildup on it. This device showed an efficiency of 98.1% in an experimental ex vivo study. Objectives: Assess the feasibility and safety of the device under real surgical conditions. Methods: An in vivo pilot study included 30 patients undergoing thoracic surgical procedures using LacrimaSurg. The procedures were recorded for further analysis by the researchers. The characteristics of the patients (age, sex, body mass index, Charlton comorbidity index), data related to the surgical environment (differences between the axillary temperatures of the patient and the operating room) and data inherent to the procedure itself (type of surgery and duration of each procedure) were recorded. The investigators watched the surgical videos and recorded the residue buildup and fogging events that leaded to impaired surgeon\'s vision. Data regarding the number of times the optics got dirty, the need for further jets of crystalloid solution and the need for mechanical cleaning of the optics were collected to evaluate efficacy. Comparative serum measurements of sodium and potassium electrolytes before and after surgery were recorded for safety assessment. The data were organized and analyzed by means of simple linear correlations and t test for continuous variables and Fisher\'s exact test for categorical variables. Results: The use of the device allowed 97% of the procedures to be performed without interruption for mechanical cleaning of the optics. No characteristics inherent to the patients or to the procedures that contributed to the fogging or filth of the optics were identified. There were no statistically significant differences between pre- and postoperative serum ions, and no postoperative complications related to the use of the device were observed. Conclusion: The device was shown to be effective in preventing interruption of surgical procedures due to dirt or fogging of the optics, its use was considered safe and did not cause postoperative complications.