OBJECTIVE: To demonstrate the effectiveness and practical outcomes of percutaneous ethanol sclerotherapy in patients with symptomatic simple renal cysts. MATERIALS AND METHODS: The authors reviewed the outcomes of ten patients (eight men and two women) in the age range between 28 and 72 years (mean, 55 years) submitted to at least two procedures of percutaneous sclerotherapy for symptomatic simple renal cysts. Main presentation was refractory flank pain in all patients, seven of them with some degree of hydronephrosis because of the parapyelic localization of the cyst. The aspirated volume ranged from 20 to 1300 ml (mean, 200 ml). The mean follow-up period following the procedure was of seven months. Two patients had ultrasoud-guided sclerotherapy, and eight, computed tomography-guided sclerotherapy. The hospital stay period ranged between 24 and 72 hours. Complete success corresponded to total cyst regression, and partial success corresponded to recurrence of less than half the original cyst volume. RESULTS: Complete cyst ablation was achieved in seven patients and partial resolution in three. No complication was observed and the therapy was well tolerated by all of the patients. CONCLUSION: Percutaneous ethanol sclerotherapy of symptomatic simple renal cysts is a safe, effective and minimally invasive procedure, with results similar to the ones reported by other studies.

Keywords: Kidney diseases, Sclerotherapy, Ethanol

OBJECTIVE: To quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material. MATERIALS AND METHODS: In the period from June/2003 to August/ 2005, 60 patients were submitted to percutaneous transluminal angioplasty and stenting. Among these patients, 30 were followed-up with intravascular ultrasonography. Data were analyzed in a laboratory of quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3%) patients were men, and 14 (46.7%), women, and the mean age was 60.3 years. Arterial hypertension was observed in 22 patients (73.3%), smoking in 18 (62.1%), hyperlipidemia in 20 (66.7%), and diabetes in 9 (30%). A total of 20 nitinol stents (66.7%) and 10 stainless steel stents (33.3%) were implanted. Four patients were classified as TASC A (13.3%), 15 TASC B (50%) and 11 TASC C (36.7%). The neointimal hyperplasia volume ranged from 49.02 mm³ to 112.87 mm³ (mean, 80.33 mm³). The rate of intrastent obstruction ranged from 18% to 47% (mean, 27.4%). The clinical outcomes achieved with stenting were sustained through the follow-up. CONCLUSION: Neointimal hyperplasia is a common finding after percutaneous transluminal angioplasty and stenting, but in the present study the stenosis rate was never higher than 50%. There was no statistically significant difference in intrastent stenosis rates in relation to stents materials, clinical and arterial risk factors.

Keywords: Stent, Iliac artery, Interventional ultrasonography, Hyperplasia

OBJECTIVE: To compare low-field (0.2 T) with high-field (1.5 T) magnetic resonance imaging in the assessment of pelvic endometriosis and adenomyosis. MATERIALS AND METHODS: Twenty-seven female patients with clinically suspected endometriosis were prospectively evaluated by means of high-field and low-field magnetic resonance imaging. The reading of the images was performed by a single radiologist, initiating by the low-field, followed by the high-field images. High-field magnetic resonance imaging was utilized as the golden-standard. RESULTS: Among the 27 patients included in the present study, 18 (66.7%) had some type of lesion suggesting the presence of endometriosis demonstrated at high-field images. In 14 of these patients the diagnosis was correctly established by low-field magnetic resonance imaging. Endometriomas, tubal lesions, and endometriotic foci > 7 mm identified at the high-field images were also identified at low-field images with 100% accuracy, sensitivity and specificity. Among the nine patients diagnosed with adenomyosis by high-field images, eight were correctly diagnosed by low-field images with 88.9% accuracy, specificity and sensitivity. CONCLUSION: Low-field magnetic resonance imaging demonstrated a low sensitivity in the detection of small endometriotic foci, high sensitivity in the detection of endometriomas and large endometriotic foci, and high accuracy in the detection of adenomyosis when compared with high-field magnetic resonance imaging.

Keywords: Magnetic resonance imaging, Endometriosis, Adenomyosis, Diagnosis

OBJECTIVE: To evaluate the reproducibility of unenhanced and contrast-enhanced computed tomography in the assessment of patients with acute pancreatitis. MATERIALS AND METHODS: Fifty-one unenhanced and contrast-enhanced abdominal computed tomography studies of patients with acute pancreatitis were blindly reviewed by two radiologists (observers 1 and 2). The morphological index was separately calculated for unenhanced and contrast-enhanced computed tomography and the disease severity index was established. Intraobserver and interobserver reproducibility of computed tomography was measured by means of the kappa index (kappa). RESULTS: Interobserver agreement was kappa = 0.666, 0.705, 0.648, 0.547 and 0.631, respectively for unenhanced and contrast-enhanced morphological index, presence of pancreatic necrosis, pancreatic necrosis extension, and disease severity index. Intraobserver agreement (observers 1 and 2, respectively) was kappa = 0.796 and 0.732 for unenhanced morphological index; kappa = 0.725 and 0.802 for contrast-enhanced morphological index; kappa = 0.674 and 0.849 for presence of pancreatic necrosis; kappa = 0.606 and 0.770 for pancreatic necrosis extension; and kappa = 0.801 and 0.687 for disease severity index at computed tomography. CONCLUSION: Computed tomography for determination of morphological index and disease severity index in the staging of acute pancreatitis is a quite reproducible method. The absence of contrast-enhancement does not affect the computed tomography morphological index reproducibility.

Keywords: Pancreatitis, X-ray computed tomography, Disease severity index, Prognosis, Contrast media, Necrosis

OBJECTIVE: To propose a model to standardize computed tomography reports on abdominal aortic aneurysms. MATERIALS AND METHODS: Interviews were carried out with members of Vascular Surgery Division of our institution, in the period between April and October 2004, aiming at developing a standardized model of computed tomography reports on abdominal aortic aneurysms. Based on this model, a questionnaire was elaborated and sent to other nine surgeons, all of them experienced in the field of abdominal aortic surgery. The questionnaires response rate was 55.5% (5/9). RESULTS: The most frequently mentioned parameters of interest for evaluation of abdominal aortic aneurysms were: maximum diameter of proximal aortic neck, proximal aortic neck length to lower renal arteries, shape of proximal aortic neck, maximum diameter of the aneurysm and diameter of the common iliac arteries. These data allowed the development of a proposal for a model to standardize computed tomography reports. CONCLUSION: A model for standardized tomographic analysis of abdominal aortic aneurysms has met vascular surgeons' needs for following-up patients and planning their treatment.

Keywords: Aorta, Aneurysm, Computed tomography

OBJECTIVE: To determine and compare the efficacy of image-guided percutaneous needle aspiration (PNA) versus percutaneous catheter drainage (PCD) in the treatment of intra-abdominal liquid collections. MATERIALS AND METHODS: A prospective study involving 52 patients referred to our service for percutaneous treatment of abdominal liquid collections was carried out. Sixteen of these patients had intra-abdominal liquid collections (six patients with simple localized collections and ten patients with complex, multiseptated or multiple, collections). The volume of the collections ranged from 40 to 1,200 ml (median, 200 ml). PCD was performed in ten (62.5%) collections and PNA in six (37.5%) collections. Successful treatment was defined as complete resolution of the collection with both clinical and laboratorial recovery. RESULTS: Success was achieved in 75% of cases. The success rate was 100% and 60% in the groups submitted to PNA and PCD, respectively. Successful treatment was observed in 50% of the patients submitted to PCD with collections £ 200 ml, and in 75% of the patients with larger collections. Complete resolution with PCD was obtained in 33.3% of complex, 42.9% of infected and 100% of simple or sterile collections. Only two minor complications (transient bacteremia and cutaneous infection) due to the procedures were observed. CONCLUSION: Our results showed that PCD and PNA are safe and effective in the treatment of intra-abdominal collections. In this study, needle aspiration was more effective than drainage, particularly for smaller collections.

Keywords: Intra-abdominal collections, Percutaneous needle aspiration, Percutaneous catheter drainage

OBJECTIVE: To determine and compare the efficacy of percutaneous needle aspiration and percutaneous catheter drainage, both guided by imaging methods, for the treatment of liver abscesses. MATERIALS AND METHODS: From 52 patients referred to our service for percutaneous treatment of abdominal abscesses, 17 presented liver abscesses, 13 of which were considered noncomplex and four were considered complex (multiloculated, multiple or associated to fistulas). Percutaneous needle aspiration was performed in 7/17 patients and 10/17 patients were submitted to percutaneous catheter drainage. The method used was considered successful when there was complete abscess resolution with both clinical and laboratorial improvement. RESULTS: The procedures were successful in 82.4% of all cases. In the group submitted to percutaneous needle aspiration the rate of success was 57.1% and in the group submitted to percutaneous catheter drainage the rate of success was 100%. Successful treatment was achieved in 75% of the patients submitted to percutaneous needle aspiration for abscesses smaller than 100 ml, but in only 33.3% of the patients with abscesses between 100 and 250 ml. There was complete resolution of the abscesses with percutaneous needle aspiration in 75% of the simple abscesses and in 25% of the complex abscesses. CONCLUSION: Percutaneous catheter drainage is more effective than percutaneous needle aspiration for the treatment of liver abscesses. Needle aspiration may probably be used as a valid alternative for smaller and noncomplex abscesses.

Keywords: Liver abscesses, Percutaneous needle aspiration, Percutaneous catheter drainage

Objective: To study the profile of patients with PSA level between 2.6 and 10.0 ng/ml and submitted to prostate biopsy, determining possible patterns that might lead to a reduction of unnecessary biopsies. Materials and Methods: In the period from 2007 to 2009, a cross-sectional study was developed with 1,282 patients with PSA levels between 2.6 and 10.0 ng/ml, and submitted to prostate biopsy. Results: Cancer prevalence was 28.6%. On average, the patients with positive biopsies were older, with higher PSA levels and density, and smaller prostate volume as compared with the patients with negative biopsies. In the analysis of PSA density, the cancer patients averaged 0.31 ng/ml/cc, while patients with negative results averaged 0.10 ng/ml/cc. Utilizing a cutoff value of 0.15 ng/ml/cc for PSA density as a cancer positiveness criterion, the authors obtained sensitivity of 74% and specificity of 70%. The cutoff value should be reduced to increase the sensitivity. With a cutoff value of 0.09 ng/ml/cc, sensitivity reached 84% (CI 95%: 80–87%), and specificity, 75% (CI 95%: 72–78%). Conclusion: The systematic use of PSA density as an indicator to proceed with the investigation of a patient with biopsy could substantially reduce the amount of unnecessary procedures.

Keywords: Prostate; Prostate biopsy; Prostate cancer; PSA density.

OBJECTIVE: To evaluate the incidence of postprocedural complications in patients submitted to transrectal ultrasound-guided prostate biopsy at the Unit of Intervention, Department of Imaging Diagnosis of Escola Paulista de Medicina - Universidade Federal de São Paulo. MATERIALS AND METHODS: Telephone interviews were conducted with 132 patients who had undergone transrectal ultrasound-guided prostate biopsy in the period from April 2011 to June 2011, according to the institution's protocol. RESULTS: Post-biopsy complications were categorized into two groups - minor and major complications, according to their need for further clinical evaluation. Complications were reported by 59 patients (61.8%), most of them (86.4%) with mild and self-limited symptoms, classified as minor complications. Eight patients (8.2%) had major complications, one of which required in-hospital treatment. Urinary retention was the major and most common complication. CONCLUSION: The present study has demonstrated a low prevalence of major complications after transrectal prostate biopsy.

Keywords: Prostate; Biopsy; Morbidity; Ultrasonography; Complications.